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Dental Trauma Flashcards

1
Q

What is the most common type of dental trauma in primary dentition?

What is the most common type of dental trauma in permanent dentition?

A

What is the most common type of dental trauma in primary dentition?
Luxations, peak 2-6 years old

What is the most common type of dental trauma in permanent dentition?
Fractures

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2
Q

What kind of dental injury in the primary dentition is most commonly associated with the development of dental anomalies in the permanent dentition?

A

Intrusion and avulsion

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3
Q

Does the IADT recommend the immediate extraction of the traumatized primary tooth if the direction of displacement of the root is toward the permanent tooth germ?

A

No because
1. There is evidence of spontaneous reeruption of intruded primary teeth
2. There is a concern that further damage may be inflicted on the tooth germ during extraction
3. Lack of evidence that immediate extraction will minimize further damage to the permanent tooth germ.

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4
Q

A 3 year old presents for new patient exam with the CC of “it looks like he has a chipped tooth.” Fracture is confined to enamel only.

What radiographs and follow up does the patient need?

What treatment, if any, should the patient receive?

A

According to the IADT, no radiographs are recommended and no follow up recommended.

Can smooth out any sharp/rough edges
Possible soft food diet
Encourage gingival healing and avoid plaque accumulation with soft bristle toothbrush, can give Chlorhexidine rinse 0.2% 2x/day for 1 week

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5
Q

According to the IADT, how is an enamel fracture in primary dentition managed?

A
  • Smooth out any rough/sharp edges
  • Review OHI to keep hard and soft tissues clean
  • Brush with soft bristle toothbrush, can apply 0.1-0.2% chlorhexidine gluconate rinse 2x/day for 1 week
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6
Q

How do you assess for potential tooth fragments in soft tissue?

A
  1. Palapate the puncture/laceration
  2. Soft tissue radiograph at 1/4 the exposure time
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7
Q

What radiographs, treatment and follow-up recommendations are there for an uncomplicated crown fracture in primary dentition?

A
  1. Baseline radiograph of traumatize tooth/teeth is optional; radiographs of soft tissue for fragments if indicated
  2. Treatment: Cover exposed dentin with GI or composite immediately or at later appointment
  3. Review OHI and diet with guardian
  4. Can give 0.2% Chlorhexidine rinse 2x/day for 1 week
  5. Follow up after 6-8 weeks
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8
Q

What are the clinical follow-up times for a primary tooth with a complicated crown fracture?

A
  • 1 week
  • 6-8 weeks
  • 12 months, take radiograph
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9
Q

What radiographs, treatment and follow-up recommendations are there for complicated crown fracture in primary dentition?

A
  1. Baseline radiograph + soft tissues if indicated
    Review tx options on behavior/level of cooperation, prognosis, risks/benefits
  2. Local anesthesia
  3. Rubber dam isolation
  4. Non-setting calcium hydroxide direct pulp cap or cervical pulpotomy depending on the size of the fracture
  5. Cover exposed dentin with glass ionomer
  6. Restore tooth
  7. POI: soft food diet, chlorhexidine rinse 2x/day for 1 week, any unfavorable outcomes
  8. Follow up at 1 week, 6-8 week, 1yr + radiograph
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10
Q

If there is a clinical indication to splint in the event of a root frature of a primary tooth, what are the clinical follow-up times and when is the splint removed?

A
  • 1 week
  • 4 weeks, remove splint
  • 8 weeks
  • 1 year
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11
Q

In the event of alveolar fracture in primary dentition, what is the recommended treatment and follow-up regimen?

A
  • Treatment: Local anesthesia, reposition mobile segment, Flexible Splint for 4 weeks
  • Clinical exam after 1 week, 4 weeks (remove splint, take radiographs), 8 weeks, 1 year (take radiographs to assess eruption of permanent successor)
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12
Q

What is the radiographic and follow-up protocol for a concussed primary tooth?

