Trauma Flashcards
What is the prevalence of trauma in primary dentition?
11% to 30%; most common between 1.5 to 2.5 years of age.
What are the key components of trauma assessment in primary teeth?
History, head injury check, medical & dental history, clinical exam, radiographs, diagnosis.
What key questions should be asked in history-taking for dental trauma?
How, when, where? Is the injury consistent with the story and the child’s age?
What types of radiographs are preferred in primary dentition trauma?
Periapicals taken as occlusals; lateral view for intrusion injuries.
Are sensibility tests reliable in primary teeth?
No – they are very unreliable.
What is the most common type of injury in primary dentition?
Luxation injuries.
What are the aims of treating dental trauma in primary teeth?
Prevent damage to permanent teeth, treat pain, restore function and aesthetics.
What factors influence treatment decisions in primary dentition trauma?
Behavior, parental choice, medical history, type of injury.
Does early loss of a primary incisor affect speech or occlusion?
No effect on speech or occlusion.
How should subluxation or concussion be managed in primary teeth?
Soft diet, analgesics, monitor.
When should a laterally luxated primary tooth be extracted?
If unstable, significantly extruded, or interfering with occlusion.
What is the typical management of an extruded primary tooth?
Usually extracted as it often interferes with occlusion and becomes non-vital.
How should an intruded primary tooth be managed?
Leave unless it interferes with the permanent successor, gets infected, or fails to re-erupt in 3–6 months.
Should avulsed primary teeth be reimplanted?
No – reimplantation is contraindicated.
How are fractures without pulp exposure in primary teeth treated?
Leave as is or smooth, or restore with composite or strip crown.
How are fractures with pulp exposure in primary teeth treated?
Extraction, pulpotomy, or pulpectomy depending on severity.
How are root fractures in primary teeth managed?
If stable – monitor. If unstable – extract coronal segment and leave apical.
What are potential sequelae of primary tooth trauma?
Discolouration, loss of vitality, damage to permanent successor.
What does grey discolouration suggest?
Pulp hemorrhage – often resolves on its own.
What does yellow discolouration indicate?
Pulp canal obliteration – often a sign of healing.
What signs indicate loss of vitality in a primary tooth?
Pain, mobility, abscess, radiographic pathology – not sensibility tests.
What is the likelihood of damaging the permanent successor based on age?
<2 years: 63% risk; >5 years: 25% risk.
What are common effects of trauma on permanent successors?
Discolouration, hypoplasia, dilaceration (crown/root), odontome-like formations, root duplication, root/tooth development failure.
What is dilaceration in a developing permanent tooth?
Abrupt change in root direction due to trauma; may delay or prevent eruption.
How are dental fractures classified?
Enamel
Enamel–Dentine (Complicated or Uncomplicated)
Crown–Root (Complicated or Uncomplicated)
Root
What is an enamel infraction and how is it treated?
A crack in enamel with no loss of tooth substance. Treatment: none, desensitizing agents, or seal with unfilled resin.
What are the treatment options for uncomplicated enamel-dentine fractures?
Composite restoration, crown, or fragment reattachment.
What is the risk of pulp necrosis in extensive proximal fractures with and without dentine coverage?
No treatment: 54% risk
With dentine coverage: 8% risk
What factors affect treatment of complicated enamel-dentine fractures?
Time since injury
Contamination
Associated luxation
Root development stage
Why is pulp vitality especially important in immature teeth?
Vital pulp promotes continued root development and reduces the risk of cervical root fracture.
What are the treatment options for complicated crown fractures?
Pulp Cap
Partial Pulpotomy (Cvek)
Cervical Pulpotomy
Pulpectomy
Apexification
When is pulp capping appropriate and what is its success rate?
For small, recent, clean exposures. ~81–88% success over 5 years.
Describe the steps in a partial pulpotomy (Cvek).
LA & isolation
Remove 2mm pulp
Haemostasis
Apply non-setting calcium hydroxide
Apply hard-setting liner & restore
What is the success rate of partial pulpotomies?
Around 90–95%.
When is cervical pulpotomy indicated and what’s the success rate?
In necrotic/contaminated immature teeth. Success ~79%.
