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Endo > Dental Trauma > Flashcards

Dental Trauma Flashcards

1
Q

Most dental trauma occurs in
____ age range

A

7-14

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2
Q

Most trauma occurs in the _______ region of the maxilla & mandible

A

anterior

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3
Q

What are the options for primary dentition injuries?

A

– Prevent injury to succedaneums tooth
– Patient comfort
– Avulsed primary teeth seldom replaced

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4
Q

What are the primary rules of dental trauma?

A
  • TRAUMA IS NEVER PLANNED
  • TIMELY TREATMENT IS BASIC TO SUCCESS
  • OCCURS AT THE LEAST CONVENIENT TIME
  • TRAUMA is for LIFE
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5
Q

What are the rates of dental trauma in permanent dentition?

A

15.2%

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6
Q

What are the rates of dental trauma in primary dentition?

A

22.7%

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7
Q

What are the rates of dental trauma in adolescents?

A

18.1%

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8
Q

_____% children in the USA will have dental trauma

A

4-14

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9
Q

What is the epidemiology for dental trauma in children 5 years of age?

A
  • 1/3 injuries in primary dentition
  • Luxation (More common)
  • Males more frequent than females
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10
Q

What is the epidemiology for dental trauma in children 5 years of age?

A
  • 20 to 30% will suffer dental trauma
  • Uncomplicated crown fracture (More common)
  • Males more frequent than females
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11
Q

What are the different traumatic injuries classifications?

A
  • Concussion
  • Subluxation
  • Intrusion
  • Extrusion
  • Lateral luxation
  • Avulsion
  • Crown fracture
  • Crown-root fracture
  • Root fracture
  • Bone fracture
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12
Q

How do you treat an uncomplicated crown frature (without pulp exposure)?

A
  • NO PROBLEM IF VITAL
  • RELAX AND RESTORE
  • RECALL AND TEST SENSIBILITY
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13
Q

What are the treatment options for a complicated crown fracture?

A
  • Pulp Cap: Use Bioceramic materials
  • Pulpotomy: preferred if open apex
  • RCT: preferred if apex closed or post necessary
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14
Q

Crown-root fractures often fracture at an…

A

angle

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15
Q

How can you see the crown-root fracture line?

A

Take several angled X-rays varying both vertical & horizontal angulations or CBCT

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16
Q

What is the treatment for a crown-root fracture?

A
  • 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
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17
Q

Remember, the __ lesion is not always seen with a cracked root

A

J

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18
Q

J lesion, if present, does not always mean root is CRACKED/FRACTURED (___%)

A

28%

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19
Q

What are methods of documenting vertical root fracture?

A
  • transillumination
  • restoration removal + staining
  • surgical exposure
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20
Q

The ________ fracture is often easily visualized on the radiograph

A

horizontal

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21
Q

Horizontal root fractures seldom every occur on __________ teeth

A

posterior

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22
Q
A

horizontal root fracture

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23
Q

Prognosis with horizontal root fracture depends upon…

A
  • 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
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24
Q

What do you do to fix this?

A

Try to reposition and splint 2-4 wks, check for sensibility after 30 days. Refer to a specialist.

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25
Q

For an alveolar fracture splinting is required for ___ weeks

A

4-6

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26
Q

What are the characteristics of an alveolar fracture?

A
  • The bone segment containing the involved tooth is mobile.
  • Sometimes it complicates healing
  • Discomfort may be greater
  • Should not affect the final result.
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27
Q

What is the order of luxation injuries from least to greatest damage?

A

Concussion
Subluxation
Extrusion
Lateral
Intrusive

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28
Q

What is the most common of all dental injuries?

A

Luxation Injuries

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29
Q

What is the least severe luxation injury?

A

Concussion

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30
Q

What are the characteristics of concussion luxation injury?

A
  • No displacement of tooth nor mobility
  • Tooth tender to touch “Bruised PDL”
  • No radiographic abnormalities
31
Q

What do you do for a concussion luxation injury?

A
  • Assess sensibility.
  • Have a base line, then in 2-4 weeks & follow 1yr
32
Q

What are the characteristics for a subluxation injury?

A
  • Tooth tender to touch & slightly mobile (1+) but not displaced
  • Possible hemorrhage from gingival crevice
  • No radiographic abnormalities
  • Damage to supporting structures?
33
Q

What do you do for a subluxation luxation injury?

A
  • Assess sensibility.
  • Have a base line, then in 2-4 weeks & follow 1yr
34
Q

What are the characteristics of a lateral luxation injury?

A
  • Displaced laterally & often locked in bone
  • Not tender to touch, not mobile
  • Alveolus fractured
  • Increased PDL space best seen on eccentric or occlusal radiographs
35
Q

How do you treat a lateral luxation injury?

A
  • Anesthetize & reposition + Flexible splint MANDATORY for 4-6 weeks
  • Assess sensibility. Have a base line. RCT within/10 days
36
Q
A

lateral luxation injury

37
Q

What is a flexible splint?

