injuries and classification Flashcards
What is an Enamel Fracture
Small fracture limited to enamel with no dentine exposure.
Are any special investigations required for an enamel fracture?
No, no radiographs would be required.
Management of an Enamel Fracture
- Smooth any sharp edges.
- Encourage good OH to prevent plaque accumulation.
- Encourage return to normal duet as soon as possible.
What is another name for an Enamel / Dentine Fracture
An uncomplicated fracture.
Why is an enamel / dentine fracture classed as uncomplicated?
As there is no pulp exposure.
Are there any special investigations indicated for an Enamel / Dentine fracture?
Soft tissue X-ray
What material should be used to cover the exposed dentine in primary teeth?
GIC is preferred but composite can also be used.
Why is an Enamel / Dentine / Pulp Fracture classed as complicated?
Due to pulp involvement.
What kind of radiographs would be taken for an enamel / dentine / pulp fracture?
Intra Oral PA or a soft tissue x-ray.
What are the 2 treatment options for a tooth with an enamel / dentine / pulp fracture?
Pulpotomy or Extraction
Do crown-root fractures involve the pulp?
These fractures can be with or without pulp involvement.
Due to the common presentation of a crown-root fracture, what should be the first step be in treatment?
Removal of loose fragments.
Why is it important to first remove loose fragments when a patient presents with a crown-root fracture?
To assess restorability.
Where is it recommended to refer to when a patient presents with a crown-root fracture?
Paeds team.
When a fracture extends subgingivally, what treatment option may be recommended?
Extraction.
Which type of fracture would see a break within the root?
Root Fracture
In the event of a root fracture, what may be seen in the crown?
May be extruded or mobile.
What would happen when a root fracture is present and the child bit together?
Premature contact.
When would NO TREATMENT be indicated for a root fracture?
If the coronal fragment is still in place.
monitor for spontaneous repositioning
Following a root fracture, if the coronal fragment is mobile, what would the most suitable treatment option be?
XLA of the coronal fragment and allow the apical fragment to be displaced by natural exfoliation.
What would be observed in an alveolar fracture?
Mobility and dislocation of a segment.
How would you manage an alveolar fracture?
- Reposition under local/general anaesthetic.
- Splint and stabilise for 4 weeks.
Following a concussion injury, what would be present orally?
Changes may not be visible.
Tender to touch but has not been displaced.
Normal mobility.
What may be observed following a subluxation injury?
Similar to concussion, tender to touch but changes may not be visible.
- GINGIVAL BLEEDING FROM THE GINGIVAL MARGIN*
What are luxation injuries?
Where the tooth has altered in position.
What are the 3 types of luxation?
- Extrusive (pulled out)
- Intrusive (pushed in)
- Lateral (angulation)
What is an extrusive luxation?
Partial displacement of the tooth out of the socket.
Why is a intraoral PA a good diagnostic tool for an extrusive luxation?
Confirms extrusion as it may present similar to a root fracture.
If the there is no occlusal interference in an extrusive or lateral luxation, what would the best treatment option be?
Leave and allow to spontaneously reposition.
If there is some occlusal interference from the extrusive or lateral luxation, what is the best mode of treatment?
Extraction under LA.
What is a lateral luxation?
When the tooth has been displaced in a palatal/lingual or labial direction.
With regards to mobility, what would be expected in a lateral luxation?
Immobile due to the root impinging on the bone.
What happens in an intrusive luxation?
Displacement through the labial bone which can impinge on the developing successor.
What is the preferred method of treatment for an intrusive luxation?
Allow to spontaneously reposition for 6 months - 1 year.
What is the first thing to do after an avulsion?
Locate the missing tooth fragment.
Should primary teeth be re-implanted after avulsion?
No - NEVER reimplant primary teeth.
What are the intervals for follow up?
- 2 weeks
- 4 weeks
- 3 months
- 6 months
- yearly to 5 years and beyond.
What does a Core Outcome Set do?
Tracks how the teeth are healing.
What 9 things are included in the Core Outcome Set?
- PDL healing
- Pulp Space Healing
- Pain
- Discolouration
- Tooth Loss
- Quality of Life
- Aesthetics (pt perception)
- Trauma Related Dental Anxiety
- Number of Clinical Visits
At what ages do permanent incisors develop and calcify?
Between 0-3 years.
If trauma occurs during 0-3 years old, what could the effect of this be?
Damage on the permanent dentition.
What would a colour change of yellow indicate?
Pulp Canal Obliteration
What are the 2 different types of resorption patterns associated with tooth trauma?
- Infection Related Inflammatory Root Resorption
- root shortens; gets eaten away by the infection.
- red shine through around the tooth. - Ankylosis Related Replacement Root Resorption
- trauma site doesn’t grow down with the rest of the dentition.
Advice for Parent/Guardians:
- There is a risk that the primary tooth may lose vitality and die.
- The parent should look out for:
- discolouration
- swelling or lumps on the gum
- mobility
- tenderness / pain. - There is also risk of damage to the PERMANENT tooth.
How might tooth tenderness / pain be observed in a child?
A change in diet or refusal to bite on front teeth.
What are 8 possible complications to permanent teeth following primary tooth trauma?
- Opacity
- Hypoplasia
- Dilaceration
- Root angulation alteration
- Arrest of root development - fully or partially.
- Delayed eruption due to granulation tissue
- Ectopic eruption (lost guidance pathway)
- Impaction to malformation
