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Module 6 - Trauma > Trauma 1 and 2 > Flashcards

Trauma 1 and 2 Flashcards

1
Q

What is the primary function of the pulp

A

To form the tooth

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2
Q

What is the pulp very vulnerable to?

A

inflammation

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3
Q

What is the apical blood supply very vulnerable to?

A

shear injury

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4
Q

What is the minimum width of the apical foramen?

A

at least 0.4mm wide

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5
Q

At what point does an anterior tooth want to rotate if it sustains a blow to the crown? What happens if the movement is outside physiological limits?

A
  • About 1/3rd down from the apex.
  • Blood vessels entering the pulp chamber are SHEARED OFF.
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6
Q

Can a “loose” front tooth with sheared off blood vessels following trauma become revascularized?

A

YES
- in the ABSENCE OF INFECTION, capillary buds from the apical tissue can grow through the foramen (0.5mm a day) and revascularize the pulp chamber.

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7
Q

What is the blood pressure once it reaches the arterioles that supply the pulp?

A

30mmHg

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8
Q

What is the importance of apical arteriolar pressure vs pulpal tissue pressure?

A

If pulpal tissue pressure is HIGHER than apical arterior pressure –> NO blood flow to pulp –> PULP DIES.

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9
Q

What happens if a pulp becomes necrotic prior to root development completion?

A

Arrested root development.

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9
Q

A young child presents with an exposed dental pulp following trauma to a permanent front tooth. What is the main treatment priority?

A

Preserve the vitality of the dental pulp.

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10
Q

A dental pulp becomes non vital due to the apex being moved through bone by trauma (sheared BV). Can it be revascularized?

A

YES
- New, vital tissue from the PDL can grow through the apex (replace necrotic tissue).
- 3-4 WEEKS to fill the pulp chamber.

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11
Q

A dental pulp becomes non vital due to the apex being moved through bone by trauma (sheared BV). What will prevent revascularization?

A
  • Heavy infection: prevent revascularization + patient may develop a dental abscess.
  • Light infection: revascularization inhibited + body’s defense systems may contain infection in root canal –> tooth remains asymptomatic for months/years despite completely necrotic pulp.
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12
Q

What may be seen on radiograph when a tooth is revascularizing?

A

Increased cellular activity around the apex can result in a SMALL, RADIOLUCENT “CAP”. This is called TRANSIENT APICAL BREAKDOWN.

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13
Q

What is transient apical breakdown? What is the treatment for this?

A
  • small, radiolucent cap on the 1/12 and 2/12 periapical views.
  • If only sign of non-vitality, WATCH AND WAIT rather than start endo.
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14
Q

What is the eventual fate of a revascularized permanent/ primary tooth? Why?

A
  • Always go on to PULP CANAL OBLITERATION.
  • Because the new cells growing in from the PDL only differentiate into a primitive odontoblast.
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15
Q

When is revascularization rare in a traumatized tooth with a necrotic pulp?

A

Where the CROWN IS FRACTURED (allows bacterial ingress).

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16
Q

What are the 2 responses dentine can give with a vital dental pulp?

A
  1. A painful response.
  2. Deposits of secondary dentine.
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17
Q

When does dentine cause a painful response?

A

To anything that causes fluid movement in the tubules.

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18
Q

Does dentine in a revascularized tooth provide a painful response?

A

NO
- Painful response only occurs when odontoblastic processes are occupying the dentinal tubules.
- In revascularized teeth, the tubules remain EMPTY.

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19
Q

What vitality test is useless for revascularized teeth?

A
  • TEST CAVITY.
  • As tubules remain empty of odontoblastic processes, instrumenting the dentine of a vital, revascularized tooth will not produce any pain until the pulp is reached.
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20
Q

2 reasons odontoblasts would deposit secondary dentine?

A
  1. External irritant (ex. caries).
  2. Calcium hydroxide placed over an exposed pulp.
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21
Q

What happens to odontoblasts following revascularisation?

A
  • Odontoblasts die.
  • Odontoblast-like cells that differentiate from the revascularizing tissue lay down dentine-like tissue in a disorganized way until the whole chamber is filled. Termed PULP CANAL OBLITERATION.
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21
Q

What is the treatment for pulp canal obliteration?

A
  • No indication for endodontic treatment unless there are signs and symptoms of infection.
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22
Q

What must we do urgently when presented with a traumatised tooth? Why?

A
  • Must COVER EXPOSED DENTINE URGENTLY.
  • Dentine is permeable, especially when odontoblastic tubules are empty and not sealed by secondary dentine.
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23
Q

What can a necrotic and infected pulp result in in terms of the root?

