Trauma 1 Flashcards
when is peak period for trauma to permanent teeth
7-10 years
when would you expect the apex of an upper central incisor to be closing
9-9.5 years
when is trauma most common
children with a large overjet
if over jet is greater than 9mm then the incidence to trauma is double
what causes trauma
○ Falls
○ Bike, skateboard, road traffic accidents
○ Sport
○ Fights
what questions should be asked when taking a detailed history
• How did it happen? • When did it happen exactly? • Where are the lost teeth / fragments? • Any other symptoms? ○ That could be more pressing than the dental injury
what things in a medical history do we need to be aware of that might influence dental treatment
○ Rheumatic fever
○ Congenital heart defects
○ Immunosuppression
• These conditions are not contraindications to treatment but appropriate additional treatment may need to be given
Such an antibiotic cover
what should be included in the extra-oral examination
○ Lacerations - any tears of the soft tissues of the lips or the face
○ Haematomas
○ Haemorrhage / CSF
§ One of the ways to detect this is if the patient has a bleeding nose, see CSF in the nasal stream - blood would be a straw coloured liquid
○ Subconjunctival haemorrhage
○ Bony step deformities ~ feel for these
○ Mouth opening
§ Assess whether they could get their mouth open properly or not
○ Rule out facial / jaw fractures ~ Important these things are detected early
what is included in the intra oral examination
look at / examine: ○ Soft tissue ~ any lacerations or tears ○ Alveolar bone ~ Feel for any steps, displacement, mobility ○ Occlusion ○ Teeth
where should you check for foreign bodies
- If fragments of teeth break off they are most likely to have fallen to the ground
- Check for soft tissue damage
○ Possibility there is a tooth fragment - Penetrating wounds, foreign bodies
○ part of a tooth / bit of grit / glass - Soft tissue radiograph to check lacerations
when carrying out a tactile test with probe, what are you looking for?
○ Fracture lines
§ Horizontal or vertical
§ (transillumination from curing light can help)
○ Pulpal involvement
what can tooth mobility indicate
- displacement of tooth (within socket)
- root fracture
- bone fracture (in this case it is more likely that there is more than just one mobile tooth)
name sensibility tests
○ Thermal
§ Ethyl chloride (ECL)
§ Warm gutta-percha
○ Electrical
§ Electric pulp tester (EPT)
why would you carry out sensibility tests?
Testing nerve of tooth to see if the nerve responds
if you have a positive response to the nerve then the blood vessel must be vital / alive
how would you carry out a sensibility test using ethyl chloride
□ Put on cotton pellet
□ Wait until it looks frosty
□ Place this on the labial third of the tooth
□ Patient indicates to you whether or not they feel cold
how would you carry out a sensibility test using EPT
□ Electric machine which is used on the labial third of the patient’s tooth to stimulate an electrical impulse into the tooth
□ Patient lets you know whether they can feel that or not (Like a pulsating or tapping on the tooth)
□ Patient creates a circuit by holding onto the rod of the EPT - they let go whenever they feel something and then get reading from metre
what is a vitality test
Testing if something is vital means testing whether or not it has a blood supply
how would percussion help aid diagnosis in an intra-oral exam
Duller note may indicate root fracture
what is traumatic occlusion
Traumatic occlusion = when a patient cannot get their teeth back together normally
Traumatic occlusion demands urgent treatment
Very uncomfortable for the patient
Usually the tooth that has been damaged / traumatised / displaced is what is propping the occlusion open
list suitable radiographs for trauma examinations
intra-oral
Occlusal
OPT
Soft tissue
what is a trauma sticker / stamp
Something you tend to use in clinic to help you with long term trauma monitoring - gives a list of things you want to look at / examine every time a patient comes in
a percussion note that is different to the adjacent teeth might indicate what
A percussion note that is different to the adjacent teeth might indicate a root fracture or indicate problem with resorption
what teeth should you do sensibility tests on after trauma
Compare injured tooth with the adjacent non-injured tooth
Always test adjacent teeth and opposing teeth in addition to those obviously injured. These teeth might have received either direct or indirect concussive injuries
how long after the injury should sensibility tests continue to be carried out
Continue sensibility tests for at least 2 years after an injury
If everything is well you can discharge them from a trauma point of view
can you make clinical judgements on sensibility tests alone
no
when is classifying a fracture complicated
when the pulp is involved
when is classifying a fracture not complicated
when the pulp is not involved
what are the different classifications of fracture
> enamel fracture > enamel-dentine fracture > enamel-dentine-pulp fracture > uncomplicated crown root fracture > root fracture > complicated crown root fracture
what can root fractures be sub-categorised into
apical third
middle third
coronal third
depending on where the fracture is
what is an uncomplicated crown root fracture
fracture of the enamel, dentine and on into the root but still not affecting the pulp
what does prognosis depend on
• Stage of root development
○ Teeth can still be immature / developing / in a vulnerable stage
○ Stage of root development can either positively or negatively affect the prognosis
• Type of injury
○ Hierarchy of mild to severe
- If PDL is damaged too
- Time between injury and treatment
• Presence of infection
○ If there is infection there then clearly the prognosis of the tooth is not going to be as good
Even if you patch everything up and everything seems well it can be a good idea to give warning signs that not everything will be 100% in terms of prognosis
what would you do in emergency treatment of a trauma patient
• Aim to retain vitality of any damaged or displaced tooth by protecting exposed dentine by an adhesive ‘dentine bandage’
○ This is in relation to crown fractures
- Treat exposed pulp tissue
- Reduction and immobilisation of displaced teeth
• Tetanus prophylaxis
○ Tetanus immunisation is something most children will have received but you will want to make sure that that is up to date
○ Iif a tooth came out on a muddy rugby field and the tooth landed in a pile of mud then making sure the tetanus is up to date is important in this case
○ Check this through liaising with the GP
• Antibiotics ?
○ Depending on where it has happened and what kind of injury it is
use trauma guidelines
what is included under intermediate treatment for trauma patients
• + / - pulp treatment
○ Does the pulp need treatment?
○ Do we need to remove the pulp? [Partial pulp removal?]
• Restoration
Minimally invasive eg acid etch restoration