A

No baseline radiograph recommended

Follow up at 1 week and then 6-8 weeks

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13
Q

What is the difference between a concussed tooth and subluxated tooth?

A

Concussed: Tender to touch, no mobility or displacement, no sulcular bleeding

Subluxated: Tender to touch, increased mobility, no displacement, sulcular bleeding may be present

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14
Q

What is the radiographic and follow-up protocol for a subluxated primary tooth?

A

Baseline radiograph

Clinical exam at 1 week
6-8 weeks
Radiographs only when pathosis is suspected

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15
Q

What radiographs, treatment and follow-up recommendations are there for a primary tooth that has been extrusively luxated?

A

Baseline radiograph

Check degree of displacement and mobility, any occlusal interferences, root formation and child’s ability to tolerate treatment

Allow tooth to reposition if minimal extrusion

If extrusion >3mm, extract

Clinical exam after 1 week
6-8 weeks
1 year

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16
Q

When do you make the decision to extract an extrusively luxated primary tooth?

A

If extrusion is greater than 3mm

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17
Q

What radiographs, treatment and follow-up recommendations are there for a primary tooth that has been laterally luxated?

A

Baseline radiograph

If minimal luxation, allow tooth to spontaneously reposition

If severe displacement:
1) extract or
2) splint

Clinical f/u if no splint:
1 week
6-8 weeks
6mos
1 yr

Clinical f/u if no splint:
1 week
4 weeks, remove splint
8 weeks
6mos
1 yr

18
Q

A mom says, “my 4yo child fell hard and completely knocked out his front tooth.”

What steps do you take next after med/dent/social hx?

A

EOE: assess extraoral trauma/bodily injuries, rule out possibility for abuse

Ask if the missing tooth was found. If not, check if tooth was imbedded into other soft tissues such as lips, cheeks, nose or it may have been ingested/aspirated. If there are respiratory symptoms, refer pt to ER

Take radiograph
Do not re-implant tooth

Clinical f/u at 1 week then 6-8 weeks

19
Q

What are the imaging, treatment and follow-up protocols are a permanent tooth with a fracture confined to enamel only?

A
  1. 1 PA
  2. Determine if tooth is luxated - if so, follow luxation protocols
  3. If tooth fragement is available, can rebond it. If not, smooth or restore with composite restoration
  4. Clinical and radiographic f/u at 6-8 weeks then 1 yr
20
Q

What are the imaging, treatment and follow-up protocols are a permanent tooth with an uncomplicated enamel/dentin fracture?

A
  1. 1 PA
  2. If tooth fragement is available, can rebond it after soaking in water/saline for 20 mins. If not, restore with composite resin. Use a calcium hydroxide liner if fracture is 0.5mm from pulp/pulpal blushing covered with GI
  3. Clinical and radiographic f/u at
    6-8 weeks
    1 yr
22
Q

What are the treatment guidelines for a complicated crown fracture in a permanent tooth?

A
  1. 1PA
  2. Account for missing tooth fragment, evaluate for concomitant luxation injury
  3. Immature tooth- need to preserve pulp vitality with direct pulp cap or cvek pulpotomy. Closed apex, partial pulpotomy. Resin restoration
  4. Clinical and radiographic f/u at 6-8 weeks, 3 mo, 6 mo, 1yr
23
Q

What are the treatment guidelines for an uncomplicated crown-root fracture in a permanent tooth?

A
  1. Radiographs: 1PA, 2 additional at different angulations, 1 occlusal. Can consider CBCT
  2. Stablize fragment if possible until definitive tx plan. Can remove fragment and restore, orthodontic or surgical extrusion, extraction, autotransplantation
  3. Clinical and radiographic f/u at 1 week, 6-8 weeks, 3mo, 6mo, 1yr then yearly for at least 5 yrs
24
Q

What are the treatment guidelines for a complicated crown-root fracture in a permanent tooth?

