Trauma Flashcards
What is subluxation?
An injury to the tooth-supporting structures resulting in increased mobility but no tooth displacement. Bleeding from the gingival sulcus confirms the diagnosis.
What is extrusion?
Partial displacement of the tooth out of its socket. The tooth will also be loose due to partial or total separation of the PDL. The alveolar socket bone is intact. The tooth may also have an element of protrusion/retrusion.
What is lateral luxation?
Displacement of the tooth other than axially. Usually accompanied by comminution or fracture of either the labial or the palatal/lingual alveolar bone. Tooth is frequently non-mobile although there has been partial/total separation of the PDL.
What is intrusion?
Displacement of the tooth into the alveolar bone. This injury is accompanied by comminution or fracture of the alveolar socket.
What is avulsion?
The tooth is completely displaced out of its socket. Clinically the socket is found empty or filled with coagulum.
What is an enamel infraction?
An incomplete fracture (crack) of the enamel without loss of tooth structure.
What is concussion?
An injury to the tooth-supporting structures that does not cause increased mobility or displacement of the tooth but does cause pain to percussion.
What is the treatment for concussion?
Soft diet 1 week
Monitor pulpal condition 1yr
What is the treatment for subluxation?
Usually just monitor & soft diet
Sometimes flexible splint for 2 weeks for patient comfort
What are the different classifications of crown fracture?
Enamel
Enamel Dentine
Enamel Dentine Pulp
What is the treatment for lateral luxation?
Saline rinse exposed root
Reposition under LA
Flexible splint 4 weeks
What are the three treatment options for intrusion injuries?
Spontaneous eruption
Orthodontic repositioning
Surgical repositioning
What is the treatment for extrusion?
Clean exposed root surface and reposition
Flexible splint 2 weeks
How would you differentiate a root fracture from an extrusion injury?
Take an X-Ray and look for Radiographic signs of root fracture
What is the treatment for a root fracture?
Rinse exposed root with saline
Reposition if coronal segment displaced
Check position with radiograph
Flexible splint 4 weeks (if apical/middle)
Flexible splint up to 4 months (if coronal)
Monitor pulp healing for 1 yr
What is the treatment for an alveolar fracture?
Manual repositioning or using forceps of displaced segment
Flexible splint 4 weeks
What post-op advice would you give to someone who has experienced dental trauma?
Soft diet 2 weeks
Avoid contact sports
Chlorhexidine mouthwash 1x daily for 1 week
What information is recorded in a trauma stamp/when a patient presents with a trauma?
Tooth FDI Mobility Displacement TTP Colour Sinus/tender in sulcus Thermal (Eth Cl) Electric (EPT) Radiograph
What treatment would you choose for an intrusion injury of less than 6mm?
Open Or Closed Apex:
Disimpact and allow to spontaneously erupt for 3wks
If no movement - orthodontic repositioning
How would you treat an intrusion injury of >6mm?
Open or closed apex:
Disimpact and surgically reposition
Flexible splint 4wks
What is ankylosis?
Fusion of the tooth to bone
What is the prognosis of a closed apex tooth with an intrusion injury?
5yr pulp survival - 0%
5yr resorption - 100%
What is the prognosis of a closed apex tooth that has been avulsed?
5yr pulp survival - 0%
Frequent root resorption
How should you monitor teeth that have been treated for traumatic injuries?
Clinical tests - trauma stamp
Sensibility tests - electric & thermal (at time of injury, 1m, 3ms, 6monthly for 2yrs)
Radiographs - root development, resorption, comparison
What injuries are treated with a flexible splint for two weeks?
Subluxation
Extrusion
Avulsion
What injuries are treated with a flexible splint for 4 weeks?
Luxation
Avulsion (if PL rubbed off)
Apical/middle third of root fracture
What injury is treated with a flexible or rigid splint for 4 weeks?
Dentoalveolar fracture
What injury is treated with a flexible splint for 4 months?
Coronal third root fracture
What advice should you give to someone with an avulsed tooth?
Hold by the crown
Rinse under cold water
Replant
If unable to replant store in saliva, saline or milk
What does EADT and EAT stand for?
Extra-alveolar dry time
Extra-alveolar time
How would you treat an avulsion injury with an EADT >60 min?
Open and closed apex: Remove necrotic PL Soak in 2% NaF for 20mins Extirpate & obturate outside mouth Flexible splint 4 weeks Systemic antibiotics (and tetanus)
How would you treat an avulsion injury in a closed apex tooth that has been replanted by the patient?
Clean & verify position (clinically & radiographically)
Flexible splint 2 weeks
Systemic antibiotics
Tetanus booster if avulsed tooth was in contact with soil
RCT 7-10 days after replantation & before splint removal
How would you treat an avulsion injury on a closed apex tooth with an EADT of less than 60 minutes?
Replant
Flexible splint 2wks
Systemic antibiotics & tetanus (if in contact with soil)
RCT 7-10 days after replantation and before splint removal (CaOH as intra-canal medicament 1 month then replace with GP)
How would you treat an avulsion injury on an open apex tooth with an EADT of less than 60 minutes?
Clean & apply topical antibiotics to socket
Replant tooth
Flexible splint 2wks
Systemic antibiotics (& tetanus)
Review at 2wks - RCT if revascularisation doesn’t occur
What are the four types of root resorption?
External surface
External inflammatory
Internal inflammatory
Replacement resorption (ankylosis)
Why is ns calcium hydroxide used initially in pulp treatment of open apex teeth?
To try and halt root resorption so tooth can eventually be obturated with GP.
If no progressive resorption occurs for 12 months, obturate with GP.
If progressive resorption occurs, ns CaOH can be changed every 6 months and dentist can plan ahead for prosthetic replacement.
What is the treatment for ankylosis?
No Rx
What is pulp canal obliteration?
Response of vital pulp.
Progressive hard tissue formation within the pulp cavity resulting in gradual narrowing.
What should you look for in a trauma examination?
Extra-Oral:
Laceration, haematoma, haemorrhage/CSF, sub conjunctival haemorrhage, bony step deformities, mouth opening
Intra-Oral:
Soft tissue, alveolar bone, occlusion, teeth