A

Can result in EXTERNAL INFLAMMATORY ROOT RESORPTION due to diffusion of bacterial products down the tubules and into the PDL where they cause an inflammatory reaction.

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24
Q

What happens if the PDL is lost?

A
  • Dentine will become OSSEOINTEGRATED into bone.
  • Dentine will be replaced by bone over a few years, called REPLACEMENT RESORPTION.
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25
Q

What is the treatment for replacement resoprtion?

A
  • In the absence of infection, NO INDICATION for RCT.
  • Pulp is usually vital and if replacement resorption starts, nothing can stop it.
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26
Q

3 differences of dentine vs bone?

A

Bone:
- Turns over.
- Very vascular.
- Slightly more flexible.

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27
Q

What us a consequence of bone being very vascular when there is inflammation?

A
  • If inflammation is present, body will remove calcified tissue to allow more vascular tissue to be available to combat the infection.
  • Appears as RADIOLUCENCY.
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28
Q

What is the relative size of radiolucencies seen on radiograph compared to real life?

A

Space is considerably LARGER in reality as the lesion has to start resorbing through CORTICAL PLATES to be seen as a radiolucency.

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29
Q

What happens if a tooth receives a blow from something SOFT (ex. fist, knee)?

A
  • There is time for fluid
    transfer in the bone to occur.
  • Bone can distort, so that the “harder” tooth will often remain intact as it moves through the bony
    tissue.
  • The apical blood vessels will be severed aka NON VITAL PULP.
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30
Q

What happens if a tooth receives a blow from something HARD (ex. pavement, road)?

A
  • No time for the bone to distort.
  • Tooth will
    fracture    , dispersing the energy.
  • Remaining tooth is often not displaced.
  • VITAL PULP.
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31
Q

What is the PDL? what does it do?

A
  • Vital, vascular tissue.
  • Separates the cementum/dentine of the root from bone.
32
Q

3 things that will happen if the PDL is lost.

A
  • Osseointegration of root into bone (root eventually disappears).
  • Ankylosis.
  • Infra occlusion.
33
Q

Why does PDL have good reparative potential?

A

PDL cells on both the root
surface and the socket wall.

34
Q

2 injuries that can cause the PDL to break down?

A
  1. Intrusions: Cells on both sides of the PDL get
    crushed.
  2. Avulsions: The cells on the root surface become
    desiccated and die.
35
Q

What is degloving? What will happen if not treated?

A
  • When the mucosa is stripped off from the underlying bone in an apical direction following trauma.
  • Failure to reposition the flap will cause unaesthetic thick band of attached mucosa high in the patient’s sulcus.
36
Q

What does the junctional epithelium do? Once damaged how long does it take to re attach?

A
  • Narrow band of tissue that forms a seal around the tooth.
  • Takes 4-5 days to reattach.
37
Q

How long does the PDL take to mature following injury? What is the clinical importance of this?

A
  • Months to mature.
  • When you remove the splint from a replanted incisor, it will only be the JE holding it in for a couple of months.
38
Q

What % of 15 year old boys and girls have some visible evidence of dental trauma? What teeth?

A
  • 15% of boys.
  • 10% of girls.
  • 90% of cases to the MAXILLARY CENTRAL INCISORS.
39
Q

What are the 3 peak times for dental trauma?

A
  • 1-2 years: learning to walk.
  • 8-10: playing about.
  • 14-16: puberty, contact sports.
40
Q

Trauma frequency in 5 year old children? F vs M? What injury is most common?

A
  • 1/3rd suffered trauma to primary dentition.
  • Boys slightly more than girls.
  • Usually due to FALLS, LUXATION most common.
41
Q

Trauma frequency in 12 year old children? F vs M? What injury is most common?

A
  • 20-30% suffered.
  • Boys 1/3rd more frequently affected than girls.
  • Due to sports, bicycles, CROWN FRACTURE.
42
Q

What are the most common ages fro trauma for primary, mixed and permanent dentition?

A
  • Primary dentition: 1-2 (learning to walk).
  • Mixed dentition: 8-10.
  • Permanent: 15.
43
Q

What occlusion predisposes to dental trauma?

A
  • INCREASED OVERJET with PROTRUSION OF UPPER INCISORS and INSUFFICIENT LIP CLOSURE.
44
Q

How to check for fracture of the supporting tissues (maxilla or mandible) clinically? (3) (no radiograph).

A
  • Check the occlusion.
  • Palpate borders.
  • Check suture lines.
45
Q

What would be seen clinically if the alveolous surrounding teeth became fractured? What is this termed?

