Dental trauma

Question 1

What is involved in a trauma review?

Answer 1

Sinus/tender in sulcus 
Colour 
TTP
Mobility 
EPT
EC
Displacement/percussion note 
Radiographs

Question 2

When would you carry out a pulp cap and what Is the process?

Answer 2

Pulp cap: 1mm small exposure occurred within 24hrs
- trauma sticker and radiographs (non TTP, +ve sensibility testing)
- LA and dam
- clean area and disinfect with sodium hypochlorite
- aPply calcium hydroxide or MTA white to pulp exposure
- restore tooth with restoration
Review 6-8 weeks then 1 year

Question 3

When would you carry out a Cvek pulpotomy and what is the process?

Answer 3

Partial pulpotomy - large exposure >1mm or 24hrs since trauma

• trauma review and x-rays
• La and dam
• clean area and disinfect with sodium hypochlorite
• remove 2mm of pulp and place saline soaked CW pellet over exposure until haemostasis is achieved (if no haemostasis proceed to full coronal pulpotomy) \
• apply CaOH then vitrebond and restore

Question 4

Why would you carry out a full coronal pulpotomy and what is the process?

Answer 4

For non bleeding or non haemostasis pulps:

• assess bleeding then remove all coronal pulp
• place calcium hydroxide in pulp chamber
• seal with GIC lining and restore

Follow up 6-8 weeks and 1yr.

Question 5

What injuries require 2 week flexible splinting?

Answer 5

Subluxation
Extrusion
Avulsion (open and closed apex <60mins EADT)

Question 6

What injuries require 4 ŵeek flexible splinting?

Answer 6

Luxation. 
Apical/middle 3rd root fractures 
Intrusion 
Dento-alveolar fractures
Avulsion (closed apex >60mins EADT)

Question 7

What injury requires flexible 4 month splinting?

Answer 7

Coronal 3rd root fracture

Question 8

What is the review schedule for root fractures?

Answer 8

6-8 weeks, 4 months, 6 months, 1yr and yearly for 5yrs.

Question 9

What is a concussion injury?

Answer 9

Injury to tooth supporting structures without increased mobility or displacement of the tooth, but TTP.

Question 10

What is a subluxation injury?

Answer 10

Injury to tooth supporting structures with increased mobility but without displacement of the tooth. Acute trauma will have bleeding from gingival sulcus.

Question 11

What is an extrusion injury?

Answer 11

Partial displacement of the tooth out of its alveolar socket which will appear longer in the mouth.
Partial or total separation of the PDL resulting in loosening and displacement of tooth - protrusion or retrusion.
Radiographically - widening of PDL and outline of socket visible

Question 12

What is a lateral luxation injury?

Answer 12

Displacement of tooth other than apical and is accompanied by comminution or fracture of either the labial or lingual alveolar bone.
Partial or total separation of PDL.
Apex forced into the bone by displacement which results in tooth being non mobile.
Percussion note sounds metallic, TTP, non-mobile.

Question 13

What is an intrusion injury?

Answer 13

Displacement of tooth into alveolar bone in an axial direction with comminution or fracture of alveolar socket.
Incisal edges more apical. TTP, non mobile, metallic percussion note.
Radiographically: loss of PDL space, ACJ more apical.

Question 14

What is an Avulsion injury:

Answer 14

Complete displacement of tooth out of its socket

Question 15

What are the different types of management options for intrusion injuries?

Answer 15

Open apex:

• upto 7mm: spontaneous repositioning
• > 7mm: orthodontic +/- surgical

Closed apex (RCT needed):

• up to 3mm: spontaneous
• 3-7mm: orthodontic +/- surgical
• > 7mm: surgical

Question 16

What thickness of wire is used for splinting?

Answer 16

0.018 SS orthodontic wire

Question 17

With regards to a Avulsed closed apex teeth what is the management?

Answer 17

Regardless of EADT the teeth should be root treated ASAP

Question 18

What are the long term effects to primary teeth and permanent teeth from trauma?

Answer 18

Discolouration 
Delayed exfoliation 
Enamel defects 
Abnormal root/tooth morphology (dilaceration) 
Delayed eruption
Ectopic tooth position 
Odontome formation

Question 19

What are the pulp survival rates for closed apex teeth?

Answer 19

Concussion: 96%
Subluxation: 85%
Extrusion: 45%
Lateral luxation: 25%
Intrusion: 0%
Avulsion: 0%

Question 20

What are the pulp survival rates for open apex teeth?

Answer 20

Concussion: 100%
Subluxation: 100%
Extrusion: 95%
Lateral luxation: 95%
Intrusion: 40%
Avulsion: 30%

Question 21

An 8yr old attends practice with mum, who telephoned 90mins who to report son has knocked out upper front tooth in cycling accident. They arrive with tooth wrapped in handkerchief. On examination it is apparent tooth 11 has avulsed.
What is the management?

Answer 21

Carry out RCT on the tooth extra orally

• replant tooth
• place flexible splint 0.018 wire for 4 weeks

Question 22

What is the correct splinting time for cervical 1/3rd root fracture?

Answer 22

4months

Question 23

A 14yr old patient attends with fractured upper central incisors which has been damaged in fight 3 days ago, clinically a pulp exposure is evident. How do you best treat this?

Answer 23

Cvek pulpotomy
- Under LA and dental dam Remove 2-3mm of pulp tissue until bleeding stops on application with CW) soaked in NaOCl.
Apply CaOH2 , seal and restore.

Question 24

When diagnosing a necrotic pulp how many signs or symptoms should they have prior to RcT?

Answer 24

2 signs/symptoms

Question 25

What material is used at apex of canal to create cement barrier?

Answer 25

MTA or biodentine

Question 26

What signs would best fit for a diagnosis of a fractured zygoma?

Answer 26

Diplopia

Step deformity

Question 27

What clinical signs would most likely indicate a fracture of the body of the mandible?

Answer 27

Lingual haematoma and inability to bite together properly