Introduction to Dental Related Trauma Flashcards
What is the benefit of photographic documentation of dental trauma patients
- Allows monitoring of soft tissue healing
- Assessment of tooth discolouration
- Re-eruption of an intruded tooth
- Development of infra-positioning of an ankylosed tooth
- Provides medico-legal documentation
What is splinting in dentistry
This is when loose/weakened teeth are attached to other teeth to make them a single unit and therefore stronger
What kinds of teeth is short term, non rigid splinting recommended
- Luxated, avulsed and root-fractured teeth
N.B. short term = 2 weeks - 4 months
What is the effect of splinting on the PDL
Flexible splinting promotes the healing of the PDL but this is not completely proven
What is the effect of splinting on the pulp
rigid splinting appears to slow down the pulpal revascularisation
When should antibiotics be considered in dental trauma patients
- Up to clinician but there is only limited evidence for use of systemic antibiotics in the management of luxation injuries and no evidence that antibiotics improve outcomes for root-fractured teeth
AY BAWS CAN I HABE DE NOTE PLZ
topical antibiotics are shown to help PDL recovery and decrease the extent of external root resorption
Why should you be careful when doing sensibility testing at the time of the injury
They can frequently give no response, indicating a transient lack of pulpal response and regular follow ups are required to make a pulpal diagnosis
What is pulp canal obliteration
Where hard tissue is deposited on the walls of the root canal and fills most of the pulp system, leaving it narrow and restricted
With which teeth is pulp canal obliteration the most common
In teeth with open apices that have suffered a severe luxation injury
NOTE: PCO USUALLY INDICATES ONGOING PULPAL VITALITY
What types of injury frequently show pulp canal obliteration
- Extrusion
- Intrusion
- Lateral luxation
- Following root fractures
What is the incidence of pulp necrosis in teeth with PCO
1-16%
Is endodontic intervention needed in teeth with PCO injuries
- Often it is not needed unless pulpal necrosis is evidenced by periapical pathos’s and/or symptoms and when a negative response to EPT has been detected
Following splinting of teeth what patient instructions should be given
- Follow up visits
- Soft diet
- Avoid biting on splinted teeth
- Meticulous oral hygiene
- Use antibacterial like chlorhexidine for 1-2 weeks
How frequent should the follow ups be for dental trauma/splinted teeth patients
- 2 weeks
- 4 weeks
- 8 weeks
- 4 months
- 6 months etc etc
What are the emergency treatment options for a crown-root fracture with or without pulpal exposure
- Fragment removal only
- Fragment removal and gingivectomy
- Orthodontic extrusion of apical fragment and RCT
- Surgical extrusion
- Decoronation
- Extraction
When should the follow up for a crown-root fracture with or without pulpal exposure be
6-8 weeks and then 1 year
What is the prognosis of a crown-root fracture with pulpal exposure with surgical and orthodontic extrusion treatments
Surgical extrusion root resorption = 25% after 5 years
Orthodontic extrusion root resorption = 15% after 5 years
What is the % estimated risk of tooth loss with a root fracture luxation injury
21.5%
What is the % estimated risk of pulp necrosis with a root fracture luxation injury
30.9%
What is the % estimated risk of pulp canal obliteration with a root fracture luxation injury
> 69.8%
What is the treatment for an alveolar fracture
- Manual repositioning or repositioning using forceps of the displaced segment
- Stabilise the segment with flexible splinting for 4 weeks
What treatment is required for alveolar fracture patients in their follow up appointments and when should these appointments happen
- Splint removal and radiographic control after 4 weeks
- Clinical and radiographic control after 6-8 weeks, 4 months, 6 months, 1 year and then yearly for 5 years
What is a luxation injury
when the tissues, ligaments and sometimes bone that support your teeth become injured
What is a concussion luxation injury
Concussion is an injury to tooth-supporting structures without abnormal loosening or displacement but with marked reaction to percussion
What are the treatment options for concussion luxation injuries
Usually no need for treatment but should monitor the pulpal condition for at least 1 year
What treatment should be done at the follow up appointments for concussion luxation patients
Clinical and radiographic control at 4 weeks, 6-8 weeks and 1 year
What is a subluxation injury
This is when there is injury to the periodontal tissue that has caused increased mobility but hasn’t been displaced from its socket
What are the clinical findings of a subluxation injury
- Tooth is TTP and has increased mobility, hasn’t been displaced
- Bleeding from gingival crevice may be noted
- Sensibility testing may be negative initially indicating transient pulpal damage
- Monitor pulpal response until a definitive pulpal diagnosis can be made
What can usually be seen radiographically with subluxation injuries
