Trauma 1 and 2 - intro Flashcards
what is the most common trauma injury in preschoolers up to the age of 5 years old?
luxation
what type of occlusion is a predisposing factor for dental trauma?
increased overjet with protrusion upper incisors
what dental tissues are involved in healing post dental trauma?
pulp
PDL
apex formation
bone and gingivae/ mucosa
do mature or immature teeth withstand trauma better? and why?
immature teeth
they have a bigger blood supply and open apex
if an immature tooth loses vitality, what must be used to close its apex?
MTA - mineral trioxide aggregate
what are the physiological properties of enamel?
hard and brittle
what are the physiological properties of dentine?
porous
pulpodentinal complex - odontoblasts
what must be performed if a tooths dentine is traumatised?
immediate seal
what are the physiological components of gingivae?
gingival fibres
junctional epithelium
alveolar mucosa
how many days does it take for junctional epithelium to reattach after trauma?
up to 5 days
what is the difference between primary and secondary healing intention?
primary - wound closure by surgical treatment
secondary - wound left to heal by itself
what are the physiological properties of pulp?
encased in hard tissue
can repair
what is the function of root sheath of hertwig?
guides root formation
what does the PDL connect and what is it composed of?
connects the tooth cementum to gingiva and alveolar bone
had the PDL got good healing potential?
yes
what are the 2 ways the PDL may be disrupted after dental trauma?
crush
separation
what are the physiological properties of bone?
vascular
active remodelling
what happens to dental bone when there is inflammation?
resorption
inflammatory mediators induce osteoclasts
what may occur if there is displacement of the apex of a tooth?
ischaemia
can revascularisation occur if the apex is displaced?
likely if apex is more than 1mm
rare if apex is less than 0.5mm
what is a special consideration when there is trauma to a primary tooth?
the developing permanent dentition beneath
how may a developing permanent dentition be damaged?
direct trauma
infection/ inflammation of primary teeth
what are the classifications of dental trauma injuries following WHO1995?
dental injuries
periodontal injuries
soft tissue injuries
skeletal injuries
what are the classifications of dental (tooth) injuries following WHO 1995?
enamel infraction (incomplete crack)
enamel #
enamel dentine # (uncomplicated)
enamel dentine pulp #(complicated)
crown root # without pulp involvement
crown root # with pulp involvement
root # (cervical or mid 1/3)
how is an enamel infarction described?
incomplete # (crack) of the enamel without loss of tooth structure
- not tender
- no radiographic abnormalities
how is an enamel # described and investigation results?
complete # of enamel
- loss of enamel
- no sign of exposed dentin
- not tender
- no mobility
- positive sensibility test
- enamel loss radiographically
how is enamel dentine # (uncomplicated) described and investigation results?
confined to enamel and dentin with loss of tooth structure but not exposing pulp
- no TTP
- no mobility
- positive sensibility test
- enamel-dentin loss radiographically
how is enamel dentin pulp # (complicated) described and investigation results?
involving enamel and dentin with loss of tooth structure and exposed pulp
- no mobility
- no TTP
- exposed pulp sensitive to stimuli
- enamel-dentin loss radiographically
how is a crown root # without pulp involvement described and investigation results?
involving enamel, dentin and cementum with loss of tooth structure but not exposing the pulp
- crown fracture extending below gingival margin
- TTP
- coronal fragment mobile
- positive sensibility test for apical fragment
- apical extension of fracture usually not seen radiographically
how is crown root # with pulp involvement described and investigation results?
involving enamel, dentin and cementum and exposing the pulp
- TTP
- coronal fragment mobile
- apical extension of fracture not seen radiographically
how is root # (cervical or mid 1/3) described and investigation results?
coronal segment may be mobile and displaced
- may be TTP
- bleeding from gingival sulcus
- sensibility testing initially negative
- transient crown discolouration (red or grey) may occur
if a tooth has a root # (cervical or mid 1/3rd), what may sensibility testing result in and indicate? and what must be monitored regularly?
sensibility testing may initially be negative which indicates transient or permanent neural damage
pulpal status should be monitored
what angle if the fracture in a tooth that is classified as a root # cervical or mid 1/3
horizontal or oblique plane
how may horizontal fractures be detected?
PA 90 degree
how may oblique fractures in the apical third be detected?
occlusal
varying horizontal angles
4 types of periodontal injuries?
concussion
subluxation
luxation
avulsion
describe concussion and investigation results
“bruised”
no displacement
TTP
no radiographic abnormalities
describe subluxation and its investigation results
“loosened”
no displacement
TTP
increased mobility
negative initial sensibility testing
no radiographic abnormalities
what must be monitored for a tooth with subluxation?
pulpal response as sensibility testing may be initially negative - transient pulpal damage
describe extrusive luxation and its investigation results
tooth appears elongated
excessively mobile
negative sensibility result
radiographically - increased PDL apically
describe intrusive luxation and its investigation results
tooth displaced axially into alveolar bone
immobile
percussion may give a high, metallic (ankylotic) sound
negative sensibility tests
radiographically - absent PDL from all/ part of root, CEJ located more apically
describe lateral luxation and its investigation results
tooth displaced palatal/ lingual
immobile
percussion gives a high, metallic (ankylotic) sound
fractured alveolar process
negative sensibility tests
radiographically - widened PDL on eccentric or occlusal exposures
how may you treat a primary tooth that has experienced lateral luxation?
if there is no occlusal interference - tooth can reposition spontaneously
if tooth interferes with occlusion - selectively grind the tooth
list 3 types of intra oral soft tissue injuries
grazes/ lacerations
degloving
contusions (bruises)
list 3 extra oral soft tissue injuries
grazes/ lacerations
contusions (bruises)
inclusion of foreign bodies e.g., gravel, tooth fragments
list 4 areas for skeletal injuries
alveolus
mandible
maxilla
cranial
describe an alveolar fracture and its investigation results
2 or more teeth moving as a block
segment mobility and dislocation
occlusal change
sensibility testing may or may not be positive
what may be seen radiographically with alveolar fractures? and what radiographs should be taken?
fracture lines located at any level from marginal bone to root apex and above apex
in addition, 3 angulations and occlusal film, panoramics can be helpful
what can be considered in prevention of trauma for a child with double digit overjet in mixed dentition?
2 phase overjet reduction with functional appliance
provide mouthguards for sports
what are the 3 types of gumshields?
stock type I
boil and bite type II
custom made type III
describe a stock type I gumshield
bulky plastic
constant biting force to retain
describe a boil and bite type II gumshield
thermoplastic moulded within mouth
deform over time
describe a custom made type III gumshield
ethylene vinyl acetate
vacuum formed over stone cast
5mm thick and extend to distal 6s
can be built in multiple layers (laminations)
what are features of an ideal gumshield?
covers teeth
extends into labial sulcus
greater extension more evenly impact force
