Dental Trauma Flashcards
Most dental trauma occurs in
____ age range
7-14
Most trauma occurs in the _______ region of the maxilla & mandible
anterior
What are the options for primary dentition injuries?
– Prevent injury to succedaneums tooth
– Patient comfort
– Avulsed primary teeth seldom replaced
What are the primary rules of dental trauma?
- TRAUMA IS NEVER PLANNED
- TIMELY TREATMENT IS BASIC TO SUCCESS
- OCCURS AT THE LEAST CONVENIENT TIME
- TRAUMA is for LIFE
What are the rates of dental trauma in permanent dentition?
15.2%
What are the rates of dental trauma in primary dentition?
22.7%
What are the rates of dental trauma in adolescents?
18.1%
_____% children in the USA will have dental trauma
4-14
What is the epidemiology for dental trauma in children 5 years of age?
- 1/3 injuries in primary dentition
- Luxation (More common)
- Males more frequent than females
What is the epidemiology for dental trauma in children 5 years of age?
- 20 to 30% will suffer dental trauma
- Uncomplicated crown fracture (More common)
- Males more frequent than females
What are the different traumatic injuries classifications?
- Concussion
- Subluxation
- Intrusion
- Extrusion
- Lateral luxation
- Avulsion
- Crown fracture
- Crown-root fracture
- Root fracture
- Bone fracture
How do you treat an uncomplicated crown frature (without pulp exposure)?
- NO PROBLEM IF VITAL
- RELAX AND RESTORE
- RECALL AND TEST SENSIBILITY
What are the treatment options for a complicated crown fracture?
- Pulp Cap: Use Bioceramic materials
- Pulpotomy: preferred if open apex
- RCT: preferred if apex closed or post necessary
Crown-root fractures often fracture at an…
angle
How can you see the crown-root fracture line?
Take several angled X-rays varying both vertical & horizontal angulations or CBCT
What is the treatment for a crown-root fracture?
- Anesthetize
- Remove FX element
- Determine Pulpal Exposure & Restorability
—if no exposure – restore
—if exposed VPT or RCT
—if open apex - VPT; RCT if apex closed - Be certain there is NOT a 2nd component of FX
Remember, the __ lesion is not always seen with a cracked root
J
J lesion, if present, does not always mean root is CRACKED/FRACTURED (___%)
28%
What are methods of documenting vertical root fracture?
- transillumination
- restoration removal + staining
- surgical exposure
The ________ fracture is often easily visualized on the radiograph
horizontal
Horizontal root fractures seldom every occur on __________ teeth
posterior
horizontal root fracture
Prognosis with horizontal root fracture depends upon…
- Level of FX
- Restorability
- Periodontal Health
- Vitality of Pulp
- Stage of Root Development
- Time since injury
- Age of patient
- Cooperation of patient
- Availability for follow-up
- Approximation opportunities
- Stabilization options
What do you do to fix this?
Try to reposition and splint 2-4 wks, check for sensibility after 30 days. Refer to a specialist.
For an alveolar fracture splinting is required for ___ weeks
4-6
What are the characteristics of an alveolar fracture?
- The bone segment containing the involved tooth is mobile.
- Sometimes it complicates healing
- Discomfort may be greater
- Should not affect the final result.
What is the order of luxation injuries from least to greatest damage?
Concussion
Subluxation
Extrusion
Lateral
Intrusive
What is the most common of all dental injuries?
Luxation Injuries
What is the least severe luxation injury?
Concussion
What are the characteristics of concussion luxation injury?
- No displacement of tooth nor mobility
- Tooth tender to touch “Bruised PDL”
- No radiographic abnormalities
What do you do for a concussion luxation injury?
- Assess sensibility.
- Have a base line, then in 2-4 weeks & follow 1yr
What are the characteristics for a subluxation injury?
- Tooth tender to touch & slightly mobile (1+) but not displaced
- Possible hemorrhage from gingival crevice
- No radiographic abnormalities
- Damage to supporting structures?
What do you do for a subluxation luxation injury?
- Assess sensibility.
- Have a base line, then in 2-4 weeks & follow 1yr
What are the characteristics of a lateral luxation injury?
- Displaced laterally & often locked in bone
- Not tender to touch, not mobile
- Alveolus fractured
- Increased PDL space best seen on eccentric or occlusal radiographs
How do you treat a lateral luxation injury?
- Anesthetize & reposition + Flexible splint MANDATORY for 4-6 weeks
- Assess sensibility. Have a base line. RCT within/10 days
lateral luxation injury
What is a flexible splint?
Allows physiologic movement of the teeth in order to minimize ankylosis
What is the way to use a flexible splint in the past?
.020 or 18 gauge ortho wire bonded to tooth for 1-2 weeks unless alveolar FX had occurred. Then 4-6 wks
What are the characteristics of extrusive luxation injury?
