Dental trauma Flashcards
What is involved in a trauma review?
Sinus/tender in sulcus Colour TTP Mobility EPT EC Displacement/percussion note Radiographs
When would you carry out a pulp cap and what Is the process?
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
When would you carry out a Cvek pulpotomy and what is the process?
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
Why would you carry out a full coronal pulpotomy and what is the process?
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.
What injuries require 2 week flexible splinting?
Subluxation
Extrusion
Avulsion (open and closed apex <60mins EADT)
What injuries require 4 ŵeek flexible splinting?
Luxation. Apical/middle 3rd root fractures Intrusion Dento-alveolar fractures Avulsion (closed apex >60mins EADT)
What injury requires flexible 4 month splinting?
Coronal 3rd root fracture
What is the review schedule for root fractures?
6-8 weeks, 4 months, 6 months, 1yr and yearly for 5yrs.
What is a concussion injury?
Injury to tooth supporting structures without increased mobility or displacement of the tooth, but TTP.
What is a subluxation injury?
Injury to tooth supporting structures with increased mobility but without displacement of the tooth. Acute trauma will have bleeding from gingival sulcus.
What is an extrusion injury?
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
What is a lateral luxation injury?
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.
What is an intrusion injury?
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.
What is an Avulsion injury:
Complete displacement of tooth out of its socket
What are the different types of management options for intrusion injuries?
Open apex:
- upto 7mm: spontaneous repositioning
- > 7mm: orthodontic +/- surgical
Closed apex (RCT needed):
- up to 3mm: spontaneous
- 3-7mm: orthodontic +/- surgical
- > 7mm: surgical
What thickness of wire is used for splinting?
0.018 SS orthodontic wire
With regards to a Avulsed closed apex teeth what is the management?
Regardless of EADT the teeth should be root treated ASAP
What are the long term effects to primary teeth and permanent teeth from trauma?
Discolouration Delayed exfoliation Enamel defects Abnormal root/tooth morphology (dilaceration) Delayed eruption Ectopic tooth position Odontome formation
What are the pulp survival rates for closed apex teeth?
Concussion: 96% Subluxation: 85% Extrusion: 45% Lateral luxation: 25% Intrusion: 0% Avulsion: 0%
What are the pulp survival rates for open apex teeth?
Concussion: 100% Subluxation: 100% Extrusion: 95% Lateral luxation: 95% Intrusion: 40% Avulsion: 30%
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?
Carry out RCT on the tooth extra orally
- replant tooth
- place flexible splint 0.018 wire for 4 weeks
What is the correct splinting time for cervical 1/3rd root fracture?
4months
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?
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.
When diagnosing a necrotic pulp how many signs or symptoms should they have prior to RcT?
2 signs/symptoms
What material is used at apex of canal to create cement barrier?
MTA or biodentine
What signs would best fit for a diagnosis of a fractured zygoma?
Diplopia
Step deformity
What clinical signs would most likely indicate a fracture of the body of the mandible?
Lingual haematoma and inability to bite together properly