A

Allows physiologic movement of the teeth in order to minimize ankylosis

38
Q

What is the way to use a flexible splint in the past?

A

.020 or 18 gauge ortho wire bonded to tooth for 1-2 weeks unless alveolar FX had occurred. Then 4-6 wks

39
Q

What are the characteristics of extrusive luxation injury?

A
  • Elongated mobile tooth (Cl. II mobility or greater)
  • Radiographs show increased apical periodontal space
  • Manually reposition
40
Q

What is the treatment for extrusive luxation injury?

A
  • Flexible splint MANDATORY 14 days
  • Assess sensibility. Have a base line, then in 2&4 weeks. RCT if needed
41
Q

What is likely to happen with an intrusive luxation injury?

A

external root resorption

42
Q

What is the most severe luxation injury?

A

intrusive luxation injury

43
Q

What are the characteristics of an intrusive luxation injury?

A
  • 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
44
Q

What is the treatment for intrusive luxation injury?

A
  • 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)
45
Q

What is the RCT intervention for an intrusive luxation injury?

A

100%

46
Q

What is avulsion?

A

Tooth is knocked completely out of mouth

47
Q

Extra-oral dry time is CRITICAL _______ minutes for survival of PDL

A

0-15

48
Q

Must be replaced in socket immediately or ASAP (15-20”) in order to..

A

– Prevent ankylosis
– Prevent external root resorption

49
Q

When considering avulsion the viability of the _____ must be preserved for success

A

PDL

50
Q

What is the replant treatment aimed at doing?

A

minimizing the inflammation from the two main consequences of avulsion:
1. attachment damage
2. pulpal necrosis & infection that usually results

51
Q

The SINGLE most important factor
in achieving a favorable outcome is the _______ at which a clean tooth is properly replanted (viable PDL) 15”

A

SPEED

52
Q

Keeping the attached PDL _____ is paramount when replanting

A

moist

53
Q

What are the options for transporting a tooth in appropraite medium?

A
  • “save-a-tooth”
  • “via span”
  • milk or green tea
  • contact lens solution
  • place in vestibule (saliva) and report to dental office asap
54
Q

How can you be proactive when considering dental trauma especially with avulsed teeth?

A

Provide instructions & transport media to area schools and sports facilities – Practice Builder

55
Q

What are the first aid instructions for an avulsed tooth?

A
  • handle by crown only
  • pick off debris with tweezers
  • replant tooth at the site if possible
56
Q

Take ______ to make sure there is no alveolar FX (cone beam) & that adjacent teeth are OK

A

films

57
Q

What are steps of treating a avulsed tooth/replantation?

A
  • take films
  • remove from transport media
  • gently clean socket
  • replant and check occlusion
  • take films
  • flexible splint
  • RX antibiotics
  • possible tetanus booster
58
Q

What shoud you NOT do with an avulsed tooth?

A
  • submerge in tap water
  • allow tooth to dry
  • scrub root
  • handle by root
59
Q

What is the treatment for this case?

A
  • 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
60
Q

What are the post-treatment instructions for this case?

A

– 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)
61
Q

What are the potential long term results of trauma?

A
  • SOME TRAUMA OUTCOMES ARE FOREVER *
  • Effects on Pulpal Spaces
  • Resorption
  • Ankylosis
62
Q

Trauma usually has completely _________ pulp canals in the traumatized central incisors. No caries.

A

sclerosed

63
Q

Trauma to a tooth can stimulate the pulp to generate massive amounts of _____________. End Result is a sclerosed & non negotiable canal.

A

tertiary dentin

64
Q

Trauma to the pulp can cause the pulp to discontinue ________________

A

development
- remain at the stage present at the time of injury

65
Q

What is ankylosis (bone apposition)?

A
  • A problem following trauma and long term rigid splinting
66
Q

Tooth is solidly fixed and has a high different ring when ________. Does not erupt with other teeth

A

percussing

67
Q

What can ankylosis lead to?

A

May lead to massive external replacement resorption & loss of tooth

68
Q

What is the internal appearance of ankylosis?

A

appearance of “aneurysm”
w/in canal

69
Q

What are the characteristics of replacement ERR?

A
  • Patients are generally asymptomatic
  • Typically a history of avulsion or intrusion injury
70
Q

How can you tell if a tooth is ankylosis?

A

lack of normal mobility + High pitched “metallic ring” during percussion or possibly by “submergence” (not erupting with other normal teeth)

71
Q

Our professional responsibility includes educating our patients and the community regarding the dangers of trauma as well as appropriate preventive measures and therapeutic opportunities:

A

– Talk to school nurses
– Coaches
– Youth groups, Scouts, etc.

72
Q

Our professional responsibility includes educating our patients and the community regarding the benefits of the use of ___________ during sports activity.

A

mouth guards

73
Q

How can the dentist educate on using mouth guards?

A

*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

Endo (18 decks)

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