Dental Trauma Flashcards
how do you approach dental trauma?
- hx
- exam and diagnosis
- emergency tx
- follow up
- definitive tx
what is the first step in approaching dental trauma?
- any medical referral needed? (loss of consciousness, nausea, etc)
- hx (when, where, how)
- exam (extra-oral, intra-oral, radiographic exam)
what are the minimum questions you want to ask a patient with dental trauma?
- did the patient lose consciousness?
2. any vomiting since the injury happened?
dental hart tissue injury
- crack on teeth
- fractured teeth
- pulp exposure
- color change
supporting tissue injury
- displacement of teeth
- mobility of teeth
- mobility of alveolar fragments
- occlusion abnormality
- percussion sensitivity
T/F: every traumatized tooth needs x-ray
true
what type of radiographs should be taken for primary teeth?
occlusals
radiographic evidence of pathology 2 weeks after trauma
pulpal necrosis
radiographic evidence of pathology 3 weeks after trauma
inflammatory resorption (external and internal)
radiographic evidence of pathology 6 weeks after trauma
replacement resorption (ankylosis)
short term reactions of teeth to trauma
- pulpal hyperemia (pulpitis)
2. internal hemorrhage
long term reactions of teeth to trauma
- pulp canal obliteration (PCO)
- inflammatory resorption
- replacement resorption (ankylosis)
pulpal hyperemia (pulpitis) may lead to what?
may lead to cold sensitivity
internal hemorrhage may lead to what?
(transient) discoloration
pulpal necrosis may lead to what?
percussion+/peri apical radiolucency
pulp canal obliteration (PCO) may lead to what?
yellow discoloration
inflammatory resorption may lead to what?
radiographic appearance ~mobility
ankylosis may lead to what?
lack of mobility, dull percussion sound
T/F: pulp canal obliteration and pulpal necrosis may be reversible if tx’d early
false, usually is NOT reversible
T/F: because pulp canal obliteration and pulpal necrosis are not reversible, that tooth is necrotic and needs RCT
false, it does NOT
what does PCO depend on?
- type of injury
2. stage of root development
T/F: pulpal necrosis subsequent to PCO is common
false, is uncommon (1%)
T/F: PCO occurs later than PN
true, 12 mos. vs 3 mos.
T/F: PCO increased with bands/resin fixation
true
replacement resorption
- direct union of bone and root
- resorption of root and replacement with bone
- direct result of loss of vital PDL
main goals in emergency management of dental trauma
- cover fractured teeth temporarily
2. reposition luxated teeth and stabilize
vitality tests
- electric pulp test
2. cold test
when are cold test and EPT not reliable?
its less reliable in children, open apices, and shortly after trauma
what determines the course of action for traumatized teeth?
more than singular findings, changes in signs and symptoms
dental trauma categories
- fracture injuries
2. luxation injuries
types of fracture injuries
- enamel infarction (crack)
- uncomplicated crown fx
- complicated crown fx
- uncomplicated crown-root fx
- complicated crown-root fx
- isolated root fx
tx for class I fractures in PRIMARY teeth
- do nothing?
- smooth rough edges
- restore w/ composite?
tx for class I fractures in PERMANENT teeth
- do nothing?
- smooth rough edges
- restore w/ composite?
- follow up
how long should you wait before you do a follow up?
usually 4-week
tx for class II fractures in PRIMARY teeth
- do nothing?
- composite/GI “Band-Aid” - then monitor for symptoms
- restore w composite/GI?
tx for class II fractures in PERMANENT teeth
- do nothing?
- bond fragment if available
- composite/GI “Band-Aid” - then monitor for symptoms
- restore w composite/GI
- follow up
tx for class III fractures in PRIMARY teeth
- partial pulpotomy
- pulpotomy
- pulpectomy
- extraction
when should you extract a primary tooth with a class III fracture?
comes down to behavior
tx for class III fractures in PERMANENT, young tooth w open apex or closed apex
- direct pulp cap
2. partial pulpotomy (Cvek technique)
tx for class III fractures in PERMANENT, mature tooth w closed apex
pulpectomy
at what age does the apex of maxillary centrals occur?
~10 yrs
at what age does the apex of maxillary laterals occur?
~11 yrs
at what age does the apex of maxillary canines occur?
~13-15 yrs
at what age does the apex of mandibular centrals occur?
~9 yrs
at what age does the apex of mandibular laterals occur?
~10 yrs
at what age does the apex of mandibular canines occur?
~12-14 yrs
Cvek partial pulpotomy criteria for success
- no clinical signs or symptoms (no fistula, no mobility, no pain)
- no radiogrpahic pathology
- continued development of immature roots
- formation of calcific barriers
- sensitivity to elecrical stimulation
sequelae of dental trauma
- discoloration of tooth
- acute pain
- abscess or inflammation due to necrosis of tooth
- tooth mobility
- sensitivity to cold or hot foods
- gingival irritation or inflammation
- damage to developing tooth (if the injured tooth is a primary tooth)
what should parents watch for after their child experiences dental trauma?
- watch for it to start hurting (e.g. waking up at night, stops eating and drinking)
- color change
- swelling (e.g. facial swelling, “pimple” of pus on the gums above the tooth)
- tooth getting loose
tx for tooth discoloration in PRIMARY teeth
no tx necessary
tx for footh discoloration in PERMANENT teeth
vitality tests, radiograph and other signs and symptoms should be considered when formulating tx plan
chin trauma can lead to what?
- posterior crown fractures
- mandibular condylar fractures
- cervical spine injury