trauma 4 Flashcards
what are the aetiologies or primary tooth trauma
- falls
- bumping into objects
- non-accidental = mainly from being young and lacking coordination, but need to remember not always an accident
which teeth are most commonly affected with primary tooth trauma
- maxillary central incisors
- 17-54%
- equal amounts male and female
what type of trauma is most common
- luxation
what age is most common
- 2-4 years
what are the different types of trauma
- enamel crack
- enamel dentine fracture
- enamel dentine pulp fracture
- crown root fracture
- root fracture
- luxation
- avulsion
how do you manage the patient
- reassure
- take history
- examination
- diagnosis
- emergency treatment
- advise patient about sequelae to permanent teeth
- further treatment and review
what is included in extra oral examination
- laceration
- haematomas
- haemorrhages/CSF leak
- subconjunctival haemorrhage
- bony step deformities
- mouth opening
what is looked at in intra oral examination
- soft tissue
- alveolar bone
- occlusion
- teeth
how are teeth tested
- mobility = could indicate fracture
- transillumination = can show fracture lines, pulpal degeneration, caries
- tactile test with probe
- percussion = duller note indicate fracture
- occlusion = traumatic occlusion demands urgent treatment
- radiographs = show if any foreign body or not
what is included in trauma stamp
- tooth
- mobility
- colour
- TTP
- sinus
- percussion note
- radiograph
why are EPT and thermal testing missing from trauma stamp
- no sensibility tests on primary teeth
- if tooth is resorbing get different readings
- child doesnt understand it
what are crown fractures
- enamel fracture = uncomplicated
- enamel dentine fracture = uncomplicated
- enamel dentine pulp fracture = complicated
what can be seen in concussion/subluxtion
- damage to pdl and often see bleeding around gingival crevice
what types of luxation can you get
- lateral
- intrusive
- extrusive
what is the immediate management for all injuries
- soft diet for 10- 14 days
- brush teeth with soft toothbrush
- topical chlorohexidine by parent on cotton wool roll twice daily
how often fo you see patient after initial treatment
- 1,3,6 monthly appointments taking radiographs is possible 6 monthly
- intrusion requires more frequent reviews
how to treat enamel only
- smooth sharp edges
how to treat enamel dentine fractures
- restore/bandage with composite or composer = not GI
- need to cover dentine otherwise it will dry out and die
how to treat enamel dentine pulp fractures
- endodontic therapy or extract
- careful with endo files not to go too far and damage permanent tooth underneath
how to treat crown and root fractures
- extract coronal fragment
- don’t try digging for root fragments as damage permanent
how to treat alveolar bone fracture
- reposition segment = splint to adjacent teeth for 3-4 weeks
- teeth may need extracted once alveolar stability is reached
- used to do rigid splint as bone remodelling but guideline now say flexible splint
how to treat concussion and subluxation
- observe
how to treat lateral luxation
- radiographs = will have increased pdl space apical
- if no occlusal interference then could leave to sort itself out
- forces from lip and tongue could move it back into position
- if there is occlusal interference then extract
how to treat intrusion luxation
- monitor re-eruption of tooth
- if there is no re-eruption after 6 months then extract
how to treat extrusion luxation
- extract
how to treat avulsion
- radiograph to confirm avulsion
- do not replant
- never replant a primary tooth in case you damage permanent beneath
how can you get localisation of intrusion injury with noe film
- take a periapical radiograph
- or lateral premaxilla view
what does a periapical radiograph show for luxation
- if apical tip appears shorter than contralateral tooth then it has been displaced towards or through the buccal plate = better as displaced away from permanent tooth germ
- if apical tip is indistinct and tooth appears elongated then apex is displaced toward permanent tooth germ
- root not in focus and shorter then closer to you
- root longer, then further away
what does a lateral pre-maxilla radiograph view show
- identifies direction of displacement as providing a lateral view
what are the long term affects of trauma in primary teeth
- discolouration
- discolouration and infection
- delayed exfoliation
what to do if tooth is vital
- no treatment
what to do if tooth is non-vital
- sinus or PAP on radiograph
- RCT or extraction
- if no sinus or PAP then leave and review
what to do if tooth is opaque
- no treatment
- if tooth is opaque, it is usually because there has been some sclerosis of the canal= natures own RCT
what happens in immediate discolouration of tooth
- may maintain vitality
- pink coloir
- damage to pulp caused burst blood vessels and blood has nowhere to go so goes into dentine tubules
- if pulp is still alive, it will get tidied up and tooth will go back to normal eventually
what happens in intermediate change in colour
- weeks
- tooth non-vital
- brown/black/grey
- coming from necrotic pulp products in dentine tubules
- root treat or remove
what happens in delayed exfoliation of primary tooth
- primary tooth may not resorb normally after trauma
- extraction is necessary or permanent successor will erupt ectopically
- could not resorb, or tooth became ankylosed
- tooth in weird shape
what injuries are most likely to cause problem with permanent teeth
- worse injuries at a young age
how common is enamel defects
- most common = 44%
what is hypo mineralisation
- white/yellow spot
- normal thickness of enamel
what are treatment options for hypomineralisation
- leave
- mask with composite
- localised removal and restore with composite
- external bleaching
- possibly micro abrasion
what is hypoplasia
- yellow/brown areas
- less than normal enamel thickness
what are the treatment options for hypoplasia
- restore with composite
- porcelain veneer when gingival level stabilised and at least 16 y/o = ideally into 20’s
what is treatment for crown or root dilaceration
- surgical exposure, ortho realignment, improve appearance
what is the treatment for crown or root duplication
- combining surgical and ortho
what is ectopic tooth position
- tooth in wrong place
what is arrest in tooth formation
- tooth germ at a specific site has been bumped and has just stopped developing so might never form rest of the tooth
- treatment = RCT or extraction
how can a tooth completely fail to form
- damaged very early on
how is a odontoma treated
- surgical removal
how is an underdeveloped tooth germ treated
- may disappear spontaneously on its own or require removal
what can cause delayed eruption
- premature loss of primary tooth can result in delayed eruption of about 1 year due to thickened mucosa
what should you do if there is a greater than 6 month delay in eruption from contra-lateral tooth
- take a radiograph
- palpate mucosa to see if you can feel anything
what are some long term complications of trauma to primary teeth
- crown hypoplasia
- crown dilaceration
- crown root dilaceration
- failure of eruption
- crown at wrong angle and root hanging at different angle
- root can develop at different trajectory after bumped
- arrest of root development
what is a odontoma
- could be result of intrusion
- swirly mass of dentine and enamel and cementum
- compound odontomes look like a bag if little teeth on an x-ray
- ordered denticles inside it
- areas of dentine with enamel and cementum
