Test 2: management of trauma to the teeth and supporting tissue Flashcards
T/F THe clinical exam should be conducted after the teeth in the area of injury have been cleaned of debris
True
What is class I crown fracture?
-Simple fracture of the crown involving little or not dentin
What is a class II crown fracture?
- Extensive fracture of the crown involving considerable dentin but not the dental p ulp
What is a class III crown fracture?
-Extensive fracture of the crown with an exposure of the dental pulp
What is a class IV crown fracture?
-Loss of the entire crown
How do you treat a class I fracture?
- May only need smoothing off or bonded resin
- Always do a thorough examination
What is the treatment of choice for a class II fracture?
-A temporary cover of dentin can be accomplished easily without to much additional trauma
What is the most common fracture in permanent teeth?
-Class II fracture
What are reactions of a tooth to trauma?
- Pulpal hyperemia
- Internal hemorrhage
- Dark-gray
- Light grey or yellow
What is a long range reaction of the pulp that has congestion of blood in the pulp chamber and often appears reddish
Pulpal hyperemia
When is the color change evident with internal hemorrhage from trauma?
1-3 weeks
What causes internal hemmorrhage?
-Hypermia and increased pressure causes the ruptrue of capillaries and the escape of red blood cells with breakdown and pigment formation in the tubules
What does dark-grey teeth often mean?
- Non-vital pulp
- Possibly necrotic
What does light grey or yellow often mean?
-Pulp vital with canal obliterations
What color are the teeth that have undergone calcific metamorphosis?
-Yellowish opaque color
primary teeth undergo normal root resorption
Do you splint/reposition primary teeth?
-No you either leave it alone or take it out
T or F:
injuries to teeth of children and adults present unique problems in diagnosis and treatment, and the diagnosis is difficult and often inconclusive regardless of loss of tooth structure
true
a force strong enough to fracture, intrude, or avulse a tooth is also strong enough to result in ___ or ___ injury
cervical spine or intracranial injury
patients with dental injuries should be evaluated for nausea, vomiting, drowsiness, or possible CSF leaking from ears or nose, which could indicate ___
skull fracture
T or F:
repeated injuries to the teeth are uncommon in children
false
patient complaints and experiences after injury, such as ___ or ___, can be helpful in determining the extent of dental injury
pain to thermal changes and pain upon closing mouth
not all teeth that are injured will respond to the accepted methods of testing pulp vitality because ___
the traumatized tooth may be in a state of shock
since injury is considered a dirty wound, you should always check that the patient’s ___ inoculation is current
- tetanus
- you should also make sure all immunizations are up to date, such as tdap and dpt
are all extra and intraoral injuries considered dirty?
yes
what is often the treatment of choice for class I and II fractures?
a temporary cover of dentin, which can be accomplished easily without too much additional trauma to the injured tooth
a ___ can be made to replace premature loss/extraction of primary teeth in an effort to preserve the corresponding permanent teeth
pedo partial
in the case of internal hemorrhage, what happens to the color of a tooth if the blood is reabsorbed before gaining access to dentinal tubules?
- little, if any, color change will be noticeable, and it will be temporary
- more severe cases will exhibit pigment formation
in severe cases of internal hemorrhage, how long after injury is color change evident? is the color change reversible?
- within 2-3 weeks
- some of the change is reversible, but some will remain
in severe cases of internal hemorrhage, is pulp vital?
pulp may remain vital, but if color change remains dark grey, the likelihood of vitality is low
permanent teeth that have undergone calcific metamorphosis will usually be ___ indefinitely, and must be followed because they are a potential focus of ___, especially if the root canal is totally obliterated
- retained
- infection
what type of treatment is indicated for the following:
- patient is seen within 1-2 hours after injury
- vital pulp exposure is small
- sufficient crown is left to retain a temporary restoration over the pulp capping and prevent ingress of oral fluids
direct pulp cap
what are the basic steps of a direct pulp cap?
- thin layer of dentin-type material is placed over the exposed pulp, then sealed with a bonded restoration
- most important is to seal and protect the pulp tissue from oral fluids
what are some indications for a pulpotomy?
- large pulp exposure
- small exposure, but patient didn’t seek treatment for several hours or days
- insufficient crown remaining to hold a temporary restoration
what is the general procedure for a pulpotomy?
- conservatively enlarge the exposure site
- remove 1-2mm of coronal pulp tissue (shallow) or all tissue in pulp chamber (deep)
- clean with copious irrigation
- apply calcium hydroxide in the chamber
- fill the chamber with hard setting material to seal
- restore tooth with bonded material
what type of tooth should a pulpectomy with endodontic treatment be performed on?
permanent teeth with open apex
why is hermetically sealing of a tooth with an open apex not the treatment of choice?
it includes apical surgery and is very difficult
what two things does the successful pulpotomy on an injured tooth allow?
- pulp tissue in the root canal maintains vitality
- allows apical portion to continue to develop
___ is therapy to stimulate root growth and apical repair in immature teeth with pulpal necrosis
apexification
T or F:
successful apexification does not require surgery
true
what is the general procedure for apexification?
- Under rubber dam access the tooth, with files clean out the canal, rinse with hydrogen peroxide and sodium hypochlorite, dry canal with paper points and cotton.