A
  • DENTO-ALVEOLAR FRACTURE.
  • One or more adjacent teeth appear displaced together and when gently palpated, the alveolus overlying the roots is clearly attached.
46
Q

What are the 4 types of dental trauma according to WHO 1995?

A
  • Dental.
  • Dento-alvelar/ Periodontal.
  • Soft tissue injuries.
  • Skeletal injuries.
47
Q

What is the hierarchy of checking a patient with dental trauma?

A
  1. Check for SKELETAL injuries: cranial, maxilla, mandible.
  2. Check for SOFT TISSUE injuries.
  3. Check for DENTAL or DENTOALVEOLAR/ PERIODONTAL injuries.
48
Q

7 types of dental injuries.

A
  1. Enamel infarction (incomplete crack).
  2. Enamel fracture.
  3. Enamel/ dentine fracture - UNCOMPLICATED CROWN #.
  4. Enamel/ dentine/ pulp fracture - COMPLICATED CROWN #.
  5. Crown/ root # without pulp involvement.
  6. Crown root # with pulp involvement.
  7. Root fracture (cervical, mid 1/3rd).
49
Q

What are the 4 types of PERIODONTAL trauma?

A
  1. Concussion.
  2. Subluxation.
  3. Luxation (intrusive, extrusive, lateral).
  4. Avulsion.
50
Q

How is early OJ reduction done?

A

TWO PHASE OVERJET REDUCTION:
1. First phase: 7-11 years.
2. Second phase: Adolescence.

51
Q
A

4mm horseshoe thermoplastic vinyl fabricated on upper alginate impression with good extension into the labial sulci, coloured for safety (visible in the event of loss of consciousness, dislodgementetc.).

52
Q

Why do we want gum shields to extend into the sulci?

A

The greater the extension, the MORE EVENLY THE IMPACT FORCE WILL BE DISTRIBUTED (shared by maxilla).

53
Q

What is the effect of a poorly extended gum shield?

A
  • Impact force distributed over a small SA.
  • Poor retention.
54
Q

What are the 3 types of gum shield?

A
  1. Stock (type 1).
  2. Boil and bite (type 2).
  3. Custon made (type 3).
55
Q

What is a stock gum shield?

A
  • Bulky plastic.
  • Constant biting force to retain.
56
Q

What is a boil and bite gumshield?

A
  • Thermoplastic moulded within the mouth.
  • Deform over time.
57
Q

What material makes up custom made gum shields? How are they form? How thick are they? Where do they extend? What can they protect from? (other than dental trauma).

A
  • Ethylene vinyl acetate.
  • Vacuum formed over stone cast.
  • 5mm thick and extend to distal of 6s or further.
  • Can be built in multiple layers (laminations).
  • May also protect condylar head #.
58
Q

How likely is revascularization based on the size of the apex?

A
  • Likely if apex more than or equal to 1mm.
  • Rare if apex less than or equal to 0.5mm.
59
Q

Enamel infarction - what is it? Tenderness? Radiographic presentation?

A
  • Incomplete fracture (crack) of the enamel without loss of tooth structure.
  • Not tender. (if tender consider luxation or root #).
  • No radiographic abnormalities.
60
Q

Enamel fracture - what is it? Tenderness? Mobility? Sensibility? Radiographic presentation?

A
  • Complete fracture of the enamel, loss of enamel without visible dentine.
  • Not tender.
  • Normal mobility.
  • Sensibility usually positive.
  • Enamel loss visible radiographically.
61
Q

Enamel/ dentine #, UNCOMPLICATED - what is it? Tenderness? Mobility? Sensibility? Radiographic presentation?

A
  • Confined to enamel and dentine, loss of tooth structure but not exposing the pulp.
  • Not tender to percussion.
  • Normal mobility.
  • Sensibility usually positive.
  • Enamel-dentine loss visible radiographically.
62
Q

Enamel/ dentine/ pulp #, COMPLICATED - what is it? Tenderness? Mobility? Sensibility? Radiographic presentation?

A
  • Involving enamel and dentine, loss of tooth structure and exposure of the pulp.
  • Not tender to percussion.
  • Normal mobility.
  • Sensibility usually positive.
  • Exposed pulp sensitive to stimuli.
  • Enamel-dentine loss visible radiographically.
63
Q

Crown root # without pulp involvement - what is it? Tenderness? Mobility? Sensibility? Radiographic presentation?

A
  • Involving enamel, dentin and cementum with loss of tooth structure, but not exposing the pulp.
  • Crown fracture extending below gingival margin.
  • Percussion test: Tender.
  • Coronal fragment mobile
  • Sensibility pulp test usually positive for apical fragment.
  • Radiographically, apical extension of fracture
    usually not visible.
64
Q

Crown root # with pulp involvement - what is it? Percussion? Mobility? Sensibility? Radiographic presentation?

