Trauma Adult Incisor

Question 1

9-year old brought as emergency by mother. Two hours prior, child slipped at school hitting her mouth. What key questions ask?

Answer 1

Trauma q’s: how, when, where, who
Injuries: any other injuries, LOC, vomitting
Pain hx: SOCRATES
Tooth: any concerns re aspiration?

Question 1

What should do if lost fragment?

Answer 1

Account for fragment - soft tissues
If aspirated - needs to be send for chest x-ray

Question 2

What should a dental trauma assessment include?

Answer 2

Exclusion EO injruies
Assessment of tooth: mobility, percussion, colour, vitality, tissue invovlement
Assessment adjacent teeth
Special investigation: vitality testing, RADs

Question 3

UR1 is TTP w/ enamel-dentine fracture. What is dx and mx?

Answer 3

Uncomplicated enamel-dentine fracture w/ concussion

Immediate: composite bandage and local advice re analgesia, soft diet, good OH - consider CHX if area too sore initially, avoid contact sport

Question 4

How to tx enamel-dentine fracture if have portion of fracture?

Answer 4

Bond to tooth

Question 5

What is the composition of composite?

Answer 5

Organic matrix - bisGMA etc
Inorganic filler - silica
Silane coupling agent

Question 6

What would be mx if there was an enamel-dentine-pulp fracture in immature tooth?

Answer 6

Depends on size/ time of exposure

Direct pulp cap - if pinprick exposure
Partial pulpotomy - exposed portion vital pulp is removed ( if tx > 24 hours since injury)
Complete pulpotomy

Question 7

What follow up arrange for pt w/ enamel-dentine fracture?

Answer 7

6-8 weeks and followed at 1 year

Question 8

What are potential complications following dental trauma?

Answer 8

pulpal necrosis
canal obliteration
surface resorption
inflammatory resoprtion
replacement resoprtion

Question 9

What is surface resorption?

Answer 9

repair-related
transient process involving external root surface as result of injury to cementum

Question 10

What is inflammatory resorption?

Answer 10

Infection-related
Reduction of pulpal blood supply followed by bacterial invasion of pulp through dentinal tubules

Question 11

What is replacement resorption?

Answer 11

Ankylosis
Extensive damage to PDL and cementum
Root cementum exposed to osteoclasts and replace cementum with bone

Question 12

At 8-week check, tooth has gone grey. Explain to pt what has happened?

Answer 12

Pulpal necrosis

Question 13

How to promote apexification in immature tooth?

Answer 13

Accessed for RCT and calcium hydroxide or MTA should be placed