Emergencies/Tooth Fractures/Traumtic Injuries Flashcards
What is Barodontalgia?
- Tooth pain caused by an increase or decrease in ambient pressure
- Usually reported by aircraft personnel and divers
- Tough to diagnose…pulp testing inconclusive
- Affects teeth with a vital pulp - defective restoration
- Look for etiology of chronic pulp inflammation
What is an enamel Infraction?
Incomplete fracture (crack) of the enamel without loss of tooth substance
Define an Uncomplicated Crown Fracture…
No Pulp Exposure: fracture with loss of enamel only or with loss of enamel and dentin
Define Uncomplicated Crown-Root Fracture…
No Pulp Exposure - fracture involving enamel, coronal and redicular dentin, and cementum
Define Complicated Crown Fracture…
Pulp Exposure: Fracture involving enamel and dentin with pulp exposure
Define Complicated Root Fracture…
Pulp Exposure: Fracture involving radicular dentin, cementum, and pulp; further classified according to coronal fragment displacement
Define Ellis Class I, II, and III tooth fractures…
- Ellis Class I - Enamel Only
- Ellis Class 2 - Enamel + Dentin
- Ellis Class 3 - Enamel + Dentin + Pulp
What are signs/symptoms of “Incomplete” Tooth Fracture?
- Biting Pain
- Hypersensitivity
- Visible Fracture
- Narrow Probing Defect
- Aka…cracked tooth syndrome
What are some possible treatment options for an Incomplete Tooth Fracture?
- Cuspal Protection
- Endodontics
- Extraction
What are the most commonly cracked teeth?
Mandibular Molars - 70%
Describe observation and treatment for a Vertical Root Fracture…
- Begins in root and moves coronally
- Oriented F to L
- Usually previous RCT
- Narrow probing defect w/sinus tract at base
- 2 narrow probing defects on opposite sides of root
- Treatment: Extraction
What is a tooth Concussion?
What is tooth Subluxation?
What is Tooth Extrusive Luxation?
What is Lateral Luxation?
What is Intrusive Luxation?
What is going on in this picture?
Concussion
What is going on in this picture?
Extrusive Luxation
What is going on in this picture?
Lateral Luxation
What is going on in this picture?
Intrusive Luxation
What is the least to most severe in Prognosis?
Extrusive Luxation, Intrusive Luxation, Concussion, Subluxation, Lateral Luxation…
- Concussion
- Subluxation
- Extrusive Luxation
- Lateral Luxation
- Intrusive Luxation
Describe Surface Resorption…
Self Limiting
Describe Inflammatory Resorption…
Infection
Describe Replacement Resorption…
Ankylosis
Observe Prognosis of Luxation Injuries on Immature Roots…
Observe Prognosis of Luxation Injuries of Mature Roots…
Which type of luxation injury triggers the highest amount of resorption?
Intrusion
Post trauma, pulp may not respond to…
Thermal or EPT!
How long can it take for the pulp to respond normally post trauma?
2 - 10 Months
Initial positive response may revert to negative within 2 months …usually indicates pulp necrosis
Is it important to get a baseline thermal test?
Yes
Which has a better prognosis, immature or mature root post trauma?
Immature Root!
What is going on in this picture?
Calcific Metamorphosis
- Chamber/canal obliteration by
- Calcified/fibrous tissue
- Affects - 25% of luxations
- More common with immature roots
- Yellow coronal discoloration
- Decreased or absent responses to vitality tests
Describe what is going on here…
Calcific Metamorphosis
- Diminished canal space evident on radiograph
- Pulp canal is present
- Pulp necrosis will develop in - 16% of tooth
- RCT success rate: 80%
- Routine Endodontic Intervention NOT Indicated
Does Internal Resorption affect a Vital or Non Vital Pulp?
Vital Pulp
How do you treat Internal Resorption?
- Vital Pulp
- Not common
- Inflammatory response
- Asymtomatic
- Rule out external resorption
- “Pink Tooth”
- Initiate Endo tx ASAP
- Do Not “Wait and See…”
When you have a Traumatic Root Fracture, what 4 radiographs should you take?
- Perpendicular
- Mesial
- Distal
- Occlusal
What is this?
Traumatic Root Fracture
What are 3 Prognostic Factors for Root Fractures?
- Amount of displacement
- Re-approximation of segments
- Position of the fracture
When you have a Traumatic Root Fracture, what are the chances of the Apical segment being necrosed?
