Dental Trauma Flashcards
1
Q
how do you approach dental trauma?
A
- hx
- exam and diagnosis
- emergency tx
- follow up
- definitive tx
2
Q
what is the first step in approaching dental trauma?
A
- any medical referral needed? (loss of consciousness, nausea, etc)
- hx (when, where, how)
- exam (extra-oral, intra-oral, radiographic exam)
3
Q
what are the minimum questions you want to ask a patient with dental trauma?
A
- did the patient lose consciousness?
2. any vomiting since the injury happened?
4
Q
dental hart tissue injury
A
- crack on teeth
- fractured teeth
- pulp exposure
- color change
5
Q
supporting tissue injury
A
- displacement of teeth
- mobility of teeth
- mobility of alveolar fragments
- occlusion abnormality
- percussion sensitivity
6
Q
T/F: every traumatized tooth needs x-ray
A
true
7
Q
what type of radiographs should be taken for primary teeth?
A
occlusals
8
Q
radiographic evidence of pathology 2 weeks after trauma
A
pulpal necrosis
9
Q
radiographic evidence of pathology 3 weeks after trauma
A
inflammatory resorption (external and internal)
10
Q
radiographic evidence of pathology 6 weeks after trauma
A
replacement resorption (ankylosis)
11
Q
short term reactions of teeth to trauma
A
- pulpal hyperemia (pulpitis)
2. internal hemorrhage
12
Q
long term reactions of teeth to trauma
A
- pulp canal obliteration (PCO)
- inflammatory resorption
- replacement resorption (ankylosis)
13
Q
pulpal hyperemia (pulpitis) may lead to what?
A
may lead to cold sensitivity
14
Q
internal hemorrhage may lead to what?
A
(transient) discoloration
15
Q
pulpal necrosis may lead to what?
A
percussion+/peri apical radiolucency
16
Q
pulp canal obliteration (PCO) may lead to what?
A
yellow discoloration
17
Q
inflammatory resorption may lead to what?
A
radiographic appearance ~mobility
18
Q
ankylosis may lead to what?
A
lack of mobility, dull percussion sound
19
Q
T/F: pulp canal obliteration and pulpal necrosis may be reversible if tx’d early
A
false, usually is NOT reversible
20
Q
T/F: because pulp canal obliteration and pulpal necrosis are not reversible, that tooth is necrotic and needs RCT
A
false, it does NOT
21
Q
what does PCO depend on?
A
- type of injury
2. stage of root development
22
Q
T/F: pulpal necrosis subsequent to PCO is common
A
false, is uncommon (1%)
23
Q
T/F: PCO occurs later than PN
A
true, 12 mos. vs 3 mos.
24
Q
T/F: PCO increased with bands/resin fixation
A
true
25
replacement resorption
1. direct union of bone and root
2. resorption of root and replacement with bone
3. direct result of loss of vital PDL
26
main goals in emergency management of dental trauma
1. cover fractured teeth temporarily
| 2. reposition luxated teeth and stabilize
27
vitality tests
1. electric pulp test
| 2. cold test
28
when are cold test and EPT not reliable?
its less reliable in children, open apices, and shortly after trauma
29
what determines the course of action for traumatized teeth?
more than singular findings, changes in signs and symptoms
30
dental trauma categories
1. fracture injuries
| 2. luxation injuries
31
types of fracture injuries
1. enamel infarction (crack)
2. uncomplicated crown fx
3. complicated crown fx
4. uncomplicated crown-root fx
5. complicated crown-root fx
6. isolated root fx
32
tx for class I fractures in PRIMARY teeth
1. do nothing?
2. smooth rough edges
3. restore w/ composite?
33
tx for class I fractures in PERMANENT teeth
1. do nothing?
2. smooth rough edges
3. restore w/ composite?
4. follow up
34
how long should you wait before you do a follow up?
usually 4-week
35
tx for class II fractures in PRIMARY teeth
1. do nothing?
2. composite/GI "Band-Aid" - then monitor for symptoms
3. restore w composite/GI?
36
tx for class II fractures in PERMANENT teeth
1. do nothing?
2. bond fragment if available
3. composite/GI "Band-Aid" - then monitor for symptoms
4. restore w composite/GI
5. follow up
37
tx for class III fractures in PRIMARY teeth
1. partial pulpotomy
2. pulpotomy
3. pulpectomy
4. extraction
38
when should you extract a primary tooth with a class III fracture?
comes down to behavior
39
tx for class III fractures in PERMANENT, young tooth w open apex or closed apex
1. direct pulp cap
| 2. partial pulpotomy (Cvek technique)
40
tx for class III fractures in PERMANENT, mature tooth w closed apex
pulpectomy
41
at what age does the apex of maxillary centrals occur?
~10 yrs
42
at what age does the apex of maxillary laterals occur?
~11 yrs
43
at what age does the apex of maxillary canines occur?
~13-15 yrs
44
at what age does the apex of mandibular centrals occur?
~9 yrs
45
at what age does the apex of mandibular laterals occur?
~10 yrs
46
at what age does the apex of mandibular canines occur?