A
  1. Radiographs: 1PA, 2 additional at different angulations, 1 occlusal. Can consider CBCT
  2. Stablize fragment if possible until definitive tx plan. Immature teeth partial pulpotomy, mature teeth pulpectomy, restore in conjunction with possible orthodontic/surgical extrusion. Other tx options include extraction, autotransplantation
  3. Clinical and radiographic f/u at 1 week, 6-8 weeks, 3mo, 6mo, 1yr then yearly for at least 5 yrs
25
What are the treatment guidelines for a root fracture in a permanent tooth?
1. Radiographs: 1PA, 2 additional at different angulations, 1 occlusal, CBCT if available 2. Stablize immediately with passive, flexible splint for 4 weeks for apical or mid-root fractures (up to 4 mo if fracture is within the cervical third). Verify repositioning with radiograph Do not do RCT right away, only when clinically indicated and only the coronal segment. If fracture is above alveolar crest in a mature tooth, remove mobile fragment and consider RCT with post-retained crown with possible crown lengthening or extrusion, 3. Clinical and radiographic f/u at 4 week splint removal, 6-8 weeks, 4mo (only for coronal third root fractures), 6mo, 1yr then yearly for at least 5 yrs
26
What are the treatment guidelines for an alveolar fracture in a permanent tooth?
1. Radiographs: 1PA, 2 additional at different angulations, 1 occlusal, CBCT if available 2. Stablize immediately with passive, flexible splint for 4 weeks. Suture lacerations if needed Do not do RCT right away at this emergency visit only when clinically indicated. 3. Clinical and radiographic f/u at 4 week splint removal, 6-8 weeks, 4mo, 6mo, 1yr then yearly for at least 5 yrs
27
What are the treatment guidelines for a concussed permanent tooth?
1. 1 PA 2. No treatment necessary 3. Clinical and radiographic f/u at 4 weeks and 1 year
28
What are the treatment guidelines for a subluxated permanent tooth?
1. 1 PA, plus 2 additional at different angles 2. No treatment is normally needed. If tooth is excessively mobile or pain when biting, can splint for 2 weeks 3. Clinical and radiographic f/u at 2 week (splint removal, 12 weeks, 6mo, 1 year
29
What are the treatment guidelines for an extrusively luxated permanent tooth?
1. 1 PA, plus 2 additional at different angles and 1 occlusal radiograph 2. Local anesthesia, reposition back into socket, splint for 2 weeks 3. Clinical and radiographic f/u at 2 week (splint removal, 4 week, 8 week, 12 week, 6mo, 1yr then yearly for at least 5 yrs
30
A 13yo boy comes into your office for an emergency. His central incisor was avulsed but was reimplanted within 15 minutes. What are your next steps in managing this patient?
1. Medical hx, Neurological assessment, Acute Trauma Assessment form, rule out non-accidental injury/abuse 2. Clean the area with sterile water or saline 3. Verify the position of the reimplanted tooth clinically and radiographically (if tooth is in the wrong place/rotated, can reposition with 48hrs) 4. Administer local anesthetic, without vasoconstrictor if possible 5. Use passive, flexible splint with 0.016" SS wire and composite for 2 weeks (4 if alveolar fracture). Can use nylon wire only if there are enough permanent teeth to stabilze adjacent teeth 6. Suture gingival lacerations 7. 7 day course of Systemic antibiotics: Amoxicillin or Doxycycline (no tetracycline/doxycycline <12yo) 8. Chlorhexidine 2x/day for 2 weeks 9. Initiate RCT within 2 weeks 10. Remove splint at 2 weeks 11. F/u at 1mo, 3mo, 6mo, 1yr, yearly for 5 yrs
31
What are some favorable outcomes following treatment of an avulsion permanent tooth with an open apex?
Asymptomatic, functional, normal mobility, no sensitivity to percussion, and normal percussion sound. Radiographic evidence of continued root formation and tooth eruption. Pulp canal obliteration is expected and can be recognized radiographically sometime during the first year after the trauma. It is considered to be the mechanism by which the “pulp” heals after replantation of avulsed immature permanent teeth.
