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BDS3 Restorative > Permanent teeth dental trauma diagnosis and treatment > Flashcards

Permanent teeth dental trauma diagnosis and treatment Flashcards

1
Q

What are the different types of luxation injuries?

A
  • Concussion
  • Subluxation
  • Extrusion
  • Lateral luxation
  • Intrusion
  • Avulsion
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2
Q

What are the different types of fracture injuries?

A
  • 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
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3
Q

What is subluxation injury?

A
  • Injury to tooth-supporting structures resulting in increased mobility
  • No displacement of tooth
  • Bleeding from gingival sulcus
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4
Q

What is a concussion injury?

A
  • Injury to tooth- supporting structure without increased mobility or displacement of tooth
  • Pain to percussion
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5
Q

What are the special test findings of a concussion injury?

A

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

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6
Q

What is the treatment of a concussion injury?

A
  • Usually no need for treatment
  • Monitor pulpal condition for at least 1 year
  • Clinical and radiographic follow up 4 weeks and 1 year
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7
Q

What are the patient instructions for concussion injury?

A
  • 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
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8
Q

What are the special test findings of a subluxation injury?

A

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

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9
Q

What is the treatment of subluxation injury?

A
  • 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
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10
Q

What is the patient instructions for subluxation injury?

A
  • 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
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11
Q

What is the follow up of subluxation injury?

A
  • Splint removal and radiographic follow up 2 weeks
  • Clinical and radiographic follow up 2 weeks, 12 weeks , 6months and 1 year
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12
Q

What is an extrusion injury?

A
  • 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
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13
Q

What are the clinical findings of extrusion injury?

A

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

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14
Q

What radiographs do you want to take for extrusion injury?

A
  • Occlusal
  • Periapical
  • 2 eccentric exposures from different horizontal angulations
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15
Q

What is the treatment for extrusion injury?

A
  • 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
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16
Q

What to do if pulp becomes necrotic after extrusion injury?

A
  • Endodontic treatment appropriate to tooth’s stage of root development
17
Q

What are the patient’s instructions for extrusion injury?

A
  • 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
18
Q

What is the follow up of extrusion injury?

A
  • 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
19
Q

What is lateral luxation?

A
  • 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
20
Q

What are the special test findings of lateral luxation injury?

A

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

21
Q

What radiographs are recommended for lateral luxation injury?

A
  • Occlusal
  • Periapical
  • 2 eccentric exposure from diff horizontal angulations
22
Q

What is the treatment of lateral luxation injury?

A
  • 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
23
Q

What are the patient instructions for lateral luxation injury?

A
  • Soft food 1 weeks
  • Good hygiene
  • Brush with soft brush and rinse with chlorhexidine 0.1% to prevent plaque and debris build up
24
Q

What is the follow up for lateral luxation injury?

A
  • 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.
25
Q

What is intrusion injury?

A
  • Displacement of tooth into alveolar bone
  • Accompanied by comminution or fracture of alveolar socket
26
Q

What are the special test findings of intrusion injury?

A

Visual - Displaced axially into alveolar bone
Percussion - High metallic (ankylotic) sound
Mobility - immobile
Sensibility - Negative response
Radiographic findings - Periodontal ligament space absent from all or part of root
- CEJ more apically in intruded tooth than adjacent non injured tooth

27
Q

What are radiographs recommended for intrusion injury?

A
  • Occlusal
  • Periapical
  • 2 eccentric exposures from diff horizontal angulations
28
Q

What risk is tooth intrusion associated with?

A
  • Ankylosis or infection related resorption
  • Risk of tooth loss due to this
29
Q

What is the treatment for intrusion injury for teeth with immature root development?

A
  • Allow re-eruption without intervention (spontaneous repositioning) for all intruded teeth independant of the degree of intrusion.
  • If no re-eruption within 4 weeks, initiate orthodontic repositioning.
  • Monitor pulp condition.
  • Spontaneous pulp revascularization may occur. - - - However, if there are signs of infectious pulp necrosis or infection related resorption, root canal treatment is indicated and should be initiated as soon as possible.
30
Q

What is the treatment of mature root development for intrusion injury?

A
  • Allow re-eruption without intervention if the tooth is intruded <3 mm. If no re-eruption within 4 weeks, reposition surgically and splint for 2 weeks (see more about Splinting in our Vocabulary), or reposition the tooth orthodontically.
  • If the tooth is intruded 3-7 mm, reposition surgically or orthodontically.
  • If the tooth is intruded beyond 7 mm, reposition surgically.
  • Root canal treatment should be initiated within 2 weeks or as soon as the position of the tooth allows in order to prevent infection related resorption.
31
Q

What is an avulsion injury?

A
  • Tooth completely displaced out of its socket
  • Clinically socket found empty or filled with coagulum

BDS3 Restorative (4 decks)

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