Trauma IV Flashcards
What are common aetiologies of primary tooth trauma? (3)
- Falls
- Bumping into objects
- Non-accidental
Which teeth are most commonly affected in primary tooth trauma?
- Maxillary central incisors
- Prevalence 17-54%
- Male = Female
What type of dental trauma is most common in primary teeth trauma?
- Luxation commonest
At what ages is the peak incidence of primary teeth trauma?
2-4 years
What is the prevalence of an ED fracture?
7-13%
What is the prevalence of a CR fracture?
2%
What is the prevalence of a root fracture?
2-4%
What is the prevalence of a luxation injury?
62-69%
What is the prevalence of an avulsion injury?
7-13%
What is included in patient management? (7)
- Reassure
- History
- Examination
- Diagnosis
- Emergency treatment
- Advice patient of sequelae to permanent teeth (very important to talk about and record the possibility of damage to the permanent dentition)
- Further treatment and review
Why do we want a proper diagnosis of the injury before we start treatment?
- Want a proper diagnosis because that is what is going to help you decide what you are going to do in regards to treatment
What do we want to include in a trauma history? (5)
The injury:
- When
- Where
- How
- Any other symptoms
- Lost teeth/fragments (and are these accounted for)
When taking a trauma history what do we want to know about the dental history? (3)
- Previous trauma
- Treatment experience
- Parent and child attitude
When doing a trauma examination we want to look extra-orally. What are we looking for? (6)
- Laceration
- Haematomas
- Haemorrhage/CSF
- Subconjunctival haemorrhage
- Bony step deformities
- Mouth opening
When doing a trauma examination we want to look intra-orally. What are we looking for? (4)
- Soft tissues
- Alveolar bone
- Occlusion
- Teeth
When doing an intra-oral exam we are looking for soft tissue damage. What are we looking for? (2)
- Penetrating wounds
- Foreign bodies
When doing an intra-oral exam we are looking at tooth mobility. What might this indicate? (3)
- Displacement
- Root fracture
- Bone fracture
When doing an intra-oral exam we might use transillumination. what might this indicate? (3)
- Fracture lines in teeth
- Pulpal degeneration
- Caries
When doing an intra-oral examination we can do a tactile test with a probe. What do we look for? (3)
- Horizontal fractures
- Vertical fractures
- Pulpal involvement
When doing percussion tests, what might indicate a root fracture?
- If we hear a duller note
When doing an intra-oral exam what are we looking for in regards to occlusion?
- Traumatic occlusion demands urgent treatment (this might involve the removal of a primary tooth)
When doing an intra-oral exam we will use radiographs. What are the possible radiographs we might use? (5)
- Intra-oral
- Ant occlusal
- Lateral pre-maxilla
- OPT
- Soft tissue
What is involved in a trauma stamp? (7)
- Tooth
- Mobility
- Colour
- TTP
- Sinus
- Percussion note
- Radiograph
What are the different trauma classifications we have? (9)
- Enamel fracture - uncomplicated
- Enamel-dentine fracture - uncomplicated
- Enamel-dentine pulp fracture - complicated
- Crown-root (pulp involved)
- Root fracture
- Alveolar fracture
- Concussion/subluxation
- Luxation - lateral, intrusive, extrusive
- Avulsion
What are the classifications of crown fractures? (3)
- Enamel only
- Enamel + dentine
- Enamel, dentine + pulp
What are the different classifications of luxation? (3)
- Lateral
- Intrusion
- Extrusion
What is immediate home management of all trauma injuries? (5)
- Soft diet for 10-14 days (normal diet just cut everything small and chew with molars)
- Brush teeth with soft toothbrush after every meal
- Topical chlorhexidine by parent twice daily for one week (cotton wool rolls for swabbing)
- After initial treatment review 1, 3, 6 monthly taking radiographs if possible 6 monthly
- Intrusion requires more frequent review because in intrusion injuries you want to monitor the re-eruption of the tooth
What is the treatment of an enamel only fracture?
- Smooth sharp edges
What is the treatment of enamel only or enamel-dentine fractures?
- Restore/bandage with composite or compomer (do not use GI)
- Important that you cover up the exposed dentine because if you leave it exposed then bacteria can go through the dentine tubules into the pulp and the tooth will die
What is the treatment of enamel-dentine-pulp fractures?
- Endodontic therapy or extract
- Most of these will be extracted
- Would not fill with GP - would fill with a calcium hydroxide and iodoform paste
- Danger with this is that using your endodontic file might encroach upon the follicle that is around the permanent tooth
- We really don’t want to do that
We don’t take working length radiographs with files in the tooth in primary teeth
How would we treat crown and root fractures? (2)
- Extract coronal fragment
- Don’t be overzealous to remove any root fragments that aren’t obvious. These should be left to resorb physiologically
How would we treat alveolar bone fractures? (2)
- Reposition segment. Splint to adjacent teeth 3-4 weeks
- Teeth may need to be extracted after alveolar stability has been achieved
- Guidelines now say to use a flexible splint instead of a rigid splint for this
How would we treat concussion and subluxation?
- Observation
How would we treat a lateral luxation injury? (3)
- Radiograph - increased pl space apically
- No occlusal interference - allow to position spontaneously
- Occlusal interference - extract
Why might we use a radiograph to localise an intrusion injury?
