Trauma Guidelines Primary Dentition - International Association of Dental Traumatology 2020 Flashcards
What are the clinical findings for an enamel only fracture
fracture involved enamel only
What are the radiographs indicated for enamel only fracture
- none
- if TTP, consider x-ray to rule out luxation or root fracture
What is the tx for enamel only fracture
smooth sharp edges
comp restoration if desirable
When should we follow up enamel only fracture
none required
What are the favourable outcomes of enamel only fractures
- asymptomatic
- pulp healing
- continued root development in immature teeth
What are signs of pulp healing
- no colour change of crowns
- no sign of pulpal necrosis or infection
What are the unfavourable outcomes of enamel only fracture
- symptomatic
- crown discolouerd
- signs of pulpal necrosis/infection
- no further root development in immature teeth
What are signs of pulp necrosis/infection
- sinus tract
- gingival swelling
- abscess
- increased mobility
- persistant dark grey discolouration with signs of infection
- no further root development in immature teeth
What is the general aftercare for all injuries
- watch out when eating, dont want to further traumatise tooth
- encourage healing by good OH using soft brush or cotton swab and use CHX mouthwash - two times daily for a week
What are the clinical considerations for enamel dentine fratcure with no pulp exposure
- locate missing tooth fragment
- risk of it being imbedded or aspirated
- fracture with no pulp exposrue
What radiographs do we take for enamel dentine fracture with no pulp exposure
baseline xray option
take xray of soft tissues if unaccounted for
if TTP, rule out luxation and root fracture
What is the treatment for enamel dentine fracture with no pulp exposure
cover exposed dentine with GI/comp
can restore lost tooth structure with comp
What is the follow up for enamel dentine fracture with no pulp exposure
- 6-8 wks
- only follow up with x-ray if signs of pulp necrosis and/or infection
What are the favourable outcomes of enamel dentine fracture with no pulp exposure
- asymptomatic
- pulp healing
- continued root development
What are the unfavourable outcomes of enamel dentine fracture with no pulp exposure
- symptomatic
- crown discoloured
- signs of pulp necrosis/infection
- no further root development
What are the clinical considerations of complicated crown fracture (enamel dentine pulp)
- exposed pulp
- locate missing tooth fragment
What radiographs do you want for a complicated crown fracture
- PA or occlusal for diagnosis and baseline
- screen for signs of displacement and root injury
- take x-ray soft tissue if concerned about embedding
What is the tx for complicated crown fracture
- aim to preserve pulp
- if not then pulpectomy (not really mentioned in IADT guidelines) or XLA
Why should we aim to preserve pulp in complicated fractures
to encourage normal root growth known as apexogenesis
What ways can we preserve pulp
- pulp cap
- partial pulpotomy
- coronal pulpotomy
When can we do a pulp cap
When pulp exposure within 24h and <1mm exposure
How do we do a pulp cap
cover exposure with setting caoh
cover with gi
cover with comp
What is the procedure for partial pulpotomy - briefly
- dam
- remove 2mm pulp and arrest haemorrhage with saline
- NScaoh placed
- cover with GI
- cover with comp
When is partial pulpotomy indicated
exposure >1mm
>24h
When is coronal pulpotomy indicated
- pulp hyperaemic or necrotic
What is the procedure for full pulpotomy
remove all coronal pulp
place nscaoh
seal with GIC lining
How is a pulpectomy done on a primary tooth
- file 2mm short of WL
- no radiograph with file inside done for WL
- CaOh and iodoform paste so tooth can resorb away
When is the follow up for complicated crown fracture
1 wk, 6-8 wks, 1y
x-ray 1 yr following pulpotomy
What is an unfavourable outcome for complicated crown fracture
- symptoamtic
- crown discoloured
- signs of pulp nercosis
- no further root development in immature teeth
What is a favourable outcome for complicated crown fracture
- asymptomatic
- pulp healing
What are signs of continued root development
increase in root length
thicker dentine walls
no PAP
no root resorption
What are the clinical findings for uncomplicated crown roto fracture
- fracture involves enamel dentine and root
- pulp not exposed
- may notice loose but still attached fragments
- TTP
What x-rays do you want for crown-root fracture
PA or occlusal
What is the tx options for uncomplicated crown root fracture
- no tx and rapid referral
- extract coronal fragment and restore if possible with GIC
- if unrestorable, remove loose fragments without damaging the permanent and then leave firm root in situ