What treatment is used for a necrotic tooth with open apex?
Apexification.
Define apexification.
Inducing apical closure via mineralised tissue in a non-vital tooth with open apex.
What are the limitations of apexification?
No root length/thickness increase
Difficult final fill
Risk of cervical root fracture
Describe apexification steps.
Working length: 1–2 mm short of apex
Clean with large files & NaOCl
Dress with Ca(OH)₂
Reassess every 3 months
Obturate when hard barrier forms (9–12 months)
What is the success rate for apexification in forming a hard tissue barrier?
75–96%.
What are alternative treatments to apexification?
Premolar transplant
MTA (Mineral Trioxide Aggregate)
Regenerative Endodontics
What % of dental trauma cases are crown-root fractures?
About 0.5%.
What are the restorative challenges of crown-root fractures?
Isolation
Endo access
Crown margins
Impression techniques
What are the treatment options for crown-root fractures?
Supragingival restoration
Surgical exposure
Surgical/ortho extrusion
Referral
How are root fractures classified?
Horizontal or vertical, single or multiple.
How are root fractures diagnosed?
Clinical: mobility, extrusion, luxation
Radiographs: 2 vertical plane views (e.g., paralleling + occlusal)
What is the treatment for an undisplaced root fracture?
No splinting – monitor only.
What is the treatment for a displaced root fracture?
Reposition coronal fragment, flexible splint for 4 weeks.
What are the 4 types of healing in root fractures?
Hard tissue union
Connective tissue interposition
Bone + connective tissue
Granulation tissue (pulp necrosis)
What happens in pulp necrosis with root fracture?
Apical segment may remain vital. Root fill to fracture line, often with prior calcium hydroxide dressing.
What are the keys to trauma management success?
Good history, examination, documentation, and accurate diagnosis.
What is an uncomplicated crown-root fracture?
Fracture involving crown and root, below the gum, without pulp exposure.
What is a complicated crown-root fracture?
Fracture involving crown and root with pulp exposure.
How are crown-root fractures diagnosed?
History, clinical exam, and radiographs (2 angles, sensibility tests, CBCT if needed).
How are crown-root fractures managed in primary teeth?
Usually extract coronal portion; apical portion removal depends on risk to permanent tooth.
What is emergency management in permanent teeth?
Stabilise the loose fragment with flowable composite for comfort.
What is the ‘fragment removal only’ treatment?
Remove coronal fragment and restore. If pulp exposed, manage with endodontics.
What is the ‘fragment removal + gingivectomy’ option?
Remove fragment + crown lengthening → then endo and post crown.
When is gingivectomy or ostectomy indicated?
If fracture extends palatally below gingiva.
What is orthodontic extrusion in crown-root fracture management?
Remove coronal segment, extrude root, restore. May need endo and gum reshaping.
What is surgical extrusion (intentional replantation)?
Reposition root coronally, possibly rotate, then endo if mature root or pulp involved.
What is a coronectomy (root submergence)?
Leave root in situ to preserve bone for future implant; needs healthy PDL.
When is extraction necessary for crown-root fractures?
In severe apical or vertical fractures—followed by denture/bridge.
What is the review protocol for crown-root fractures?
Follow IADT guidelines for monitoring and follow-up.
What is a pulpotomy?
Partial removal of the pulp, done in both primary and permanent teeth.
What is the most common material used in pulpotomy of primary molars?
Ferric sulphate.
What is the most common material used in pulpotomy of permanent anterior teeth?
Calcium hydroxide or Biodentine.
What are the indications for pulpotomy in primary teeth?
Vital pulp exposure from caries/mechanical cause; asymptomatic or transient pain.
What are the indications for pulpotomy in permanent teeth?
Vital pulp exposure from caries or trauma; asymptomatic or transient pain.
What are the contraindications for pulpotomy?
Non-vital pulp, irreversible pulpitis, infection/resorption signs, cardiac disease, immunocompromised.
What are alternatives to ferric sulphate in primary teeth?
Biodentine, MTA.
What are alternatives to calcium hydroxide in permanent teeth?
Biodentine.
What is the definitive restoration after pulpotomy in primary molars?
Stainless steel crown.
What is the definitive restoration after pulpotomy in permanent teeth?