~12-14 yrs
47
Cvek partial pulpotomy criteria for success
1. no clinical signs or symptoms (no fistula, no mobility, no pain)
2. no radiogrpahic pathology
3. continued development of immature roots
4. formation of calcific barriers
5. sensitivity to elecrical stimulation
48
sequelae of dental trauma
1. discoloration of tooth
2. acute pain
3. abscess or inflammation due to necrosis of tooth
4. tooth mobility
5. sensitivity to cold or hot foods
6. gingival irritation or inflammation
7. damage to developing tooth (if the injured tooth is a primary tooth)
49
what should parents watch for after their child experiences dental trauma?
1. watch for it to start hurting (e.g. waking up at night, stops eating and drinking)
2. color change
3. swelling (e.g. facial swelling, "pimple" of pus on the gums above the tooth)
4. tooth getting loose
50
tx for tooth discoloration in PRIMARY teeth
no tx necessary
51
tx for footh discoloration in PERMANENT teeth
vitality tests, radiograph and other signs and symptoms should be considered when formulating tx plan
52
chin trauma can lead to what?
1. posterior crown fractures
2. mandibular condylar fractures
3. cervical spine injury
53
tx for enamel fracture
1. band-aid temp restoration
| 2. no tx
54
tx for enamel crack
no tx needed
55
tx for enamel-dentin fracture
band-aid temp restoration
56
tx for enamel-dentin fracture w pulp exposure
1. pulp cap
2. Cvek pulpotomy
3. RCT (open apex vs closed apex)
57
tx for crown-root fracture
1. band-aid
2. orthodontic extrusion and restoration
3. extraction, decoronation
58
tx for crown-root fracture w pulp exposure
1. pulp cap
2. Cvek pulpotomy
3. RCT (open apex vs closed apex)
4. orthodontic extrusion and restoration
5. extraction, decoronation
59
tx of isolated root fracture
1. no tx
2. splint (if increased mobility) for 4 weeks
3. splint for 4 months if cervical
60
types of luxation injuries
1. concussion
2. subluxation
3. intrusive luxation
4. extrusive luxation
5. lateral luxation
6. avulsion
61
T/F: we often see more than just one type of traumatic injury in a patient
true
62
what do we always go by based on the type of injury?
by the most critical and longest follow up that is recommended based on the type of injury
63
T/F: always take initial x-ray from all traumatized teeth
true
64
what are our concerns for crown/root fracture injuries?
1. pulp
| 2. restorability of the tooth
65
what are our concerns for luxation injuries?
1. PDL
| 2. vitality of the tooth
66
what are other factors in tx planning a traumatized tooth?
1. permanent teeth vs primary teeth
| 2. permanent teeth: mature vs immature apex
67
what is a key determinant for successful tx?
follow up
68
concussion
- an injury to the tooth-supporting structures without abnormal loosening or displacement of the tooth but with marked reaction to percussion
- aka tooth gets "bumped"
69
tx for concussion of PRIMARY teeth
1. no emergency tx
2. discuss potential sequelae w parents
3. monitor for symptoms
70
tx for concussion of PERMANENT teeth
1. no emergency tx
2. discuss potential sequelae w parents
3. monitor for symptoms
4. follow up
71
subluxation
an injury to the tooth-supporting structures w abnormal loosening, but without displacement of the tooth
72
tx for subluxation of PRIMARY teeth
1. no emergency tx
2. monitor for symptoms
3. tooth may tighten
73
tx for subluxation of PERMANENT teeth
1. no emergency tx
2. monitor for symptoms
3. tooth may tighten
4. follow up
74
how long should you wait before follow up of subluxation?
follow up in 2-4 weeks
75
how long after subluxation accident should you take a radiograph?
1 month
76
intrusive luxation
displacement of the tooth into the alveolar bone
77
what is intrusive luxation accompanied by?
comminution or fracture of the alveolar socket
78
when should an extraoral lateral film be taken?
intrusive luxation
79
tx for labially displaced intrusion of PRIMARY teeth
if tooth was displaced labially (toward or through labial bone plate), then allow spontaneous re-eruption
80
occlusal x-ray of labially displaced intrusion of PRIMARY teeth
shortening
81
tx for tooth displaced into developing bud intrusion of PRIMARY teeth
if tooth displaced into developing tooth bud, then extract
82
occlusal x-ray of tooth displaced into developing tooth bud intrusion of PRIMARY teeth
elongation
83
at what age is the greatest risk for injuries to developing teeth?