- Elongated mobile tooth (Cl. II mobility or greater)
- Radiographs show increased apical periodontal space
- Manually reposition
What is the treatment for extrusive luxation injury?
- Flexible splint MANDATORY 14 days
- Assess sensibility. Have a base line, then in 2&4 weeks. RCT if needed
What is likely to happen with an intrusive luxation injury?
external root resorption
What is the most severe luxation injury?
intrusive luxation injury
What are the characteristics of an intrusive luxation injury?
- Tooth appears shorter: displaced into alveolar bone
- PDL destruction/alveolar crushing. Beware of ankylosis/resorption/
- pulp necrosis is all but certain in
mature teeth - Not tender to touch, not mobile
- Percussion test: sounds different
- Radiographs not always conclusive
What is the treatment for intrusive luxation injury?
- Slightly luxate with forceps or band and move orthodontically ASAP.
- Splinting is place 14 days or more if alveolar fx is present.
- Tooth with open apex may spontaneously re-erupt depending on the depth of penetration. (Less than 7mm)
What is the RCT intervention for an intrusive luxation injury?
100%
What is avulsion?
Tooth is knocked completely out of mouth
Extra-oral dry time is CRITICAL _______ minutes for survival of PDL
0-15
Must be replaced in socket immediately or ASAP (15-20”) in order to..
– Prevent ankylosis
– Prevent external root resorption
When considering avulsion the viability of the _____ must be preserved for success
PDL
What is the replant treatment aimed at doing?
minimizing the inflammation from the two main consequences of avulsion:
1. attachment damage
2. pulpal necrosis & infection that usually results
The SINGLE most important factor
in achieving a favorable outcome is the _______ at which a clean tooth is properly replanted (viable PDL) 15”
SPEED
Keeping the attached PDL _____ is paramount when replanting
moist
What are the options for transporting a tooth in appropraite medium?
- “save-a-tooth”
- “via span”
- milk or green tea
- contact lens solution
- place in vestibule (saliva) and report to dental office asap
How can you be proactive when considering dental trauma especially with avulsed teeth?
Provide instructions & transport media to area schools and sports facilities – Practice Builder
What are the first aid instructions for an avulsed tooth?
- handle by crown only
- pick off debris with tweezers
- replant tooth at the site if possible
Take ______ to make sure there is no alveolar FX (cone beam) & that adjacent teeth are OK
films
What are steps of treating a avulsed tooth/replantation?
- take films
- remove from transport media
- gently clean socket
- replant and check occlusion
- take films
- flexible splint
- RX antibiotics
- possible tetanus booster
What shoud you NOT do with an avulsed tooth?
- submerge in tap water
- allow tooth to dry
- scrub root
- handle by root
What is the treatment for this case?
- Gently aspirated clot
- Replanted 7 & 8
- FLEXIBLE splint placed
- Occlusion evaluated
- Pulpal Extirpation within 7-10 days.
- Current thinking says to extirpate at time of emergency visit and place CaOH medication in canal
What are the post-treatment instructions for this case?
– Chlorhexidine rinses
– Do not chew on these teeth
– Call us if: XS pain, swelling
– Next appointment time
- Antibiotics, doxycycline 100 mg, bid, x 7 days
- Pain RX prn
- Referral for Tetanus booster (10 years)
What are the potential long term results of trauma?
- SOME TRAUMA OUTCOMES ARE FOREVER *
- Effects on Pulpal Spaces
- Resorption
- Ankylosis
Trauma usually has completely _________ pulp canals in the traumatized central incisors. No caries.
sclerosed
Trauma to a tooth can stimulate the pulp to generate massive amounts of _____________. End Result is a sclerosed & non negotiable canal.
tertiary dentin
Trauma to the pulp can cause the pulp to discontinue ________________
development
- remain at the stage present at the time of injury
What is ankylosis (bone apposition)?
- A problem following trauma and long term rigid splinting
Tooth is solidly fixed and has a high different ring when ________. Does not erupt with other teeth
percussing
What can ankylosis lead to?
May lead to massive external replacement resorption & loss of tooth
What is the internal appearance of ankylosis?
appearance of “aneurysm”
w/in canal
What are the characteristics of replacement ERR?
- Patients are generally asymptomatic
- Typically a history of avulsion or intrusion injury
How can you tell if a tooth is ankylosis?
lack of normal mobility + High pitched “metallic ring” during percussion or possibly by “submergence” (not erupting with other normal teeth)
Our professional responsibility includes educating our patients and the community regarding the dangers of trauma as well as appropriate preventive measures and therapeutic opportunities:
– Talk to school nurses
– Coaches
– Youth groups, Scouts, etc.
Our professional responsibility includes educating our patients and the community regarding the benefits of the use of ___________ during sports activity.
mouth guards
How can the dentist educate on using mouth guards?
*Make appropriate mouth guards available at an affordable cost to the community.
*Talk to coaches and youth sponsors.
*Sponsor a Team in your area.
*Volunteer your services
