Dental Trauma 2 Flashcards
What is the prevalence of primary tooth trauma, and which teeth are most commonly affected?
16-40% prevalence, with maxillary primary incisors being most commonly affected
At what age is the peak incidence of primary tooth trauma observed?
Between 2-4 years old
Name the three main aetiologies of primary tooth trauma.
Falls, bumping into objects, and non-accidental injuries
List the classifications of primary tooth trauma.
- Fracture injuries: Enamel fracture, enamel-dentine fracture, crown-root fracture, root fracture, alveolar fracture.
- Displacement injuries: Concussion, subluxation, lateral luxation, intrusion, extrusion, avulsion.
What is the key emergency treatment principle for primary tooth trauma?
Observation is often appropriate unless there is a risk of aspiration, ingestion, or occlusal interference.
Describe the clinical findings and management of an enamel fracture in primary teeth.
Findings: Fracture involves enamel only.
Management: Smooth sharp edges; no radiographs or follow-up recommended.
Describe the clinical findings, radiographs and management of an enamel-dentine fracture without pulp exposure in primary teeth.
• Clinical findings: Fracture involves enamel and dentine.
The pulp is not exposed
• Radiograph: Baseline optional
Soft tissue to locate fracture fragment
• Management: Account for fragment
Cover all exposed dentine with glass
ionomer/ composite
How do you manage an enamel-dentine fracture with pulp exposure?
- Account for the fragment.
- Perform a partial pulpotomy or extract the tooth.
- Follow-up at 1 week, 6-8 weeks, and 1 year.
Radiograph: Baseline periapical or occlusal
Soft tissue to locate fracture fragment
How do you manage a restorable crown-root fracture with pulp exposure?
- Perform a pulpotomy or endodontic treatment.
- Cover the exposed dentine.
What is the management for a restorable crown-root fracture without pulp exposure?
Remove the coronal fragment and protect the exposed dentine.
How do you manage an unrestorable crown-root fracture?
Extraction
What radiographs are recommended for a crown-root fracture in primary teeth?
Baseline periapical or occlusal radiographs are suggested to assess the extent of the fracture.
What are the follow-up intervals for crown-root fractures?
Clinical follow-up at 1 week, 6-8 weeks, and 1 year.
How do clinical findings differ in root fractures based on the location of the fracture?
• Coronal fractures: Often mobile and displaced.
• Apical/mid-root fractures: Generally stable with no mobility.
What radiographs are recommended for root fractures?
Baseline periapical or occlusal radiographs are used to assess the fracture location.
What is the management for root fractures without displacement?
No treatment is required; monitor at 1 week, 6-8 weeks, and 1 year.
How do you manage a root fracture with displacement but limited mobility?
Allow the tooth to reposition naturally, and monitor.
When is extraction indicated for root fractures?
• Excessive mobility.
• Occlusal interference.
What follow-up is required after root fractures with splinting?
• Clinical: 1 week, 4 weeks (splint removal), 8 weeks, and 1 year.
• Radiographic monitoring may be included as needed.
What are the clinical findings in alveolar fractures?
Fractures involve alveolar bone and may extend to adjacent bone, often with mobility of the segment.
What radiographs are recommended for alveolar fractures?
Baseline periapical, occlusal, and lateral views to assess the extent of the fracture.
How are alveolar fractures managed initially?
- Reposition the fractured segment.
- Stabilise with a flexible splint attached to adjacent uninjured teeth for 4 weeks.
What is the follow-up protocol for alveolar fractures?
• Clinical: 1 week, 4 weeks, 8 weeks, 1 year, and 6 years.
• Radiographic: 4 weeks and 1 year.
What happens if alveolar stability is achieved but teeth remain compromised?
Extraction of compromised teeth may be necessary after stabilisation.
What are the clinical findings in a concussion injury?
Tooth is tender to touch but not displaced or mobile; no sulcular bleeding.
What is the management for a concussion injury?
No treatment required; observe the tooth.
What is the follow-up protocol for concussion injuries?
Clinical follow-up at 1 week and 6-8 weeks.
What are the clinical findings in subluxation?
Tooth is tender to touch with increased mobility but not displaced; no sulcular bleeding.
What radiographs are recommended for subluxation injuries?
Baseline periapical or occlusal radiographs
What is the management for subluxation?
No treatment required; observe the tooth.
What is the follow-up protocol for subluxation?
Clinical follow-up at 1 week and 6-8 weeks.
What are the clinical findings in lateral luxation?
Tooth is displaced palatally, lingually, or labially and is immobile
How is lateral luxation managed when there is no/minimal occlusal interference?
Allow for spontaneous repositioning.
What is the management for severe lateral luxation with significant displacement?