A
  • Involving enamel, dentin
    and cementum and
    exposing the pulp.
  • Percussion test: tender
  • Coronal fragment mobile
  • Radiographically, apical
    extension of fracture
    usually not visible.
65
Q

Root # (cervical or mid 1/3) - what is it? Percussion? Mobility? Sensibility? Radiographic presentation?

A
  • The coronal segment may be mobile and may be
    displaced.
  • The tooth may be tender to percussion.
  • Bleeding from the gingival sulcus may be noted.
  • Sensibility testing may give negative results initially, indicating transient or permanent neural damage.
  • Monitoring the status of the pulp is recommended.
  • Transient crown discoloration (red or grey) may occur.
66
Q

What is the fracture shape for a root # (cervical or mid 1/3)? How can this be visualized radiographically?

A
  • HORIZONTAL: can be detected in the regular periapical 90o angle film with the central beam through the tooth. Usually the case with fractures in the cervical third.
  • OBLIQUE: an occlusal view or radiographs with varying
    horizontal angles are more likely to demonstrate the fracture. Usually APICAL THIRD fractures.
67
Q

At what parts of the root do horizontal vs oblique fractures usually occur?

A
  • Horizontal: CERVICAL third.
  • Oblique: APICAL third.
68
Q

Concussion - displacement? TTP? Mobility? radiograph?

A
  • No displacement.
  • The tooth is tender to
    touch or tapping.
  • No increased mobility.
  • No radiographic
    abnormalities.
69
Q

Subluxation - displacement? TTP? Mobility? Sensibility? radiograph?

A
  • No displacement.
  • Tender to touch or tapping.
  • Increased mobility.
  • Bleeding from gingival crevice may be noted.
  • Sensibility testing may be negative initially, transient pulpal damage.
  • Monitor pulpal response until a definitive pulpal diagnosis can be made.
  • Radiographic abnormalities are usually not found.
70
Q

Luxation, EXTRUSIVE - appearance? Sensibility? Radiograph?

A
  • Tooth appears ELONGATED and excessively mobile.
  • Sensibility test likely negative.
  • Increased PDL space apically on radiograph.
71
Q

Luxation, INSTRUSIVE - clinical appearance? sensibility? Radiograph?

A
  • Tooth displaced axially into alveolar bone.
  • IMMOBILE.
  • Percussion may give a HIGH, METALLIC SOUND.
  • Sensibility likely negative.
  • Radiographically: PDL may be absent from part/ whole root, CEJ located more apically in the intruded tooth vs adjacent non injured teeth.
72
Q

What is an important consideration for INSTRUSIVE luxation in primary teeth?

A

The PERMANENT TOOTH GERM. Thus consider direction of displacement:
- Palatally: MORE likely to damage successor.
- Labially: LESS likely to damage successor.

73
Q

Luxation, LATERAL - clinical appearance? sensibility? Radiograph?

A
  • Tooth is displaced in labial/ palatal direction.
  • IMMOBILE.
  • Percussion usually gives HIGH, METALLIC SOUND.
  • FRACTURE OF THE ALVEOLAR PROCESS PRESENT.
  • Likely NEGATIVE sensibility test.
  • Widened PDL on eccentric/ occlusal views best seen.
74
Q

What is the management for lateral luxation of primary teeth (2)?

A
  • No occlusal interference: tooth should be allowed to reposition spontaneously.
  • Occlusal interference: selectively grind tooth to eliminate interference.
75
Q

What are 3 types of intra oral soft tissue injuries?

A
  • Grazes/ lacerations.
  • Degloving injuries.
  • Contusions (bruises).
76
Q

What are 3 types of extraoral soft tissue injuries?

A
  • Grazes/lacerations.
  • Contusions.
  • Inclusion of foreign bodies (ex. tooth fragments, gravel).
77
Q

4 types of skeletal injuries?

A
  • Alveolus.
  • Mandible.
  • Maxilla.
  • Cranial.
78
Q

2 or more teeth are moving as a block. What could this suggest?

A

ALVEOLAR FRACTURE.

79
Q

What is the appearance of an alveolar fracture radiographically? What views are indicated?

A
  • Fracture lines may be located at ANY LEVEL (marginal bone, root apex, above apex).
  • 3 angulations, occlusal film + potentially DPT to determine COURSE + POSITION of fracture lines.
80
Q

When may you see bleeding from the gingival crevice?

A
  • Subluxation
  • Root fracture.

Module 6 - Trauma (2 decks)

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