- Can do this to decide whether the root of the tooth has gone into the tooth germ or not
When localising an intrusion injury with one film why is it not paralax?
- As we are only using one radiograph
There are 2 types of film we can use to help localise intrusion injuries. What are these?
- PA or lateral premaxilla (extra oral film)
Why might we want to localise an intrusion injury using a radiograph?
- Being able to assess the danger to the permanent tooth allows better counselling re prognosis
When using a periapical to localise an intrusion injury how would we do it?
- Use a periapical sized film but take it more like it was an occlusal because kids don’t tolerate having all the cone beam ring holders etc to make everything parallel
When taking a periapical radiograph to localise an intrusion injury, what does it mean if the apical tip appears shorter than that of the contralateral tooth?
- Then it has been displaced toward or through the buccal plate (this is the preferable direction - away from the developing tooth germ)
When taking a periapical radiograph to localise an intrusion injury, what does it mean if the apical tip is indistinct and the tooth appears elongated in comparison to the contralateral tooth?
- The apex is displaced towards the permanent tooth germ
- Tooth has gone palately in this instance
- This can give a heads up to the likely damage of the permanent successor
In relation to an intrusion injury what can a lateral premaxilla radiograph identify?
- Identifies direction of displacement as providing a lateral view
What is the treatment of an intrusion injury? (3)
- Monitor re-eruption of tooth
- If no re-eruption after 6 months consider extraction to avoid problems in eruption of permanent tooth
- Might decide to do this after 6 months or might decide you want to get to a developmental point where you feel the permanent tooth development is being compromised
What is the treatment of an extrusion injury? (2)
- Extraction
- Guidelines consider reposition but chance of damage to permanent tooth is high
What is the treatment of an avulsion injury? (2)
- Radiograph to confirm avulsion
- Do not replant - never re-implant a primary tooth - potential to damage the permanent teeth
What are 3 examples of long term effects of trauma to the primary dentition?
- Discolouration
- Discolouration and infection
- Delated exfoliation
What treatment would we do if we had a primary tooth that had been discoloured +/- infection due to trauma that is vital?
- No treatment
What treatment would we do if we had a primary tooth that had been discoloured +/- infection due to trauma that is non-vital? (2)
- Sinus or periapical area on radiograph = RCT or extraction
- No sinus or periapical infection = leave and review
What treatment would we do if we had a primary tooth that had been discoloured +/- infection due to trauma that is opaque?
No treatment
Immediate discoloration due to trauma may maintain vitality of the tooth. What colour is immediate discoloration usually?
- Usually a pinkish colour
Intermediate discoloration (weeks) due to trauma may indicate a non-vital tooth. What colour is intermediate discoloration usually?
- This is usually brown/black/grey
- Colour is coming from necrotic pulp products in the dentinal tubules
- Will have to root treat or remove or if there are no symptoms you can leave it and just keep monitoring it
One possible long term effect of trauma to primary teeth is delayed exfoliation of primary teeth. What is a problem with this?
- Primary tooth may not resorb normally after trauma. Extraction is necessary or permanent successor will erupt ectopically
Injuries to the permanent teeth is related to age and trauma to primary teeth. How does this relate?
- The worst injuries and the younger your age the more chance you are going to have a problem with your permanent teeth
Give a list of long term effects in the permanent dentition due to trauma in the primary dentition? (7)
- Enamel defects
- Abnormal tooth/root morphology (crown or root dilaceration or crown or root duplication)
- Delayed eruption
- Ectopic tooth position
- Arrest in tooth formation
- Complete failure of tooth to form (if the damage occurs really early on)
- Odontome formation
One possible enamel defect (long term effect to permanent dentition due to trauma in primary dentition) is hypomineralisation. What does this look like and what are the treatment options? (5)
- White/yellow spot (normal thickness of enamel)
T/O:
- Leave
- Mask with composite
- Localised removal and restore with composite
- External bleaching
One possible enamel defect (long term effect to permanent dentition due to trauma in primary dentition) is hypoplasia. What does this look like and what are the treatment options? (2)
- Yellow/brown areas (less than normal enamel thickness)
T/O:
- Restore with composite (porcelain veneer when gingival level established, at least 16 years but might not do until they are in their early 20’s)
One complication of trauma in the primary dentition is crown dilaceration of the permanent dentition. How can we treat this complication?
- Surgical exposure, ortho realignment, improve appearance
One complication of trauma in the primary dentition is root dilaceration/angulation/duplication of the permanent dentition. How can we treat this complication?
- Combined surgical and ortho
One complication of trauma in the primary dentition is arrest of root development of the permanent dentition. How can we treat this complication?
- RCT/extraction
One complication of trauma in the primary dentition is Odontome formation of the permanent dentition. How can we treat this complication?
- Surgical removal
One complication of trauma in the primary dentition is an undeveloped tooth germ of the permanent dentition. How can we treat this complication?
- May sequestrate spontaneously or require removal (if it is causing other problems or preventing other teeth from erupting)
What is an odontome?
- A big swirly mass of enamel, dentine and cementum
Premature loss of a primary tooth can result in delayed eruption of about 1 year due to thickened mucosa. How would we treat this?
- Take radiograph if greater than 6 month delay compared to contralateral
- Surgical exposure and ortho may be required if abnormal morphology
