Trauma 4 - (Examination) Flashcards
What are causes of primary tooth trauma?
Falls
Bumps into objects - playing, poor coordination, learning how to walk
Non accidental - abuse - always consider
What are most commonly affected teeth?
Maxillary central incisors
Why is lunation most common injury in children
the bone is softer so bone yields to force and pressure and absorbs the pressure
How do we manage a pt with trauma?
Reassure and calm pt
pt history - CO, HPC, MH, DH, FH, SH
Exam
Diagnosis - allows us to formulate tx plan
Emergency tx
Advise parent of potential damage to permanent teeth - must record in notes
Further tx and reviews
What do we have to ask about the injury?
When? Where? How? Any other symptoms? Lost teeth/fragments accounted for?
What must we consider in the medical history?
Is pt immunocompromised?
congenital heart defects or heart problems
rheumatic fever?
What dental history must w consider?
Have they had previous trauma
Past dental experience - gives us insight into what they can handle
parents and Childs attitude - how they feel towards tx
What do we look for extra orally?
lacs haematomas haemorrhage subconjunctival haemorrhage in eyes bony step deformities in eye sockets and jaw mouth opening - normal or limited?
What do we look for intra orally?
soft tissue injuries - any penetrating wounds or foreign bodies
alveolar bone - is it solid?
occlusion - is it damage or is the tooth interfering?
teeth - any mobile teeth? - can indicate displacement , root fracture or bone fracture
transillumination - curing light can help show fracture lines in teeth, pulpal degeneration or caries
tactile test with pulp
percussion - dull note can indicate root # or if it sounds diff from other teeth
occlusion - traumatic occlusion needs urgent tx
radiographs
What does the trauma stamp contain?
Tooth mobility colour ttp sinus percussion note radiograph
What tests are not useful in smaller children?
EPT, thermal pulp tests because the child can be too young to understand making the testing pointless - child may want to please us by telling us the answer they think we want to hear
What are the classifications of trauma injuries?
Enamel # Enamel dentine # enamel dentine pulp # - complicated Crown root - uncomplicated crown root - complicated concussion subluxation intrusion extrusion avulsion root # alveolar # lateral luxation
What are the 3 types of crown fractures?
Enamel only
enamel and dentine
enamel dentine and pulp
What are the 3 luxation injuries?
Lateral
Intrusion
Extrusion
What is home management for all injuries dentally?
Soft diet for 10-14 days (esp when splint in place) - still eat a normal diet just cut food up, chew with molars
Brush teeth after every meal
topical CHX by parent twice daily for one week - children can’t swallow properly till age of 4 so risk of swallowing
review 1,3,6 monthly
What injury requires more freq reviews?
Intrusion as we want to monitor reeruption
How to we treat enamel fracture only?
Flowable composite
smooth off sharp edges
How do we repair enamel or enamel dentine #?
Restore/bandage with composite resin or compomer - NOT GI!!!
We need to ensure we cover up exposed dentine or bacteria can enter and pulp will die
how do we repair enamel dentine pulp fractures?
In children majority xla
but we can do end therapy - but children have wide canal with open apex so we need to fill with MTA 5-6mm and the backfill with GP
In primary molar ends how far back do we go from radiographic apex?
2mm to avoid risking follicle around perm tooth
Do we take radiographs of ends file in children?
No, risk they bite down on it
How do we deal with crown and root fractures?
Get rid of coronal fragment - extract coronal fragment
leave any non obvious root fragments - we don’t want to damage adult tooth - leave it to resorb
Why do we avoid going looking for any root fragments in children?
We don’t want to damage the adult tooth - leave it to resorb physiologically
How do we treat alveolar bone fracture?
Reposition the segment
splint to adjacent teeth for 3-4 weeks
teeth may need xla after alveolar stability has been achieved
What type of splint do we use for alveolar bone fractures?
Flexible splint
How do we treat concussion and subluxation?
Observation
How do we treat lateral luxation?
Radiograph - check the PDL space
Consider repositioning but sometimes we prefer to allow it to spontaneously reposition
Why do our teeth sit in arches?
Because of forces applied by lip and tongue - this can help move any luxated teeth back into position
In lateral luxation if there is no occlusal interference what do we do?
We allow spontaneous repositioning
In lateral luxation if there is occlusal interference what do we do?
Extract
What types of film can we use to localise intrusion injury?
PA
Lateral premaxilla
How do we localise intrusion injury with one PA?
