Trauma 1 Tutorial

Question 1

How do you diagnose an enamel dentine pulp fracture clinically?

Answer 1

Visible loss of enamel and dentine with exposed pul tissue
No TTP
Mobility normal
Need a radiograph of soft tissues for fragment
Need a periapical/occlusal radiograph.

Question 2

What is the treatment for an enamel dentine pulp fracture?

Answer 2

Pulp cap or partial pulpotomy.

Question 3

What is included on a trauma stamp?

Answer 3

Sinus, colour, TTP, mobility, EPT, ECl, Percussion note and radiograph.

Question 4

How do you complete a pulp cap?

Answer 4

Direct- clean tooth, add MTA or non-setting calcium hydroxide and fill cavity.

Question 5

What is the clinical follow-up for an enamel/dentine/pulp fracture?

Answer 5

1 week, 6 weeks and one year.

Question 6

What are nstructions for parents when their child has an enamel/dentine/pulp fracture?

Answer 6

Try and locate fragment, bring the child in ASAP and give reassurance.

Question 7

How do you carry out a partial pulpotomy?

Answer 7

Partial pulpotomy- LA and rubber dam, clean and irrigate, reduce occlusal height, gain straight line access, remove 1-2mm of pulp using a round diamond bur, haemostasis, medicament (calcium hydroxide compound), core, crown/composite. Follow up at 1 week, 6-8 weeks, 3 months, 6 months and one year.

Question 8

Where can a fragment of tooth be in an enamel/dentine/pulp fracture?

Answer 8

Where can fragment be?
• Soft tissues
• Inhaled
• More likely in high impact injuries
• Refer to hospital for chest x-ray
• Swallowed
On the ground.

Question 9

How do you diagnose an enamel/dentine fracture?

Answer 9

Visible loss of enamel and dentine without exposed pulp tissue
No TTP
Normal mobility
Sensibility tests inconsistent
Periapical needed
Radiograph of soft tissue if fragment fractured in soft tissue.

Question 10

How do you treat an enamel dentine fracture?

Answer 10

Clean area
Disinfect area
Bond to tooth if fragment intact
or
Perform provisional treatment by covering exposed dentine with a glass ionomer or permanent restoration with bonding agent and resin
If near pulp line with calcium hydroxide and cover with glass ionomer.

Question 11

What is the advice given to patients with an enamel and dentine fracture?

Answer 11

Avoid biting into hard foods, bring fragment to appointment and store in correct storage medium.

Question 12

What is the clinical period of follow up after an enamel dentine injury?

Answer 12

6 weeks and one year.

Question 13

Visual signs of an enamel dentine fracture and coronal root fracture?

Answer 13

The coronal segment may be mobile and in some cases, displaced. Bleeding from the gingival sulcus may be noted
TTP possible
Coronal segment mobile
Periapical, occlusal and 2 eccentric exposures needed.

Question 14

Treatment for root fractures?

Answer 14

Rinse tooth
Radiographs taken
Stabilise the tooth with flexible splint for 4 weeks (4 months if near cervical area of the tooth)
No endo treatment at emergency visit
Monitor healing for one year.

Question 15

Patient instructions for root fractures?

Answer 15

Soft food for one week

Brushing with a soft brush and cleaning with chlorhexidine.

Question 16

Follow up for root fracture?

Answer 16

4 weeks, 6-8 weeks, 6 months, one year and yearly for 5 years. splint removal after 4 months for cervical root fractures.

Question 17

Treatment for enamel fracture?

Answer 17

Check for fragment in soft tissue
Bond fragment to tooth or smooth off sharp edges (composite if necessary)
Take 2 periapicals to rule out root fracture or luxation.