Trauma Flashcards
as far as trauma goes, what should you as the dentist record?
- spontaneous pain
- reaction to thermal change
- disturbances in occlusion
- extraoral wounds and palpation of facial skeleton
- injuries to intraoral soft tissues
- mobility of teeth or alveolar fragments
- sensitivity to percussion
- abnormalities in occlusion
- vitality tests
what is the radiographic evidence of pathology at 2 weeks?
pulpal necrosis
what is the radiographic evidence of pathology at three weeks?
inflammatory resorption (external and internal)
what is the radiographic evidence of pathology at 6 weeks?
replacement resorption (ankylosis)
reaction of teeth to trauma involving internal hemorrhage?
pulpal hyperemia (pulpitis)
reaction of teeth to trauma involving pulp canal obliteration
pulp necrosis
is pulp necrosis subsequent to pulp canal obliteration a common finding?
no (1%)
does pulp canal obliteration or pulp necrosis appear first?
pulp necrosis is before obliteration
what does pulp canal obliteration depend on?
- type of injury
- stage of root development
what is the etiology of inflammatory resorption?
- surface resorption of cementum exposing dentinal tubules
- pulp necrosis
- toxic products from the pulp provoke an inflammatory response in the PDL
what is replacement resorption?
- direct union of bone and root
- resorption of root and replacement with bone
- direct result of loss of vital PDL
a displacement of the tooth INTO the alveolar bone. this is often accompanied by comminution or fracture of the alveolar socket
intrusive luxation (central dislocation)
a partial displacement of the tooth OUT of the socket
extrusive luxation
peripheral dislocation, partial avulsion
a displacement of the tooth in a direction other than axially
-this is accompanied by comminution or fracture of the alveolar socket
lateral luxation
a complete displacement of the tooth out of its socket
exarticulation
complete avulsion
what are treatment alternatives in class III fractures of primary teeth?
- direct pulp capping
- CaOH pulpotomy
- pulpectomy
how successful are CaOH partial pulpotomies?
96% success with pulps exposed 1 hour to 90 days
what is the technique for CaOH partial pulpotomy?
- gently remove dentin and pulp to 1-2mm
- use copious irrigation
- cover pulp with CaOH
what are the properties of mineral trioxide aggregate?
- high pH (similar to CaOH)
- exceptional sealing properties
- hardens within hours enabling canal obturation
what is the criteria for successful pulp therapy on traumatized teeth?
- absence of clinical signs and symptoms (fistula, mobility, pain)
- completion of root development
- absence of radiographic signs of necrosis
an injury to the tooth supporting structures without abnormal loosening or displacement of the tooth but with marked reaction to percussion
concussion
an injury to the tooth-supporting structures with abnormal loosening, but without displacement of the tooth
subluxation
what is the treatment for concussion?
- inform patient and parent about potential sequelae
- monitor
what is the tx for subluxation?
- DO NOT splint
- Follow up in 2 weeks
- radiograph at one month
what is the tx for intrusive luxation with an OPEN apex
- if less than 7mm, allow spontaneous repositioning
- —if no movement in 3 weeks reposition orthodontically
- if more than 7mm, reposition surgically
what is the tx for intrusive luxation with a CLOSED apex
- if less than 3mm, allow spontaneous respositioning
- if 3-7mm, extrude tooth orthodontically (ASAP)
- if more than 7mm, surgically reposition tooth
what is the treatment for extrusive luxation?
- reposition tooth ASAP (best if within 2 hrs)
- light splint for 2 weeks
- remove pulp and fill with CaOH within 7-14 days
- CHX
- complete endo fill in 2 months if no inflammatory reaction
what is the treatment with lateral luxation?
- reposition tooth ASAP (best if within 2 hrs)
- light splint for 3-4 weeks
- remove pulp and fill with CaOH within 7-14 days
- CHX
- complete endo fill in 2-4 months if no inflammatory resorption
what is the tissue of most concern when dealing with an avulsed tooth?
PDL
healing without resorption
*most critical factor
what is the tx for an avulsed tooth?
- management at site of injury (reimplant immediately)
- transport media
- management at dental office
- adjunctive drug therapy considerations
- endo treatment
- restoration of the avulsed tooth
what are the recommended transport (storage) media for an avulsed tooth?
- socket (immediate reimplantation)
- cell culture medium
- milk
- physiologic saline
- saliva
what is the maximum extraoral (dry time) that a tooth can be out of the socket?
less than one hour
- handle by crown, gently reimplant
- splint
- remove pulp in 7-14 days
what is the management of the soft tissues of an avulsed tooth?
tightly suture any soft tissue lacerations particularly in the cervical region
as far as splints go, what is recommended and what is contratindicated?
good to use: fish line, acid etch resin, soft arch wire, ortho brackets, suture as last resort
bad to use: circuferential wire
*maintain splint for 7-10 days, longer if tooth demonstrates excessing mobility
what is splinting home care?
- no biting on splinted teeth
- soft diet
- maintenance of good oral hygiene
what is the endodontic tx for an avulsed tooth with less than one hour dry time?
- remove pulp in 7-14 days
- place CaOH
- obturate canal in 2-12 months
what is the objective of managing an avulsed immature tooth?
revitalize severed pulp
- best chance if reimplanted in 20 minutes (max 60)
- soak in doxycycline solution for 5 minutes
- reimplant and splint
- recall every 3-4 weeks
what are some additional considerations for avulsed teeth?
- require follow-up for at least 5 years
- DO NOT reimplant primary teeth
- potential complications include
- –inflammatory resorption
- –replacement resorption
- –tooth submergence
