Permanent teeth dental trauma diagnosis and treatment Flashcards
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.
What is intrusion injury?
- Displacement of tooth into alveolar bone
- Accompanied by comminution or fracture of alveolar socket
What are the special test findings of intrusion injury?
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
What are radiographs recommended for intrusion injury?
- Occlusal
- Periapical
- 2 eccentric exposures from diff horizontal angulations
What risk is tooth intrusion associated with?
- Ankylosis or infection related resorption
- Risk of tooth loss due to this
What is the treatment for intrusion injury for teeth with immature root development?
- 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.
What is the treatment of mature root development for intrusion injury?
- 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.
What is an avulsion injury?
- Tooth completely displaced out of its socket
- Clinically socket found empty or filled with coagulum
