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Paediatric dentistry > Dental trauma - types, causes and outcomes > Flashcards

Dental trauma - types, causes and outcomes Flashcards

1
Q

Peak incidences of dental trauma
(age groups, social class, abuse etc)

A

2-4 years - lack of coordination

8-10 years

more in lower socioeconomic classes

higher incidence of abuse in 0-5s

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2
Q

Aetiology of dental trauma

A

Accidental -
trips
falls
bikes/scooters
Road traffic accident
Sports

Non accidental-
Assault
physical abuse

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3
Q

Which teeth are most susceptible to dental trauma

A

Maxillary central incisors

Especially if the canines haven’t yet come through

increased overjet with protrusions increases the risk

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4
Q

Prevention of dental trauma - by parents

A

identify risks around the home

RTAs - seat belts, correctly fitting child seats

Bike helmets

Mouthguards

pet supervision

Wait till child is older for contact sports

Education - what do do if a tooth is avulsed (storage, handling, reinsertion)

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5
Q

Types of crown fracture

A

enamel infraction - crack

enamel fracture

enamel-dentine fracture

enamel-dentine-cementum

complicated crown fracture (pulp exposure)

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6
Q

Types of periodontal injury

A

concussion

subluxation

extrusive luxation

lateral luxation

intrusive luxation

avulsion

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7
Q

Concussion

A

Injury without abnormal loosening or displacement

knock to the periodontium

reaction to percussion and may be tender on biting

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8
Q

Subluxation

A

Injury with some abnormal loosening

No displacement

bleeding around gingivae

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9
Q

Extrusive luxation

A

Partial displacement of the tooth out of its socket

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10
Q

Lateral luxation

A

tooth may be partially displaced with the root apex tilted forward - not in axial direction

Non mobile

alveolar bone communition/ fracture

may have destruction of alveolar/PDL support

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11
Q

Intrusive luxation

A

Displacement of a tooth into the alveolar process

presses neuro-vascular bundle

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12
Q

Avulsion

A

complete displacement of tooth -

neurovascular bundle is completely severed

no blood supply

damage to pdl and root surface

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13
Q

Types of gingival injury

A

laceration
contusion - bruising
abrasion

(heal well with stitches)

may have loss of attached gingivae

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14
Q

Pulpal responses to dental trauma

A

Odontoblasts are present in the pulp and their processes extend into the dentine tubules.

Signals are sent along the process, signalling the OBs to deposit more dentine to protect the pulp in times of stress

Stem cells may differentiate into polymorphs to eat away infective material - bacteria (ACUTE inflammatory response)

giant cells, odontoclasts and osteoclasts may be recruited - more aggressive cells if polymorph defence system fails (CHRONIC INFLAMMATORY RESPONSE)

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15
Q

5 types of clinical test for dental trauma

A

Visual - swelling/sinus, discolouration, infection, mobility

Sound - percussion, TTP/TTpalp

Thermal - endofrost

Electrical - EPT (high values indicate tooth may be dying)

Radiographic

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16
Q

Dental trauma outcomes

A

Survival

Pulp canal obliteration

Pulp necrosis

Inflammatory internal resorption
(transient or permanent)

Replacement internal resorption

External resorption

17
Q

Pulp canal obliteration
-Clinical signs too?

A

The calcification or deposition of hard tissue within the pulp cavity

Overdrive! thick dentine wall due to odontoblast increased activity.

tooth is yellow clinically and ages prematurely

18
Q

Pulpal necrosis
(What is also seen with pulpal necrosis)

A

Death of pulpal cells;

polymorph defence system is unsuccessful

They accumulate, bruising and blood infiltrating along tubules as blood supply through apical foramen is cut off –> grey discolouration

periapical infection with some bone resorption - may become cystic

19
Q

Inflammatory internal resorption

A

Tooth is semi alive - some blood supply

Giant cells/odontoclasts which have been fighting infection have taken away dentine (polymorphs fail)

Odontoblasts have died and are no longer lining the wall of the root canal.

balloon appearance - accumulation of inflammatory cells

may start healing - if infection is small and good blood supply - enough for it to be fought off without attacking all of natural hard tissue (otherwise permanent - carries on until comm of inside pulp with PDL)

20
Q

Replacement internal resorption

A

Pulp chamber is filled with bone tissue rather than dentine tissue - osteoblast like differentiation occurs

apex is wider - no RL black space as pulp chamber or canal - only RO bone tissue

PDL may enter the space

inflammatory cells start the process followed by osteoblast like cells

21
Q

Types of external resorption

A

Surface
Inflammatory
Replacement

22
Q

Surface external resorption

A

polymorphs and giant cells can cause resorption of the root surface on the outside of the tooth

PDL may regenerated in the concavity - may see wide PDL

Teeth may have dimples anyway due to small concussions

23
Q

Inflammatory external resorption

A

Root surface and bone is resorbed and ballooning is seen

granulation tissue is seen

24
Q

Replacement resorption - ankylosis

A

root surface is replaced with bone

cementoblast layer of root has been damaged due to trauma - no PDL fibre etc

Bone and dentine side by side

Bone cells think the root/dentine is part of bone - as dentine is similar

osteoclasts treat dentine as bone and resorb it

bone remodelling in younger pts (osteoblasts will deposit bone where that dentine has been resorbed)

25
Q

Ankylosis

A

fusion between the tooth surface and the bone

differs from external replacement resorption by absence of inflamed connective tissue (usually youd get inflammatory resorption then replaced by bone - but as ankylosis is arrested you only see replaced bone)

can refer to arrested replacement resorption

26
Q

what does progressive external resorption mean?

A

the whole root is being replaced by bone

27
Q

outcomes to root development following trauma

A

root development may continue, be disrupted or arrested

root may remain the length/ stage it was at when traumatised

28
Q

Factors that influence survival of pulp after trauma

A

Blood supply - how much was it damaged?

Area and time of exposure - longer = greater chance of infection

Stage or root development - closed apex = less chance of regeneration

29
Q

Which luxation injury has the worst prognosis

A

intrusion

greatest chance of pulpal necrosis due to strangulated blood supply

even worse outcome in closed apex

Paediatric dentistry (8 decks)

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