- XLA
What is the follow up for crown root fracture - uncomplicated
fragment removal
* 1 wk, 6-8 wk, 1yr
extraction
* 1 yr
What are favourable outcomes for uncomplicated crown root fracture
- asymptomatic
- pulp healing
What are unfavourable outcomes for crown root fracture
- symptomatic
- crown discoloured
- signs of pulp necrosis/infection
- no further root development of immature teeth
What are the clinical findings for complicated crown root fracture
- involves enamel, dentine and the root
- pulp exposed
- may notice loose but still attached fragments
What x-rays for complicated crown root fracture
PA/occlusal
What is the tx for complicated crown root fracture
- fragment removal
- only if remaining tissue large enough to allow restoration adn perform pulpotomy/RCT
- XLA otherwise
What is the follow up for complicated crown root fracture
- fragment removal - 1wk, 6-8wk, 1yr. xray after 1 year only
- XLA: clinical review 1 yr
What are favourable outcomes of complicated crown root fracture
- asymptomatic
- pulp healing
- continued root development in immature teeth
What are unfavourable outcomes in complicated crown root fracture
- symptomatic
- crown discoloured
- signs of pulp necrosis
- no further root development
What are the clinical findings for root fracture
- depends on fracture location
- coronal fragment may be mobile and displaced
- occlusal interference may be present
- tooth may be TTp
What radiographs should you take for root fracture
PA or occlusal
fracture usually in mid or apical 1/3
What are the tx options for treatment of root fracture
- no tx
- repositioning
- xla of loose coronal fragment only
When is it suitable to carry out no tx for root fracture
- not displaced
- displcaed but not excessively mobile
- can expect spontaneous repositioning
When repositioning coronal root fracture, how long should a flexible splint be placed for
4 wks
What is the follow up for root fracture
1wk, 6-8 wk, 1 yr then every year until permanent tooth eruption (if no tx provided)
1wk, 4wk, 8wk, 1y if coronal fragment repositioned
1 yr if XLA
What are favourable outcomes for root fracture
- asymptomatic
- pulp healing
- realignment of root - fractured tooth
- no mobility
- resorption of apical fragment
What are unfavourable outcomes of root fracture
- symptomatic
- crown discoloured
- signs of pulp necrosis/infection
- no further root development
- no improvement in position of root fractured tooth
What are the clinical findings of alveolar fracture
- fracture involves alveolar bone
- mobility and dislocation of segment with several teeth moving together
- occlusal interference
- TTP
What x-rays should you get for an alveolar fracture
- PA/occlusal
- lateral x-ray may give information on relationship between permanent tooth and primary
- further imaging may be required to see extent of the fracture
What is the tx for alveolar fracture
- reposition
- flexible splint 4 wks to adjacent uninjured teeth
When is the clinical follow up for alveolar fracture
- 1wk, 4wk, 8wk, 1yr
- radiographs at 4 wks and 1 yr to assess impact on teeth
- follow up at 6 YO to monitor eruption
- fracture lines located at primary tooth apex –> can cause abscess
What are unfavourable outcomes for an alveolar fracture
- symptomatic
- crown discoloured
- signs of pulp necrosis/infection
- no further root development
- no improvement in position of displcaed segment and original occlusion not restored
- disturbed permanent successor
What are favourable outcomes for alveolar fracture
- asymptomatic
- pulp healing
- pdl healing
- continued root development
- realignment of segment with original occlusion
- no disturbance to permanent tooth development or eruption
What are the clinical findings of a concussion injury
- tooth TTP
- no displacement
- no gingival bleeding
What x-rays should be taken for concussion
none
What is the tx for concussion
observe
What is the follow up for concussion
- 1wk and 6-8wks
- xray only when signs of pathology
What are favourable outcomes of concussion injury
- asymptomatic
- pulp healing - normal colour of crown or transient red/gray/yellow colour and pulp obliteration
- continued root development
- continued development and eruption of permanent tooth
What is pulp obliteration
pulpal response to trauma
rapid deposition of mineralized tissue in root canal space
What are unfavourable outcomes for concussion
- symptomatic
- signs of pulp necrosis
- no further root development
- negative impact on permanent successor
What are the clinical findings of subluxation
TTP
no displacement
gingival bleeding
What xray should we take for subluxation and what would you expect to see
PA or occlusal