- Radiographic abnormalities are usually not found
What treatment options are there for subluxation injuries
- Normally no treatment needed but a flexible splint to stabilise the tooth for patient comfort can be used for up to 2 weeks
What treatment should be done at the follow up appointments for subluxation and when
2 weeks = splint removal, clinical and radiographic examination 4 weeks - clin. and rad. exams 6-8 weeks - " " 6 months - " " 1 year - " "
What is the main prognosis of a subluxation injury
Pulp Necrosis
What is an extrusive luxation injury
Injury caused by oblique forces characterised by partial displacement of the tooth out of its socket
What treatment is there for extrusive lunation injuries
- Exposed root surface of the displaced tooth is cleansed with saline before repositioning
- Reposition tooth by gently re-inserting it into the tooth socket with axial digital pressure
- Stabilise tooth for 2 weeks using a flexible splint
- Monitoring the pulpal condition is essential to diagnose associated root resorption
- In mature teeth where pulp necrosis is anticipated then RCT is indicated
AY BAWS CAN I HABE DE NOTE PLZ
Follow up for extrusive luxation injury is the same ting with splint removal and then clinical and radiographic examination
What are the most likely prognoses after an extrusive luxation injuries
> 56.5% for pulp necrosis
>21.7% for pulp canal obliteration
What is a lateral luxation injury
When alveolar bone fractures and the PDL separates, tooth isn’t loose but is angled weirdly
What are the treatment options for a lateral luxation injury
- Rinse exposed part of the root surface with saline before repositioning
- Apply LA
- Reposition the tooth with forceps or with digital pressure to disengage from bony lock and gently reposition it into its original location
- Stabilise the tooth for 4 weeks using flexible splint (4 weeks due to associated bone fracture)
- Monitor pulpal condition to diagnose root resorption, if pulp becomes necrotic = RCT
What is the most likely prognosis of a lateral laxation injury (after 10 years)
> 92.9% pulp necrosis
What is an intrusion injury
occurs mainly in the primary dentition and usually result from an axially directed impact, which drives the tooth deeper into the alveolar socket
What are the treatment options for intruded teeth
- Spontaneous eruption (doing nothing)
- Orthodontic repositioning
- Surgical repositioning
When is spontaneous eruption recommended with intruded teeth
- In teeth with mature root development only when there is minor intrusion
What benefits does spontaneous eruption treatment have
has fewer healing complications than orthodontic and surgical repositioning
What should be done if there is no movement from spontaneous eruption of intruded teeth after a few weeks
Initiate orthodontic or surgical repositioning before ankylosis can develop
When is surgical repositioning indicated for intruded teeth
Preferable in the acute phase and when the intrusion has major dislocation of more than 7mm
When is orthodontic repositioning indicated
Treatment may be preferred for patients coming in for delayed treatment and enables repair of marginal bone in the socket along with the slow repositioning of the tooth
AY BAWS CAN I HABE DE NOTE PLEASE
Splint removal and control after 4 weeks then regular monitoring
How soon should endodontic therapy be initiated post-trauma
ideally 3-4 weeks
What factors can determine treatment choice
- Root development
- Age
- Intrusion level
Name some of the prognoses of an intrusion injury after 10 years and try name their % estimated risk
Tooth loss = 28.5% Pulp necrosis >98.5% PCO = unlikely Ankylosis - 45.6% Bone loss = 45.8%
What is critical to maintain the condition of the cells for avulsed teeth
The storage medium and time out of the mouth and the dry time
After a dry time of 60minutes or more, all PDL cells are non-viable
What is the treatment for avulsed teeth
- Verify the tooth position clinically and rads (can just put tooth in with digital pressure if not already in mouth)
- Clean area with saline, chlorhexidine
- Flexible splinting for 2 weeks
- Initiate RCT within 7-10 days prior to the splint removal
- Administer antibiotics
- Check tetanus status
What antibiotics can be administered for avulsed teeth
- Tetracycline is the first choice (doxycycline 2x/day for 7 days at appropriate dose for age and weight)
- In young patients phenoxymethyl penicillin or amoxicillin at an appropriate dose for age and weight is the alternative to tetracycline
What must be considered before the systemic administration of tetracycline in young patients
the risk of discolouration of permanent teeth
If the extra-oral time of the tooth is more than 60minutes what treatment and prognosis differences are there
- Poor prognosis and high chance of ankylosis
- Same treatment e.g. cleaning, splinting, (RCT) and antibiotics
- Except treatment of avulsed tooth with 2% sodium fluoride for 20 minutes
Name some of the likely prognoses of avulsion after 10 years and try to name the % estimated risks
- Tooth loss = 45.1%
- Ankylosis = 74.2%
- Inflammatory root resorption = 31.7%
