Trauma

Question 1

Dental trauma: when are the three peak incidence?

Answer 1

2-3 years
8-10 years
15 years

Question 2

Trauma: enamel infraction (incomplete crack)

Answer 2

Question 3

Trauma: Enamel fracture

Answer 3

Question 4

Trauma: enamel dentine fracture

Answer 4

Question 5

Trauma: Enamel dentine pulp fracture

Answer 5

Question 6

Trauma: Crown root fracture without pulp involvement

Answer 6

Question 7

Trauma: Crown root fracture with pulp involvement

Answer 7

Question 8

Trauma: root fracture (cervical or mid 1/3)

Answer 8

Question 9

Periodontal trauma: concussion

Answer 9

Bruised

Question 10

Periodontal trauma: subluxation

Answer 10

Loosened

Question 11

Periodontal trauma: luxation (extrusive)

Answer 11

tooth appears longer

Question 12

Periodontal trauma: luxation (intrusive)

Answer 12

tooth appears shortened

Question 13

Intrusion

Answer 13

When primary tooth germ is intruded upon

Question 14

Periodontal trauma: luxation (lateral)

Answer 14

In primary teeth, this tooth may be allowed to reposition itself spontaneously.

Question 15

Periodontal injuries: avulsion

Answer 15

entire tooth comes out

Question 16

Skeletal injuries: alveolar fracture

Answer 16

Question 17

Trauma: prevention

Answer 17

1. Reducing a patients overjet
2. Gum shields

Question 18

What should you do if you are suspecting of a child being non-accidentally injured (NAI)?

Answer 18

Practice policy
Regional Health Board policy

FOLLOW PROTOCOL and CONSULT GUIDELINES

Question 19

What should you place a tooth/tooth fragment in if patient brings in?

Answer 19

Saline

Question 20

Most important thing to do for a patient coming in with trauma?

Answer 20

send them to a&E

Question 21

What testing may indicate an alveolar fracture?

Answer 21

When assessing mobility, adjacent teeth also move

Question 22

What may visually indicate subluxation?

Answer 22

Blood clot attached to gingival crevice (if recent <24 hours)

Question 23

How should you properly assess for root fracture following trauma?

Answer 23

take 2 views

Question 24

Treatment: enamel-dentin-pulp fracture

Answer 24

1. Cut back to healthy bleeding pulp
2. Ensure at least 2mm of clean dentine walls
3. Arrest bleeding with sterile saline cotton pellet
4. Cap with non-setting calcium hydroxide/MTA, then RMGI, then composite.

Question 25

How does calcium hydroxide interact with the pulp?

Answer 25

Will kill the pulp all cells in contact with it but also very bactericidal allowing pulpal healing.

Question 26

What area of root fracture will require longer splinting times and why?

Answer 26

Cervical third root fractures will be more unstable and require prolonged splinting (up to 4 months).

Question 27

What is a common injury with primary teeth and why?

Answer 27

intrusion which is very uncommon in the permanent dentition (toddlers don’t have the understanding to protect themselves so the hit open mouthed face first)

Question 28

primary tooth trauma treatment

Answer 28

WE NEVER splint, replant, pulp cap… etc

Question 29

Treatment for primary tooth pulpal obliteration

Answer 29

Leave if asymptomatic Extract if radiographic signs of infection/inflammation

Question 30

TAB - radiographic finding that shouldn’t be taken for non-vitality of a tooth…

Answer 30

Transient apical breakdown (TAB) is a reversible resorptive process in which the apex of a tooth shows some radiographic evidence of resorption and the crown may display some discoloration.

Question 31

Why should calcium hydroxide not be placed for longer that 4 weeks at a time?

Answer 31

It degrades collagen structure, weakening flexural strength of dentine over time.

Question 32

Treatment for primary tooth pulpal necrosis: open vs closed apex

Answer 32

Closed: treat with RCT as with an adult tooth Open: place a 4-6mm MTA plug at the apex - then continue an obturation as normal (RCT) this allows a good apical seal to be achieved

Question 33

Apical barrier formation - Calcium hydroxide or MTA?

Answer 33

MTA is gold standard

Question 34

Reactionary dentine formation

Answer 34

Pulp —> odontoblasts —> lay down reactionary dentine

Question 35

Yellowing of the tooth clinically?

Answer 35

Pulp is being narrowed by reactionary dentine

Question 36

External inflammatory resorption treatment

Answer 36

As this process is stimulated by the necrotic pulp, treatment involved RCT (for the restorable tooth)

Question 37

Cause of internal inflammatory resorption

Answer 37

chronic long-term pulpal inflammation

Question 38

Pink spot on the crown

Answer 38

Internal inflammatory resorption

Question 39

Characteristic metallic tone on percussion, tooth appears solid (without biological mobility)

Answer 39

Replacement resorption and ankylosis

Question 40

What could be causing discolouration following RCT?

Answer 40

If blood has leached into the dentinal tubules (internal bleaching - don’t want to remove too much dentine) Is GP been extended up into the chamber and showing through the crown, or dark material used to seal access cavity (i.e fuji pink)

Question 41

When would an immediate composite bandage be implicated?

Answer 41

Immediately after an enamel dentine fracture or an enamel dentine pulp fracture that has undergone a pulpotomy. Used for sealing over any exposed dentine tubules

Question 42

What kind of wire is used to make a splint and what are the necessary features of a splint?

Answer 42

0.4mm stainless steel (soft) wire passive, flexible, no shape memory, compositely bonded <2mm off tooth surface.

Question 43

What injuries would only require 2 weeks of splinting?

Answer 43

Subluxation (loosening), extrusion (tooth appears larger) or avulsion (tooth completely come out of socket)

Question 44

Which dental injuries would require 4 weeks of splinting?

Answer 44

Lateral luxation (displacement laterally) intrusion (tooth appears shorter), root fracture (apical 1/3 or mid 1/3), alveolar fracture

Question 45

Which dental injury requires 4 months of splinting time?

Answer 45

Root fracture (cervical third)

Question 46

What is the typical follow ups for a primary tooth injury?

Answer 46

1 week, 8 weeks, then 1 year.

Question 47

What is the typical follow ups for a permanent tooth injury?

Answer 47

6-8 weeks, 6 months, 1 year (annually for at least 5 years)