would expect to see normal or widened PDL space
What is the tx for subluxation
no tx
observe
What is the follow up for subluxation
- 1wk and 6-8 wks
- xray only when signs of pathology
What are favourable outcomes for subluxation
- asymptomatic
- pulp healing - normal colour of crown or transient red/yellow discolouration and pulp obliteration
- continued root development
- continued development and eruption of permanent tooth
What are unfavourable outcomes for subluxation
- symptomatic
- signs of pulp necrosis
- no further root development
- negative impact on permanent successor
What are the clinical findings of extrusive luxation
- partial displacement of tooth out of its socket
- tooth appears elongated
- occlusal interference possible
What xray for extrusive luxation
PA/occlusal
slight/substantial widening to PDL space
What is the tx for extrusive lxuation
if no occlusal interference - no tx, allow spontaneous repositioning
if excessive mobility or extruded >3mm - extract under LA
What is the follow up for extrusive luxation
1wk, 6-8 wk, 1y
where concerned about outcome, review every year until eruption of permanent
xray only when indicated
What are favourable outcomes for extrusive luxation
- asymptomatic
- pulp healing
- continued root development
- continued development/eruption of permanent tooth
- realignment of extruded tooth
- no occlusal interference
What are unfavourable outcomes for extrusive luxation
- symptoamtic
- signs of pulp necrosis
- no further root development
- negative impact on permanent sucessor
- occlusal interference
- no improvement in position
What are the clinical findings for lateral luxation
- tooth displaced palatal/labially
- immobile
- occlusal interference
- high metallic sound on TTP
What xray should you take for lateral luxation and what would you expect to see
- pa/occlusal
- increased widening to PDL space apically
- best seen on occlusal
What is the tx for lateral luxation if there is no oclcusal interference
- no tx - spontaneous repositioning, occurs within 6mo
What is the tx for lateral luxation if there is excessive displacement
options are
* extract under LA
* reposition under LA - 4wk flexible splint
When should you follow up a lateral luxation
1wk, 6-8wk, 6 mo, 1 yr
also at 4 wk if repositioned - splint removal
where concerned about outcome, review every year until eruption of permanent
xray only when indicated
What are favourable outcomes for lateral luxation
- asymptomatic
- pulp healing
- continued root development
- continued development/eruption of permanent tooth
- realignmnet of tooth
- no occlusal interference
- PDL healing
What are unfavourable outcomes of lateral luxation
- symptomatic
- signs of pulp necrosis
- no further root development
- negative impact on permanent sucecssor
- occlusal interference
- no improvement in position
- ankylosis
What are the clinical findings of intrusion
- tooth usually displaced through labial bone plate or permanent tooth bud
- tooth almost/completey disappeared into socket
- high metallic sound
- non mobile
What xray would you take for intrusion and what would you see
- PA/occlusal
- if apex displaced labially, apical tip can be seen and tooth appears shorter
- if apex displaced towards tooth germ, apical tip cannot be seen and tooth germ appears elongated
What is the tx for intrusion
- it is assoicated with damage to the permanent tooth
- for that reason, allow for spontaneous repositioning which can take up to a year
- refer
When is the follow up for intrusion
1wk, 6-8wks, 6 months, 1yr
follow up at 6yo for severe intursion to monitor for eruption of permanent tooth
What are favourable outcomes for intrusion
- asymptomatic
- pulp healing
- continued root development
- continued development/eruption of permanent tooth
- realignment of tooth
- PDL healing
What are the unfavourable outcomes for intrusion
- symptomatic
- signs of pulp necrosis
- no further root development
- negative impact on permanent succesor
- occlusal interference
- no improvement in position
- ankylosis
What are the clinical findings for avulsion
- tooth out of socket
- account for tooth
What radiograph for avulsion
PA/occlusal to rule out intrusion
What is the tx for avulsion
nil
do not replant
What is the follow up for avulsion
6-8wks
6 yo to monitor eruption of permanent
What is the favourable outcome for avulsion
no disruption to permanent
What is an unfavourable outcome for avulsion
disruption to permanent
What age is the highest risk for injury to cause damage to permanent
<3YO
What are the possible complications that parents should look out for post injury
- swelling
- dark discolouration of crown
- increased mobility
- fistula
