Trauma Flashcards
Dental trauma: when are the three peak incidence?
2-3 years
8-10 years
15 years
Trauma: enamel infraction (incomplete crack)
Trauma: Enamel fracture
Trauma: enamel dentine fracture
Trauma: Enamel dentine pulp fracture
Trauma: Crown root fracture without pulp involvement
Trauma: Crown root fracture with pulp involvement
Trauma: root fracture (cervical or mid 1/3)
Periodontal trauma: concussion
Bruised
Periodontal trauma: subluxation
Loosened
Periodontal trauma: luxation (extrusive)
tooth appears longer
Periodontal trauma: luxation (intrusive)
tooth appears shortened
Intrusion
When primary tooth germ is intruded upon
Periodontal trauma: luxation (lateral)
In primary teeth, this tooth may be allowed to reposition itself spontaneously.
Periodontal injuries: avulsion
entire tooth comes out
Skeletal injuries: alveolar fracture
Trauma: prevention
- Reducing a patients overjet
- Gum shields
What should you do if you are suspecting of a child being non-accidentally injured (NAI)?
Practice policy
Regional Health Board policy
FOLLOW PROTOCOL and CONSULT GUIDELINES
What should you place a tooth/tooth fragment in if patient brings in?
Saline
Most important thing to do for a patient coming in with trauma?
send them to a&E
What testing may indicate an alveolar fracture?
When assessing mobility, adjacent teeth also move
What may visually indicate subluxation?
Blood clot attached to gingival crevice (if recent <24 hours)
How should you properly assess for root fracture following trauma?
take 2 views
Treatment: enamel-dentin-pulp fracture
- Cut back to healthy bleeding pulp
- Ensure at least 2mm of clean dentine walls
- Arrest bleeding with sterile saline cotton pellet
- Cap with non-setting calcium hydroxide/MTA, then RMGI, then composite.
How does calcium hydroxide interact with the pulp?
Will kill the pulp all cells in contact with it but also very bactericidal allowing pulpal healing.
What area of root fracture will require longer splinting times and why?
Cervical third root fractures will be more unstable and require prolonged splinting (up to 4 months).
What is a common injury with primary teeth and why?
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)
primary tooth trauma treatment
WE NEVER splint, replant, pulp cap… etc
Treatment for primary tooth pulpal obliteration
Leave if asymptomatic
Extract if radiographic signs of infection/inflammation
TAB - radiographic finding that shouldn’t be taken for non-vitality of a tooth…
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.
Why should calcium hydroxide not be placed for longer that 4 weeks at a time?
It degrades collagen structure, weakening flexural strength of dentine over time.
Treatment for primary tooth pulpal necrosis: open vs closed apex
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
Apical barrier formation - Calcium hydroxide or MTA?
MTA is gold standard
Reactionary dentine formation
Pulp —> odontoblasts —> lay down reactionary dentine
Yellowing of the tooth clinically?
Pulp is being narrowed by reactionary dentine
External inflammatory resorption treatment
As this process is stimulated by the necrotic pulp, treatment involved RCT (for the restorable tooth)
Cause of internal inflammatory resorption
chronic long-term pulpal inflammation
Pink spot on the crown
Internal inflammatory resorption
Characteristic metallic tone on percussion, tooth appears solid (without biological mobility)
Replacement resorption and ankylosis
What could be causing discolouration following RCT?
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)
When would an immediate composite bandage be implicated?
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
What kind of wire is used to make a splint and what are the necessary features of a splint?
0.4mm stainless steel (soft) wire
passive, flexible, no shape memory, compositely bonded <2mm off tooth surface.
What injuries would only require 2 weeks of splinting?
Subluxation (loosening), extrusion (tooth appears larger) or avulsion (tooth completely come out of socket)
Which dental injuries would require 4 weeks of splinting?
Lateral luxation (displacement laterally) intrusion (tooth appears shorter), root fracture (apical 1/3 or mid 1/3), alveolar fracture
Which dental injury requires 4 months of splinting time?
Root fracture (cervical third)
What is the typical follow ups for a primary tooth injury?
1 week, 8 weeks, then 1 year.
What is the typical follow ups for a permanent tooth injury?
6-8 weeks, 6 months, 1 year (annually for at least 5 years)