Composite restoration.
Why is MTA not used in anterior teeth?
Risk of discolouration.
Why is ferric sulphate not used in permanent teeth?
Increased risk of internal root resorption.
What is the first step in a pulpotomy procedure?
Local anaesthesia (LA).
How is haemostasis achieved during pulpotomy?
Gently applying a sterile cotton pellet moistened with saline.
What if haemostasis cannot be achieved?
Consider pulpectomy or extraction.
How does pulp removal differ between caries and trauma?
Caries: remove roof & full coronal pulp; Trauma: remove ~2mm inflamed pulp.
What is used to fill the pulp chamber in primary teeth after pulpotomy?
Zinc oxide eugenol.
What is used as a liner before restoration in permanent teeth?
Glass ionomer cement (GIC).
What is an alveolar fracture?
A fracture of the alveolar process which may or may not involve the socket(s), often due to high-impact trauma.
What clinical sign suggests an alveolar fracture during examination?
Injured teeth move together when testing mobility.
What other clinical findings might be associated with alveolar fractures?
Soft tissue tearing and occlusal interference.
What radiographs are recommended for alveolar fractures in the primary dentition?
Occlusal and lateral views; OPG if suspicious of other facial fractures.
What investigations are done for alveolar fractures in permanent teeth?
Sensibility testing, two radiographs at different angles (e.g., occlusal, periapical), possibly OPG; CBCT may be initial imaging of choice.
How are alveolar fractures managed in primary teeth?
Manual repositioning and splinting for 4 weeks (IADT); consider GA or removal if repositioning is delayed or unfeasible.
How are alveolar fractures managed in permanent teeth?
Manual repositioning (digital or forceps) and splinting for 4 weeks. Monitor pulpal status and initiate RCT if necessary.
What sedation might be used to help children cope with alveolar fracture management?
Inhalation sedation (IHS) may be considered.
How should alveolar fractures be monitored?
As per IADT guidelines.
What is replacement resorption?
A type of external resorption where the root is gradually replaced by bone due to ankylosis.
Ankylosis refers to the fusion of the tooth root to the alveolar bone with loss of the periodontal ligament.
What key pathological process is involved in replacement resorption?
Ankylosis.
Ankylosis results in the fusion of the tooth root to the alveolar bone.
What are common causes of replacement resorption?
- Severe trauma
- Avulsion
- Intrusion injuries
- Prolonged dry time
- Damaged or non-viable PDL cells
PDL stands for periodontal ligament.
What does a percussion test sound like in a tooth with replacement resorption?
Metallic.
What radiographic sign indicates replacement resorption?
Loss of the periodontal ligament space and an irregular root outline as bone replaces root.
Why might a tooth with replacement resorption appear to be ‘sinking’ in children?
Because the ankylosed tooth does not erupt with the surrounding alveolar bone growth (infra-occlusion).
How is replacement resorption managed in adults?
Usually monitored unless it causes issues, as there’s no way to reverse it.
How is replacement resorption managed in growing children?
May require decoronation to preserve alveolar bone for future implant placement.
How does splinting reduce the risk of replacement resorption?
By minimizing further trauma and allowing PDL healing, splinting reduces the risk of ankylosis and replacement resorption.
What is replacement resorption in the context of dental trauma?
It is a pathological process where bone replaces the tooth root due to the death of PDL cells, leading to ankylosis.
PDL stands for periodontal ligament.
What happens to the PDL in replacement resorption?
The PDL is destroyed, especially the fibroblasts and cementoblasts, resulting in no regenerative capacity and direct contact between bone and root.
Fibroblasts are responsible for the formation of connective tissue, while cementoblasts help in cementum formation.
What is the result of bone being in direct contact with the tooth?
Ankylosis occurs, leading to progressive replacement of root structure with bone.
What are the key clinical signs of replacement resorption?
No mobility, ankylotic sound on percussion (‘cracked teacup’), and infraocclusion (especially in children).
How does replacement resorption appear radiographically?
It often shows little or no radiolucency and progresses slowly with irregular root structure blending into bone.
Which injuries are most likely to cause replacement resorption?
