Permanent teeth dental trauma diagnosis and treatment Flashcards
(31 cards)
What are the different types of luxation injuries?
- Concussion
- Subluxation
- Extrusion
- Lateral luxation
- Intrusion
- Avulsion
What are the different types of fracture injuries?
- Enamel infraction
- Enamel fracture
- Uncomplicated crown fracture (enamel-dentin fracture)
- Complicated crown fracture (enamel-dentin-pulp fracture)
- Uncomplicated crown root fracture
- Complicated crown root fracture
- Root fracture
- Alveolar fracture
What is subluxation injury?
- Injury to tooth-supporting structures resulting in increased mobility
- No displacement of tooth
- Bleeding from gingival sulcus
What is a concussion injury?
- Injury to tooth- supporting structure without increased mobility or displacement of tooth
- Pain to percussion
What are the special test findings of a concussion injury?
Visual - not displaced
Percussion test - Tender to touch or tapping
Mobility - No increased mobility
Pulp sensibility - Usually positive result (lack of response increased risk of later pulp necrosis)
Radiograph - No abnormalities
What is the treatment of a concussion injury?
- Usually no need for treatment
- Monitor pulpal condition for at least 1 year
- Clinical and radiographic follow up 4 weeks and 1 year
What are the patient instructions for concussion injury?
- Soft food for 1 week
- Good healing of teeth and oral tissues depends on good oral hygiene
- Brush with soft brush and rinse with chlorhexidine 0.1% beneficial to prevent accumulation of plaque and debris
What are the special test findings of a subluxation injury?
Visual - not displaced
Percussion - Tender to touch or tapping
Mobility - Increased mobility
Pulp sensibility - May be negative indication pulpal damage
- Positive test in about half cases (lack of response indicates increased risk of later pulp necrosis)
Radiographs - no abnormalities
What is the treatment of subluxation injury?
- Usually no need for treatment
- Clean area with water spray, saline or chlorhexidine
- Suture gingival lacerations if present
- Flexible splint to stabilise tooth for patient comfort can be used for 2 weeks
What is the patient instructions for subluxation injury?
- Soft food 1 week
- Good healing depends on good oral hygiene
- Brush with soft brush and rinse with chlorhexidine 0.1% beneficial to prevent accumulation of plaque and debris
What is the follow up of subluxation injury?
- Splint removal and radiographic follow up 2 weeks
- Clinical and radiographic follow up 2 weeks, 12 weeks , 6months and 1 year
What is an extrusion injury?
- Partial displacement of tooth out its socket
- Partial or total separation of periodontal ligament resulting in loosening and displacement of tooth
- Alveolar socket bone intact
- May have element of protrusion or retrusion
What are the clinical findings of extrusion injury?
Visual - appears elongated
Percussion - Tender
Mobility - Excessively mobile
Sensibility - Lack of response for minor displacements
- In immature teeth pulpal revascularisation usually occurs
- In mature it sometimes occurs
Radiographs - Increased periapical ligament space
What radiographs do you want to take for extrusion injury?
- Occlusal
- Periapical
- 2 eccentric exposures from different horizontal angulations
What is the treatment for extrusion injury?
- LA
- Exposed root surface cleansed with saline before repositioning
- Reposition tooth by gently re-inserting into tooth socket with axial digital pressure
- Stabilise for 2 weeks using flexible splint
- If breakdown/fracture of marginal bone splint for additional 4 weeks
What to do if pulp becomes necrotic after extrusion injury?
- Endodontic treatment appropriate to tooth’s stage of root development
What are the patient’s instructions for extrusion injury?
- Soft food for 1 week
- Good healing requires good oral hygiene
- Brush with soft brush and rinse with chlorhexidine 0.1% to prevent accumulation of plaque and debris
What is the follow up of extrusion injury?
- Clinical and radiographic follow up and splint removal 2 weeks
- Clinical and radiographic follow up 4 weeks, 8weeks, 12weeks, 6months, 1 year and then yearly for 5years
What is lateral luxation?
- Displacement of tooth other than axially
- Accompanied by comminution or fracture of labial or palatal/lingual alveolar bone
- Partial or total separation of periodontal ligament
- If both sides of alveolar socket fractured = alveolar fracture
What are the special test findings of lateral luxation injury?
Visual - Displaced in palatal/lingual or labial direction
Percussion - High metallic (ankylotic) sound
Mobility - Immobile
Sensibility - Lack of response except for minor displacements
Radiographic - Widened periapical ligament space
What radiographs are recommended for lateral luxation injury?
- Occlusal
- Periapical
- 2 eccentric exposure from diff horizontal angulations
What is the treatment of lateral luxation injury?
- Rinse exposed root surface with saline before repositioning
- LA
- Reposition with forceps or if manual then palpate gingiva to feel apex of tooth. Use finger to push down over apical end and another to push back into socket
- Stabilise for 4 weeks using flexible splint
- If breakdown/fracture of marginal bone or alveolar socket wall, splint for additional 4 weeks
- Tooth with complete root formation likely to become necrotic = RCT to prevent infection related resorption
What are the patient instructions for lateral luxation injury?
- Soft food 1 weeks
- Good hygiene
- Brush with soft brush and rinse with chlorhexidine 0.1% to prevent plaque and debris build up
What is the follow up for lateral luxation injury?
- Clinical and radiographic follow-up after 2 weeks.
- Clinical and radiographic follow-up and splint removal after 4 weeks.
- Clinical and radiographic follow-up after 8 weeks, 12 weeks, 6 months, 1 year and yearly for 5 years.
