Trauma 2 Flashcards
What are causes of primary (baby teeth) trauma?
- falls
- bumbing into objects
- non-accidental
What teeth are the most affected in primary trauma?
maxillary centrals
What type of injury is the most common in primary trauma?
luxation injuries
What is a luxation injury?
this is an injury that results in the movement of the tooth within the bone
Why are luxation injuries the most common injuries observed in children?
this is because their bone is elastic and thus more yielding
What is an indication for the use of soft tissue radiographs?
inspection of lacerations where fragment is lost
Outline the patient management for primary trauma
- reassure
- history (when, where, how)
- examination (clincal, radiographical)
- photographs (intra and extra oral)
- diagnosis
- emergency treatment
- advise patients of sequalae to permanent teeth
- further treatment and review
What is the required exposure for a soft tissue radiograph?
should be 25% of the normal radiograph/go for lowest possible exposure available
The medical history for primary trauma cases should determine…
- congenital heart defects
- immunosuppression - possible indication for antibiotics
The DH for primary trauma cases should include…
- previous trauma
- treatment experience
- child/parent attitude
What must you make note of in an extraoral assessment in a primary trauma case?
- laceration
- haematoma
- subconjunctival haemorrhage (infraorbital fractures)
- haemorrhage/CSF (base of skull fracture)
- bony step deformities
- mouth opening
How must you assess for bony step deformities?
palpate bony margins- nose, orbit, border of mandible
In an I/O examination in a primary trauma case, what should you assess?
- soft tissue
- alveolar bone
- occlusion
- teeth- mobility, displacement
What is the benefit of transillumiation?
- caries
- pulpal degeneration- pulp will appear darker
- fracture lines in teeth
Tactile probe test can help you identify…
- horizontal fracture
- vertical fracture
- pulpal involvement
A dull TTP note may be an indication of …
root fracture
What is a traumatic occlusion?
this is when a tooth has been moved into a position where the jaws can no longer meet
jaw can no longer meet due to formation of premature contacts
You must take radiographs in at least 2 angles for what types of injury? Why is this ?
- root fractures
- this is because root fractures may not be visible in one plane
- (PA/standard occlusal radiograph)
What is pulp canal obliteration?
the deposition of calcified/hard tissue along the walls of the canal
often an indication of vitality
What is a concussion injury?
a tooth that has been hit but remains immobile
TTP
immobile
What is a subluxation injury?
this is where there is small amount of displacement of the tooth
mobile
TTP
bleeding
What is a luxation injury?
- displacement of tooth due to detachment from PDL and bone
What are the types of luxation injury?
lateral
extrusion
intrusion
What is the treatment guidelines for all trauma injuries?
- soft diet for 10-14 days
- brush teeth with soft brush after every meal
- topical CHX by parent daily for one week
- after initial treatment review after 1 week, 1 month, 3 months, 6 months, 1 year and every year for 5 years (radiograph)
What are the review guidelines for intrusion injuries?
review at 1 week
4 weeks
2 months
6 months
1 year
What are the treatment guidelines for enamel and enamel dentine fractures?
- smooth edges
- restore with compomer/composite
if 0.5mm to pulp then place CaOH
What are the treatment guidelines for complicated enamel dentine fractures?
- pulpotomy (partial (cvek) and full pulpotomy)
- pulpectomy (theoretical)
- extraction
What is the treatment guideline for crown root fractures?
- extraction of coronal fraction
- root fill
- extrusion?
- restore
- don’t be overzealous to remove any root fragments that aren’t obvious. These should be left to resorb physiologically
- extract coronal fragment, leave root fragment, place flap over fragment and leave to maintain the width and length of the bone
What is the treatment guideline for alveolar bone fracture?
- reposition segment
- splint for 4 weeks
- tooth may need to be extracted after alveolar stability has achieved.
___% of complications from concussion and subluxation injuries are diagnosed within a year
95%
What are the most common complications from concussion and subluxation injuries seen in children >4 years old?
pulpal necrosis
premature tooth loss
The treatment decisions of a lateral luxation injury are dependent on…
- degree of displacement
- mobility
- occlusal interference
What happens to 95% of lateral luxation injuries?
realingn spontaneously
What is the most common risk associated with lateral luxation injuries?
- 95.7 experience pulpal necrosis /post traumatic tooth loss
What are the treatment guidelines of lateral luxation injuries?
- must take radiograph to see if there have been an increase in PDL space apically
- if there is no occlusal interference allow the tooth to realingn spontaneously (occurs within a year)
- if there is occlusal interference extraction is indicated
What is a lateral luxation injury?
this is the displacement of a tooth other than apically
What kind of lateral luxation injury increases the risk of collision with the permanent tooth bud?
when the crown has been displaced labially; the root tends to move palatally
this increases the risk of damage to the permanent bud
What kind of lateral luxation injury reduces the risk of collision with the permanent bud?
when the crown is displaced palatally; the root moves buccally away from the permanent too bud
How does a labially displaced lateral luxation injury appear on the radiograph?
tooth appears longer on the radiograph
How does a palatally displaced lateral luxation injury appear on the radiograph?
tooth appears shorter on the radiograph
What is the treatment guideline for intrusion injuries?