Severe trauma, especially crushing injuries that destroy the PDL and cementoblasts (e.g., avulsion, intrusion).
Why are fibroblasts and cementoblasts crucial in preventing replacement resorption?
They mediate the regeneration of the PDL. If these cells are lost, healing fails and the bone fuses to the tooth.
What sound is heard during percussion of a tooth with replacement resorption?
A metallic or ‘cracked teacup’ sound due to ankylosis.
What is infraocclusion and how is it related to replacement resorption?
Infraocclusion is when the ankylosed tooth appears to sink below the occlusal plane, common in growing children as alveolar bone continues to develop.
What is the long-term management of a tooth with replacement resorption?
Often monitored in adults; in children, decoronation may be needed to preserve alveolar bone for future implant placement.
What is inflammatory root resorption in the context of dental trauma?
A pathological process where infection in the pulp or periodontium stimulates resorptive activity via osteoclasts, leading to loss of tooth structure, often accompanied by periapical radiolucency.
Inflammatory root resorption is a significant concern in dental trauma cases, impacting the long-term health of the tooth.
What triggers inflammatory root resorption?
Infection of the necrotic pulp or adjacent tissues, which allows bacterial toxins and inflammatory mediators to penetrate the dentinal tubules, stimulating osteoclastic activity.
The presence of bacteria and inflammatory mediators is crucial in the development of this condition.
How does pulpal necrosis contribute to inflammatory resorption?
The necrotic pulp releases toxins that diffuse through dentinal tubules, triggering inflammatory changes and resorption of cementum and dentine.
Pulpal necrosis is often a result of trauma or decay, leading to serious complications.
What is the clinical presentation of inflammatory root resorption?
Often asymptomatic but may present with mobility, sensitivity, or abscess formation. Usually detected radiographically as a radiolucent lesion near the root surface.
Early detection is critical for effective management.
How does inflammatory resorption appear radiographically?
As a radiolucent area involving the root surface, often irregular and poorly defined, associated with periapical pathology or lateral lesions.
Radiographic assessment is essential for diagnosis.
How is inflammatory root resorption managed?
Prompt root canal therapy (RCT) to eliminate the source of infection and arrest the resorptive process. Long-term calcium hydroxide may be used in some cases before obturation.
Timely intervention can significantly improve the prognosis.
What is the prognosis of inflammatory resorption if treated early?
Generally good if infection is eliminated early and root structure is not significantly compromised.
The extent of damage plays a critical role in recovery.
What are key risk factors for inflammatory resorption post-trauma?
- Delayed pulp removal in necrotic teeth
- Intrusive luxation
- Avulsion with extended extra-oral dry time
- Poor oral hygiene and immune response
Identifying these risk factors can help in preventive strategies.
What is surface resorption?
A self-limiting, usually asymptomatic resorptive process involving minor damage to the cementum and superficial dentine, followed by repair with new cementum.
Surface resorption is often confused with more serious forms of resorption.
What causes surface resorption?
Minor trauma (e.g., concussion), orthodontic treatment, or normal remodeling. Often physiological and not associated with infection.
Understanding the causes helps in differentiating it from pathological resorption.
How does the body repair surface resorption?
Cementoblasts lay down new cementum over resorbed areas, halting the resorption process and restoring normal structure.
This repair process is crucial for maintaining tooth integrity.
How is surface resorption detected clinically?
It is usually subclinical and detected incidentally on radiographs. No mobility or symptoms are typically present.
Regular dental check-ups can help in early detection.
What does surface resorption look like radiographically?
Small, shallow, well-defined concavities on the root surface, usually without surrounding bone loss or radiolucency.
Radiographic features can help distinguish surface resorption from other types.
Does surface resorption require treatment?
No treatment is required unless it progresses. Regular monitoring may be indicated in post-trauma cases.
Monitoring is important to ensure that it does not lead to further complications.
What is the typical outcome of surface resorption?
Healing through new cementum deposition. It rarely progresses unless complicated by infection or further trauma.
The prognosis is generally favorable with proper monitoring.
In which situations is surface resorption commonly observed?
- After mild dental trauma (e.g., concussion)
- Following orthodontic treatment
- As part of normal root remodeling
Recognizing these situations can aid in early identification and management.