- Either wait 4 days or this apt fill canal with thick paste of calcium hydroxide. Excess should not be pushed beyond apex. Seal canal opening with cotton pledget and ZOE
- Let tooth sit for 6 months, determine if a “positive stop” has been created. If not retreat check in 2-3 months./ if yes fill with gutta-percha
internal resorption is a destructive process though to be caused by ___
odontoclastic action
internal resorption may be observed radiographically in the pulp chamber or canal how long after injury?
within a few weeks or months
does the destructive action of internal resorption progress slowly or rapidly?
either
is it possible to stop the progression of internal resorption?
yes, if it is caught early enough, it may be able to be stopped with endodontic procedures
what can cause external root resorption?
-trauma with damage to the periodontal tissues
describe the progression of external root resorption
- reaction starts from the outside, and the pulp may not become involved
- resorption usually continues unabated until root structure is gone
external root resorption as a result of severe trauma may show some degree of tooth ___
displacement
T or F:
there is a significant relationship between the type of tooth injury and the reaction of the pulp tissue and surrounding tissues
false
there is little relationship
T or F:
a tooth injury that causes coronal fracture as opposed to displacement has a worse pulpal prognosis
false
T or F:
injured teeth with pulpal necrosis often are asymptomatic and radiograph appears normal
true
why is it important to keep an eye on injured teeth?
they may not recover, and internal and external resorption may occur
___ is a condition caused by injury to the PDL and subsequent inflammation which is associated with invasion of osteoclastic cells, and can be observed after trauma to anterior primary and permanent teeth
ankylosis
ankylosis results in irregularly resorbed areas on the ___ surface, causing mechanical lock or fusion between the ___ and ___
- PDL
- alveolar bone and root surface
are teeth adjacent to an ankylosed tooth affected?
no, they will continue to erupt normally
studies have shown that more than ___% of young patients had changes in permanent teeth that could be traced to previous injury to primary dentition
40%
the presence of a small, pigmented hypoplastic area is referred to as ___
turner’s tooth
why do intruded permanent teeth have a poorer prognosis than primary teeth?
there is a tendency for the injury to be followed by rapid root resorption, pulpal necrosis, and ankylosis
what is the treatment for a permanent tooth with closed apex and intruded 3mm or less?
- let the tooth erupt without intervention
- watch the tooth - may need to pull down with orthodontics
what is the treatment for a permanent tooth with closed apex and intruded more than 7mm, or extruded with a closed apex?
- reposition the tooth surgically and stabilized for 4-8 weeks with a flexible splint
- pulp will become necrotic, root canal treatment started 2-3 weeks after stabilization, fill with calcium hydroxide initially to stop external resorption
what is the treatment for a permanent tooth with an open apex and intruded less than 7mm?
- allow it to erupt spontaneously
- orthodontically reposition if it doesn’t erupt within 2-4 weeks
what is the treatment for a permanent tooth that is intruded more than 7mm?
- surgically reposition the tooth and stabilize with flexible wire for 4-8 weeks
- monitor closely, initiate endodontic therapy with calcium hydroxide
extrusive luxation of an intruded permanent tooth usually results in ___
pulpal necrosis
replantation of permanent teeth continues to be practiced and recommended, however ___ often occurs with even the most precise and careful technique
slow or rapid external root resorption
what are the advantages or replantation?
- some prolonged retention
- replanted tooth can help guide surrounding teeth
- psychological component
- sometimes can last 5-10 years, sometimes only months
replantation is most commonly performed in what age patient? what gender is it more common in?
- 7-9 years
- 3x more common in males
of teeth replanted within 30 minutes, ___% show no discernable evidence of resorption 2 or more years later
90%
95% of teeth replanted more than 2 hours after injury show ___
root resorption
T or F:
incompletely formed teeth at the apex fare better than closed apex in replantation cases
true
-in closed apex, endodontic pulpotomies with calcium hydroxide should be done within a few days
what are 3 storage mediums that can be used on an avulsed tooth?
- hank’s buffered saline
- isotonic saline
- pasteurized cow’s milk (probably the most favorable medium that is easily available)
T or F:
tap water is not a very good storage medium for an avulsed teeth because it is hypotonic and leads to cell lysis, and thus is worse than subjecting the tooth to dehydration (no medium)
false
first statement is true, second statement is false (it is better than dehydration)
after replantation of a tooth that has been avulsed, a ___ is required to stabilize it during at least the first week of healing
splint
what are the criteria that an acceptable splint should meet?
- It should be easy to fabricate directly in the mouth without lengthy laboratory procedures.
- It should be able to be placed passively without causing forces on the teeth.
- It should not touch the gingval tissues, causing gingival irritation.
- It should not interfere with normal occlusion. 5. It should be easily cleaned and allow for proper oral hygiene.
- It should not traumatize the teeth or gingiva during application.
- It should allow an approach for endodontic therapy.
- It should be easily removed.
splinting times vary from ___ weeks for less severe luxation
1-2 weeks
what is subluxation?
teeth that have been laterally displaced due to fracture of the alveolar process
how long should splints be placed for more severe subluxation cases?
4-6 weeks
as a result of secondary wound healing and scar contraction, burns involving the perioral and intraoral tissues can cause various degrees of ___
microstomia
a common cause of oral burns is ___
electrical trauma
how do oral electrical burns occur?
- Child places female end of a “live” extension chord into mouth
- Child sucks or chews on exposed or poorly insulated electrical wires
- Electrolyte-rich saliva provides a short circuit between the chord terminals and mouth
- Resulted in an arc phenomenon
- Involves intense heat that causes
coagulation tissue necrosis
why is minor hemorrhage control so important in the treatment of oral electrical burns?
possibility of spontaneous arterial hemorrhage can occur in the first 3 weeks
what is the treatment of choice for oral electrical burns?
prosthetic appliance to prevent contracture of healing tissue, and to create normal-appearing commissure