Reposition the tooth with or without splinting. Extract if necessary.
What is the follow-up protocol for lateral luxation?
• No splint: 1 week, 6-8 weeks, 6 months, 1 year.
• Splint: 1 week, 4 weeks (splint removal), 8 weeks, 1 year.
What are the clinical findings in intrusion injuries?
The tooth is almost or completely pushed into the socket, often impinging on the permanent tooth germ.
How is the direction of displacement assessed in intrusion?
- Tooth appears shorter: Displaced towards the labial bone plate.
- Tooth appears elongated: Displaced towards the permanent tooth germ.
What is the management for intrusion?
Allow the tooth to reposition spontaneously.
What is the follow-up protocol for intrusion?
Clinical follow-up at 1 week, 6-8 weeks, 6 months, and 1 year.
What are the clinical findings in extrusion?
Tooth is partially displaced out of its socket, appearing elongated and mobile; occlusal interference may be present.
How is extrusion managed when there is no occlusal interference?
Allow for spontaneous repositioning.
When is extraction indicated for extrusion?
If the tooth is excessively mobile or extruded >3 mm.
What is the follow-up protocol for extrusion?
Clinical follow-up at 1 week, 6-8 weeks, and 1 year
What are the clinical findings in avulsion?
The tooth is completely out of the socket.
What is the key principle of managing avulsion in primary teeth?
Do not replant the tooth to avoid damaging the permanent tooth germ
What radiographs are essential for avulsion cases?
Baseline periapical or occlusal radiographs to confirm the diagnosis and check for retained fragments.
What is the follow-up protocol for avulsion?
Clinical follow-up at 6 weeks and 6 years.
Why is avulsion in primary teeth not treated with replantation?
Due to the high risk of damage to the permanent tooth germ.
What are the primary post-operative care recommendations for primary tooth trauma?
- Avoid biting on traumatised teeth.
- Follow a soft diet.
- Maintain meticulous oral hygiene.
- Use analgesics as needed.
What does the impact of primary dental trauma depend on?
• Age
• Type of injury
• Severity of injury
• Pulpal sequelae
• Treatment
What is the most common complication of intrusion injuries in primary teeth on permanent successors?
Enamel defects in the permanent tooth (44%).
What long-term effects can primary tooth trauma have on the permanent successor?
Enamel hypoplasia, dilaceration, delayed eruption, ectopic tooth position, arrested development, and odontome formation.
What sequelae can occur to a traumatised primary tooth?
Discolouration (vital or non-vital), discolouration with infection, and delayed exfoliation.
What does mild grey discolouration of a primary tooth indicate?
It may indicate the tooth has maintained vitality, and no treatment is required.
What does yellow/opaque discolouration of a primary tooth suggest?
Pulp obliteration; the tooth is asymptomatic and requires no treatment but monitoring.
How do you manage discolouration with infection in primary teeth?
Extract the tooth or perform endodontic treatment if there is a sinus, abscess, or swelling.
What is a potential consequence of delayed exfoliation in primary teeth?
It can affect the developing occlusion, necessitating radiographic evaluation and potential intervention.
What is a potential consequence of delayed exfoliation in primary teeth?
It can affect the developing occlusion, necessitating radiographic evaluation and potential intervention.
How does the age at which trauma occurs affect permanent tooth injuries?
• 0-2 years: Highest risk (63%).
• 3-4 years: 58%.
• 5-6 years: 24%.
• 7-8 years: 25%.
Which primary tooth injury is most likely to cause damage to the permanent successor?
Intrusion injuries.
What is the most common anomaly in permanent teeth after primary tooth trauma?
Enamel defects (44%).
How do you manage enamel hypoplasia resulting from trauma?
• Composite masking.
• No treatment if mild.
What are possible outcomes of crown or root dilaceration in permanent teeth?
• Surgical exposure and orthodontic realignment.
• Restorative improvement for aesthetics.
What causes delayed eruption in permanent teeth after trauma?
Thickened mucosa due to premature loss of a primary tooth. A delay of ~1 year is common.
What causes delayed eruption in permanent teeth after trauma?
Thickened mucosa due to premature loss of a primary tooth. A delay of ~1 year is common.
What management options exist for ectopic tooth position in permanent teeth?
• Surgical exposure.
• Orthodontic realignment.
• Extraction, if necessary.
What is the treatment for arrested development of a permanent tooth germ?
• Endodontic treatment if possible.
• Extraction if the tooth is non-restorable.
How is odontome formation managed in the permanent dentition?
Surgical removal of the odontome.
What key point should parents be informed about following primary tooth trauma?
The potential for sequelae in both the primary tooth and the permanent successor.