32
What are possible signs that a child may have a fracture in the mandible?
* Pain, swelling * Trismus (TMJ spasms) * Occlusal discrepancies * Step in occlusion * Chin asymmetry * Parasthesia of the mental nerve distribution
33
If a subcondylar fracture occurs in a child, where would we expect the condyle be displaced to?
Antero-medially because of the action of the lateral pterygoid muscle
34
If a child presents with bleeding from the ear and abrasions on the chin, what type of trauma do you expect this child to have?
Subcondylar fracture with perforation of the anterior wall of the auditory canal, tympanic membrane may be perforated Possible intracapsular fracture or fractures of the articular surface that may prevent normal funtion and growth Do NOT suction ear - can suction ossicles of the ear
35
What is the Glascow Coma Scale in children >2?
Rating score for head injuries and level of consciousness Eye opening * 4 Spontaneous * 3 To verbal * 2 To painful stimulus * 1 No response Verbal Response * 5 Oriented * 4 Confused * 3 Vocal sounds * 2 Cries * 1 No response Motor response * 6 Obeys commands * 5 Localizes pain * 4 Withdraws from pain * 3 Abnormal flexion to pain * 2 Extension to pain * 1 None >2yo - want 14-15 Moderate TBI: 9-12 Severe TBI: <8
36
A permanent central incisor with an open apex has been intruded. How do you manage this case?
1. 1 parallel PA, 2 additional PAs at different angles and an occlusal radiograph 2. Regardless of the degree of intrusion, allow the tooth to re-erupt 3. If no re-eruption within 4 weeks, orthodontically reposition the tooth. Start endodontic interventions when indicated (necrosis, external root resorption) - either pulp revascularization or apexification with CaOH2 for 2-4 weeks 4. Clinical and radiographic f/u at 2 wks, 4 wks, 8 wks, 12 wks, 6mo, 1 yr, yearly for 5 yrs
37
A permanent central incisor with a closed has been intruded. How do you manage this case?
1. 1 parallel PA, 2 additional PAs at different angles, occlusal radiograph 2. Indications for splinting/repositioning depends on the degree of intrusion <3 mm: allow to re-erupt. If no changes in 4 weeks, surgically resposition and splint >3mm: surgically reposition 3. 2 weeks: Intruded mature teeth almost always become necrotic. Start endodontic tx 4. Splint for 4 weeks 5. Clinical and radiographic f/u: 2 week (start endo) 4 week (remove splint) 8 week 12 week 6mo 1yr Yearly for 5 yrs
38
What is the prognosis for lateral luxation?
Pulpal necrosis in 15-85% - more prevalent in teeth with closed apices Open apex: pulp canal obliteration Resorption is rare in these injuries ## Footnote Handbook: Cameron
39
Go through the cranial nerve assessment.
1-Olfactory: identify smell 2-Optic: Use pen light to test pupillary reflex 3-Oculomotor/4-Trochlear/6-Abducens: Have pt follow finger through cardinal positions of gaze (tests medial/lateral rectus, superior/inferior oblique) 5-Trigeminal: have pt clench to test masseter, try to open mouth against resistance 7-Facial: Have pt use muscles of facial expression-smile/frown/lift eyebrows 8-Vestibulocochlear: Hear whispers, use tuning fork 9-Glossopharyngeal/10-Vagus: Gag reflex, use tongue depressor to evaluate symmetrical rise of soft palate when saying "ahh", swallow salive 11-Spinal accessory: lift shoulders against resistance 12-Hypoglossal: stick tongue out to watch for deviation
40
41
The choice of treatment after an avulsion depends on what two factors?
1. The maturity of the tooth - open vs closed apex 2. Viability of PDL cells (extraoral dry time) After 30 mins, most PDL cells are non-viable

OCE (8 decks)

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