0%
What are some seqelae of a Traumatic Root Fracture?
Pulp Necrosis:
- Coronal Segment: 20-44%
- Apical Segment: 0 %
- Calcific Metamorphosis: 69%
- Middle and Apical 1/3 >> Cervical 1/3
What has a better prognosis in a Traumatic Root Fracture, Middle and Apical third, or Cervical?
Middle and Apical 1/3 >> Cervical 1/3
What are the 4 types of healing of Root Fractures?
- Hard Tissue: 33% (Calcified Tissue)
- C. Tissue: 36% (Connective Tissue Between Segments)
- Bone and CT: 8%
- Non-healing (chronic inflammation (granulation tissue) → 23% RCT!!!
What are some Critical Prognostic Factors of Avulsion?
- Extra-oral dry time (preservation of PDL cells)
- Root Maturity
Do we replant primary teeth?
No!
What is the best Transport Media for Tooth Avulsion?
- Tooth Socket
- Cell-Preserving Fluid (24-96 hrs)
How much time can Milk buy you as a transport medium?
6 Hours
What Transport Mediums only last for 2 hours?
- Sterile Saline
- Saran Wrap
- Saliva
What are the worst 2 Transport Media?
- Tap water
- Back pocket (dry)
* Both of these do not buy you any time…*
How do you treat the root surface of an avulsed tooth?
- Determined by exra-oral dry time
- Think “Preserve PDL Cells”
- Keep root moist
- Do not handle root surface
- Debride gently
How do you manage the socket?
- Remove socket coagulum with gentle aspiration
- Irrigate passively with sterile saline
- Examine socket…resposition bony fragments
- Do not curette
- Replant with light digital pressure
- Compress alveolar plates
If you have a Mature Root with < then 60 minutes of dry time, what do you do?
- Replant - splint
- Pulpectomy in 7-10 days
If you have a Mature Root with > 60 minutes dry time, what do you do?
- Remove PDL/Tissue Tags
- Soak in NaF for 20 mins
- Replant - Splint
- Pulpectomy in 7-10 Days
In an Immature Root with < 60 minutes of dry time, what do you do?
- Soak in Doxycycline
- Replant/Splint
- Monitor
If an Immature root with > 60 minutes of dry time is avulsed, what do you do?
- Remove PDL/Tissue Tags
- Soak in NaF for 20 mins
- Replant/Splint
- RCT before or after
What are possible Sequelae of an Avulsion?
One has 4 different types…
- Pulp Revascularization
- Pulp Necrosis
Resorption
- Surface
- Replacement
- Inflammatory
- Invasive Cervical
How long should you wait after a tooth has been replanted to insert CaOH?
- Wait 7 days following replantation
- CaOH therapy for 4 weeks
What are some additional home care considerations for Avulsion?
- Medical Issues
- Systemic Antibiotic
- Chlorhexidine
- Analgesics
- Soft Diet
- Tetanus Status
- FOLLOW UP ACCORDING TO GUIDELINES
What is this?
- Flexible Splint
- Stabilize teeth throughout
- Verify Respositioning with Radiograph
Which kinds of trauma are optional in regards to splinting?
Concussion and Subluxation
For Extrusive Luxation, how long do you splint?
Up to 2 Weeks
If you have Lateral Luxation, how long should you splint?
4 Weeks
If you have Intrusion, how long should you splint?
4 - 8 Weeks if Repositioned
How long should you splint after avulsion if dry time < 60 and dry time > 60 minutes?
- Dry Time < 60 Minutes: 2 weeks
- Dry Time > 60 Minutes: 4 weeks
How long should you splint after a Root Fracture?
4 Weeks, If Cerivcal - Up to 4 Months!
How long should you splint an Alveolar Fracture?
4 Weeks
What kind of clinical findings would you want to monitor Post Trauma during follow up exams?
- Pulp Test
- Percussion
- Palpation
- Swelling
- Sinus Tract
- Periodontium
- Mobility
- Color Changes
What are some Radiographic Changes you would want to follow up with during a Post Trauma Exam?
- Periradicular Pathosis
- Marginal Bone Loss
- Canal Obliteration
- Root Development
What can cause Infraposition like this?
Ankylosis
When do you Decoronate a crown if it is ankylosed resulting in infraposition?
How does this help?
- Decoronate if > 1 mm
- Root preseved in alveolar process
- Helps maintain existing bone volume
- Enable possible vertical bone growth
- Replacement resorption of roots continues…