- PA or anterior occlusal radiograph to establish baseline
- allow spontaneous eruprtion
What is the follow up for intrusion injuries?
1 week review
4 weeks
2 months
6 months
1 year
What was the previous treatment guideline for lateral luxation and intrusion injuries?
- extraction of the primary tooth where the tooth was displaced towards the permanent tooth germ however this is no longer advised
Why have previous guidelines for lateral luxation and intrusion injuries changed?
- this is because there is evidence of spontaneous eruption /repositioning in these cases
- there is also concern about further damage to the permanent tooth germ from extractions
- there is also a lack of evidence that an extraction will minimise damage to the perm tooth germ
If there is an absence of spontaneous re-eruption after 6 months of an intrusion injury, what should you suspect? What further treatment can be suggested?
- root resoprtion and ankylosis
- extraction is indicated to prevent deflection of permanent successor as it tries to erupt
What traumatic injury is most likely to cause injury to the permanent successor?
intrusive luxation injury
intrusion
____% of intrusion injuries spontaneously erupt within a year
83.7%
Nearly a third of intrusion injuries will show …
Pulpal necrosis
infection related resorption (of the root of the tooth)
ankylosis related resorption (of the root of the tooth)
Treament decisions for extrusions are based on…
- degree of displacement
- mobility
- occlusal interference
What are the treatment options for a mild extrusion injury?
- can be left
- splinted for 2 weeks
All extrusion injuries will undergo ______ and ______ within a year
pulpal necrosis
premature tooth loss
What is the treatment guideline for avulsion injuries in PRIMARY teeth?
- radiograph to confirm avulsion
- do NOT reimplant
Why should you never re-implant primary teeth in avulsion injuries
- aspiration
- risk of damage to permanent tooth
What are the long term effects of injury to primary teeth?
- discolouration
- discolouration and infection
- delayed exfoliation
What is a potential cause for delayed exfoliation of primary teeth?
- pulp canal obliteration (mineralisation of the inner lining of pulp canal); makes resorption more difficult?
What are the long term effects of trauma to permanent succesors?
- enamel defects (44%)
- abnormal root/root morphology
- delayed eruption
- permanent teeth can erupt etopically following damage to primary tooth
Why are children under 4 more likely to experience damage to the permanent successor?
this is because they have longer roots as root resorption has not begun yet
therefore they are more likely to damage their successor
Immediate discolouration of primary teeth is due to …
haemosiderin in tubules
What is haemosiderin?
break down product of the blood
Haemosiderin in the tubules may regress/remain and maintain vitality. True or false
True
How does intermediate (weeks) discolouration appear in primary teeth?
- brown/black
What causes the discolouration present weeks after the injury in primary teeth (intermediate discolouration)?
pulp break down products are found in the tubules
tooth no longer vital
What discolouration is present months after the injury to primary teeth (long term)?
yellow/opaque
pulp calcification
What causes regression of haemosiderin?
it is broken down
The more profound the discolouration of the tooth , the more likely it is for the tooth to lose vitality. True or false
True
What treatment should be offered to discoloured vital primary teeth?
no treatment
What treatment should be offered to opaque teeth following injury?
no treatment
What are indicators of non-vitality?
- pain
- infection (sinus)
- periapical pathology
In a case where pulp canal obliteration leads to delayed exfoliation, what is treatment is indicated and why ?
extraction
permanent tooth may erupt ectopically
What is a dilacerated primary tooth?
this is when there is an abnormal angulation or bend in the root; less frequently occurs in the crown
What is hypomineralisation?
- poor quality enamel
- right amount of enamel (thickness) but not mineralised sufficiently
- appears as a white or yellow spot
How can you treat hypomineralisation?
- mask with composite (microabrassive technique, etch and pumice)
- localised removal and restore with composite
What is hypoplasia?
this is when there is not enough enamel (thickness)
How can you treat a combination of hypomineralisation and hypoplasia ?
yellow/brown with missing enamel
restore with composite
final restoration with porcelain veneer
What are the sequalae of to tooth and root morphology after trauma treatment?
- crown dilaceration
- root dilaceration/angulation/duplication
- arrest root development in permanent tooth
- odontome
- undeveloped tooth germ- may sequestrate spontaneously or require removal
What is the treatment for odontomes?
surgical removal
What is the treatment for a root dilaceration?
combined surgical and ortho treatment
What is the treatment for crown dilacerations?
surgical exposure
orhto-realignment
What is an odontome?
mass of enamel and dentine
epithelian and mesenchymal cells exhibit complete differentiation with the result that functional ameoloblasts and odontoblasts form enamel and dentine
Why may delayed eruption be caused following premature loss of a primary tooth?
Premature tooth loss can lead to thickened mucosa
How can you detemine delayed eruption in a tooth following trauma ?
- take radiograph if greater than 6 month delay compared to contralateral tooth
How would you manage a delayed eruption case for a tooth with abnormal morphology?
surgical exposure
ortho