1-3
84
type of injuries to developing teeth
1. discoloration
2. enamel hypoplasia
3. crown to root dilaceration
4. arrested development
5. disturbance in eruption
85
tx for intrusion of permanent teeth w/ OPEN apex ≤ 7 mm
spontaneous eruption
86
tx for intrusion of permanent teeth w/ OPEN apex > 7 mm
orthodontic or surgical repositioning
87
tx for intrusion of permanent teeth w/ CLOSED apex < 3 mm
spontaneous eruption
88
tx for intrusion of permanent teeth w/ CLOSED apex 3-7 mm
orthodontic or surgical repositioning
89
tx for intrusion of permanent teeth w/ CLOSED apex > 7 mm
surgical repositioning
90
follow up of intrusion of PERMANENT teeth
1. pulpectomy
| 2. complete gutta percha fill in 2 months if no inflammatory resorption
91
pulpectomy of intrused permanent teeth
remove pulp and fill with CaOH within 7-14 days
92
extrusive luxation
a partial displacement of the tooth out of its socket
93
tx for minor (< 3 mm) extrusion of PRIMARY teeth
1. reposition (but don't splint)
| 2. spontaneous alignment
94
tx for severe extrusion of PRIMARY teeth
extract
95
tx for extrusion of PERMANENT teeth
1. reposition w digital pressure (two-digit technique)
2. flexible splint for 2 weeks
3. rx chlorhexidine mouth rinse
96
follow up of extrusion of PERMANENT teeth
1. pulpectomy
| 2. complete gutta percha fill in 2 months if no inflammatory resorption
97
follow up after pulpectomy of extrusion of permanent teeth
remove pulp and fill with CaOH within 7-14 days
98
lateral luxation
a displacement of the tooth in a direction other than axially
99
what is lateral luxation accompanied by?
comminution or fracture of the alveolar socket
100
types of lateral luxation
1. retrusion
| 2. protrusion
101
retrusion of PRIMARY teeth w no occlusal interference
spontaneous repositioning
102
retrusion of PRIMARY teeth w occlusal interference
must be repositioned (but do not splint) or extracted
103
protrusion of PRIMARY teeth
extract (contact w developing tooth bud)
104
tx for lateral luxation of PERMANENT teeth
1. reposition w digital pressure
2. flexible splint for 4 weeks
3. rx chlorhexidine mouth rinse
105
avulsion
a complete dispalcement of the tooth out of its socket
106
tx for avulsion of PRIMARY teeth
NEVER re-implant primary teeth
107
ultimate goal of tx for avulsion of PERMANENT teeth
PDL healing without root resorption
108
what is the most critical factor of tx for avulsion of PERMANENT teeth?
maintaining an intact and viable PDL on the root surface
109
tx for avulsion of PERMANENT teeth
1. reimplant ASAP
2. flexible splint for 2 weeks
3. medications
110
prognosis of an avulsed permanent teeth depends on what?
1. open apex vs closed apex
| 2. dry time
111
if the avulsed tooth is contaminated, what should you do?
rinse w saline
112
if the avulsed tooth cannot be replanted, what should the tooth be placed in?
best transport medium available
113
transport media
1. Hank's balanced salt solution (HBSS)
2. MILK
3. saline
4. saliva (buccal vestibule)
5. water, if none above available
114
management of root surface of avulsed permanent tooth
1. objective is to maintain PDL cell vitality
2. keep moist in HBSS
3. do not handle root surface
4. gently remove persistent debris
115
what should be done if a clot is present in the avulsed socket of a permanent tooth?
use saline irrigation
116
T/F: you should curette the socket of an avulsed permanent tooth
false, do NOT curette
117
what should you do if the alveolar bone of an avulsed permanent tooth socket has collapsed?
use blunt instrument to reposition
118
what should you do after replantation of permanent teeth in an avulsed socket?
manually compress bony plates after implantation
119
T/F: you should tightly suture any soft tissue lacerations, particularly in the cervical region
true
120
what can be used for splinting after reimplanting an avulsed permanent tooth?
1. use fishline/acid-etch resin
2. soft arch wire/resin
3. ortho brackets with passive arch wire
4. suture as last resort
121
how long should a splint be maintained for after reimplanting an avulsed permanent tooth?
up to 2 weeks, longer if tooth demonstrates excessive mobility
122
home care instructions after splinting avulsed permanent teeth
1. no biting on splinted teeth
2. soft diet
3. good oral hygeine
123
follow up for avulsion of PERMANENT teeth
1. pulpectomy: remove pulp and fill with CaOH within 7-14 days
2. complete gutta percha fill in 2-12 months
124
when would you not have to complete the gutta percha fill of an avulsed permanent tooth?
no need to complete endo if tooth becomes ankylosed
125
follow up for avulsion of IMMATURE PERMANENT teeth
1. replant and splint as with mature teeth
| 2. recall every 3-4 weeks
126
best prognosis for avulsed IMMATURE PERMANENT teeth is if reimplanted within what time frame?
within 20 minutes
127
if avulsed IMMATURE PERMANENT teeth show signs of necrosis, what should be done next?
extirpate pulp and do revascularization procedure
128
how do you revascularize IMMATURE PERMANENT teeth of an avulsed socket?
1. stimulate bleeding through apex
2. place MTA on top of clot
3. allows continued root development and root wall thickening
129
what injuries need emergency tx and should be stabilized as soon as possible?
1. avulsion
2. extrusion
3. lateral luxation
130
clinical signs of aspiration
1. no syms
2. initial choking and coughing
3. irritating cough
4. wheezing
5. unilateral obstructive emphysema
6. atelectasis
7. pulmonary supparation