Take PA
if apical tip appears shorter than contralateral tooth - displaced towards or through buccal plate
if apical tip indistinct and elongated then apex is displaced towards tooth germ
If the apical tip appears shorter than contralateral tooth in PA for intrusion injury what does this mean ?
This means the tooth has been displaced towards or through the buccal plate
What is the preferred direction of an intruded tooth?
Towards or through buccal plate AWAY from developing tooth germ
What does it mean if the apical tip is indistinct and tooth appears elongated?
This mean tooth has been displaced towards permanent tooth germ
How do we manage intrusion injuries?
Monitor re-eruption - draw a pic as reminder
If no re-ruption within 6 months consider xla to avoid problems with adult tooth
When would we consider other options if intruded tooth hasn’t re-erupted ?
6 months - we would want to xla to avoid issues with eruption of adult tooth
How do we tx extrusion injuries?
Extract
or reposition under la and then flexible splint for 2 weeks
If we reposition extruded tooth what are risks?
Damage to perm tooth
How to we treat avulsions in kids?
NEVER replant primary tooth - damages permanent tooth!!!
What are some long term effect of trauma in primary teeth?
Discolouration
discolouration and infection
delayed exfoliation
What do we investigate if tooth is discoloured?
Vitality
What if tooth id discoloured ad vital?
Leave it - no tx needed
What if tooth is discoloured and non vital?
PA abscess, sinus then consider xla or Rct
if no abscess or sinus then leave and review
What does opaque tooth on x-ray suggest?
Canal have sclerosed - natures own rct
What do we do if tooth id discoloured and infected?
RCT or XLa
Why may be need to extract a primary tooth that won’t resorb?
To ensure perm successor doesn’t erupt ectopically
What does a pink colour of tooth suggest?
Pink:
immediate colour, tooth can maintain vitality and get better
the reason for pink is because BV is pulp ruptures and blood goes into dentinal tubules as it has nowhere else to go
if pulp repairs = normality returns
What are intermediate colours changes?
Brown black grey
What does an intermediate colour change suggest?
Happens weeks after trauma
indicates tooth is NV
Where does intermediate discolour come from?
Necrotic pulp products in the dentine tubules - haemosiderin and eosin
What does immediate discolouration suggest:?
Tooth may maintain vitality
What can happen to primary tooth after trauma?
it can fail to resorb or may become ankylosed
If primary tooth doesn’t resorb or becomes ankylosed what do we do?
Xla may be needed to ensure perm successor erupts normally or else it can be pushed ectopically
What is most likely complication of primary trauma?
Enamel defect
then abnormal tooth or root morphology (such as crown ir root dilac and crown or root duplication)
What are some long term effects of trauma in perm teeth?
Enamel defects
abnormal tooth or root morphology
delayed eruption
ectopic tooth position
arrest in tooth formation
complete failure of tooth to form
odontome formation
What age and type of injuries has worst prognosis for adult teeth?
Bad injury
young age
0-2 yrs = 63% chance of complication but 7-8 only 25%
What are some enamel defects?
hypo mineralisation
hypoplasia
What is hypo mineralisation?
White yellow spots with normal enamel thickness
What are tx options for hypo mineralisation?
No tx - leave
mask with Comp
localised removal and comp restoration
external bleaching - icon and micro abrasion
What is hypoplasia?
This is when there are yellow and brown areas with less than normal enamel thickness
What are tx options for hypoplasia?
Restore with comp - restores appearance and replaced missing tissue
or when pt is old enough - youngest 16 but realistically 20ish then we can do a porcelain veneer when gingival level stabilised
How do we treat crown dilacerations?
Surgical exposure
ortho realignment
improve appearance restoratively
How do we tx root dilacs/angulations/duplications
Combo of surgical and ortho
How do we tx arrest of root development?
RCT/xla
RCT - if enough root if not then consider pt as hypodontia pt
How do we tx odontome?
XLa
How do we tx undeveloped tooth germ?
may erupt spontaneously but may need to be removed if causing problems with other teeth erupting
Why can premature loss of a primary tooth delay eruption?
Due to thickened mucosa in the area
How long can premature loss of primary tooth delay eruption by?
1 year
What might we need to do to encourage eruption of adult tooth when there was premature loss of primary tooth?
Incision in gum to allow tooth to come through
When would we take a radiograph if tooth isn’t erupting?
6 months after contralateral tooth has erupted
always palpate for tooth also
