Trauma IV Flashcards
What is the aetiology of primary tooth trauma
falls
bumping into objects
non accidental
What is the most commonly effected primary teeth
max centrals
What is the prevalence between genders of primary tooth trauma
- Unlike permanent tooth trauma, the prevalence is equal among males and females
- 2-4 years is the peak incidence
What is the commonest injury
luxation
What is patient management made up of
- Reassurance
- History
- Examination
- Diagnosis
- Emergency treatment
- Advise parent of sequelae to permanent teeth and talk about and record the possibility of damage
- Further tx and review
What does the trauma history consist of
history of injury
medical history
dental history
What do we ask about for medical history
○ Anything such as rheumatic fever
○ Congenital heart defects
Immunosuppression
What do we ask for for the dental history
○ Any previous trauma? Maybe it is not part of a new injury
○ Treatment experience
○ Parent and child attitude
What does the trauma examination consist of
extra and intra oral exam
What do we look for in the extra oral exam
○ Laceration ○ Haematomas ○ Haemorrhage/CSF ○ Subconjunctival haemorrhage ○ Bony step deformities ○ Mouth opening
What do we look at for intra oral exam
○ Soft tissue
○ Alveolar bone (ensure not broken)
○ Occlusion (ensure no change)
○ Teeth
What about the soft tissue do we look at for a detailed intra oral exam
• Soft tissue damage e.g penetrating wounds, foreign bodies (may have to do something about it)
If we find tooth mobility in the intra oral exam what can this mean
• Tooth mobility - may indicate, displacement, root fracture, bone fracture
What do we do in transillumination
• Transillumination (can be done with a curing light - may show)
○ Fracture lines in teeth
○ Pulpal degeneration
○ Caries
What do we look at in a tactile test using a probe
○ Horizontal fractures
○ Vertical fractures
○ Pulpal involvement
What do we look at with percussion
duller note may indicate root fracture or it may sound different from adjacent teeth
What do we look at with the occlusion
traumatic occlusion demands urgent treatment and in the primary dentition that usually involves removal of the primary tooth
What radiographs are useful
○ Intra oral (periapicals) or anterior occlusal
○ Lateral pre-maxilla
○ OPT
○ Soft tissue
What does the trauma stamp consist of for primary teeth
• Tooth (notation) • Mobility (- or +) • Colour (description) • TTP (- or +) • Sinus (- or +) • Percussion note (norm/dull) Radiograph (- or +)
Why can we not do an EPT or thermal test on primary teeth
EPT/thermal testing is missing as it is not useful for children because if the tooth is resorbing then you may get different readings and if the child is small and not understanding what is being asked of them, you may just get a child saying something to please you, not what is right
What is the classification of trauma
· Enamel fracture - uncomplicated · Enamel dentine fracture - uncomplicated · Enamel-dentine-pulp - complicated · Crown-root (pulp involved) · Root fracture · Alveolar fracture · Concussion/subluxation · Luxation - lateral, intrusive, extrusive · Avulsion
What is the classification for crown fractures
· Enamel only
· Enamel and dentine
· Enamel dentine and pulp
What is the immediate home treatment for all injuries
· 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 or some gauze rolls for swabbing as until 4 they cant spit)
· After initial treatment review 1, 3, 6 monthly taking radiographs if possible 6 monthly
· Intrusion requires more frequent review (see guidelines) as we want to monitor the eruption
What is the treatment for enamel only injury
○ Smooth sharp edges
What is the treatment for enamel only or enamel dentine fractures
○ Restore/bandage with composite or compomer (do not use GI)
§ Need to cover exposed dentine so bacteria cannot get into the pulp if left open
What is the treatment for enamel dentine pulp fractures
○ Endodontic therapy or extract
What is different about endo in primary teeth
§ We use calcium hydroxide paste and iodiform paste so the tooth can resorb away for the adult tooth
§ The danger with endo is that the endodontic file encroaches on the permanent tooth follicle
§ Work 2mm back from the radiographic apex
§ Don’t take a radiograph with the file for the working length
What is the treatment for crown and root fractures
○ Extract coronal fragment
○ Don’t be overzealous to remove any root fragments that aren’t obvious as there is a chance that there could be damage to the permanent tooth and so these should be left to resorb physiologically
What is the treatment for alveolar bone fracture
○ Reposition segment
○ Splint to adjacent teeth 3-4 weeks
○ Previously when splinting we used a rigid splint but bone likes to be immobilised when healing so we use a flexible splint
○ Teeth may need to be extracted after alveolar stability has been achieved
What is the treatment for concussion and subluxation
Observation
What is the treatment for lateral luxation
○ Radiography to see if the periodontal space has increased apically
○ If there is no occlusal interference then allow the tooth to position itself spontaneously
○ If there is occlusal interference then extract
How do we locales intrusion
§ We don’t use paralax as we only use one radiograph
§ There are 2 types of film we can use to help localise - a periapical or a lateral premaxilla which is extra oral film so we can see if the tooth root has gone palatally to the germ or labially away from it
§ Being able to assess the danger to the permanent tooth which allows better counselling re-prognosis
How do we identify intrusion on a periapical
□ If the apical tip appears to be shorter than that of the contralateral then it has been toward or through the buccal plate which is what we want as this is away from the developing toot germ
□ If the apical tip is indistinct and the tooth appears elongated in comparison to the contra lateral tooth then the apex is displaced towards the permanent tooth germ
How do we identify displacement on a lateral premaxilla
□ Identifies the direction of displacement as providing a lateral view
What is the treatment for intrusion
§ Monitor re-eruption of tooth
§ If no re-eruption after 6 months consider extraction to avoid problems in eruption of permanent tooth
§ Look at its progress in comparison to adjacent teeth
How do we treat extrusion
○ Extract
Guidelines consider reposition but chance of damage to permanent tooth is high
How do we extract avulsion
○ Radiograph to confirm
○ Do not replant
What are the long term effects in primary teeth
· Discolouration
· Discolouration and infection
Delayed exfoliation
How do we treat discoloration on a vital tooth
no treatment, just remains discoloured
How do we treat discoloration on a non vital tooth
○ Sinus or PAP on radiograph then do RCT or extraction
No sinus or PAP then leave and review
How do we treat discoloration on an opaque tooth
No treatment
○ Usually happens because of sclerosis of the canal
What does immediate discolouration mean
may maintain its vitality
What does intermediate change in color mean
· If there is intermediate change in colour (weeks) then the tooth is non vital
The discolouration is coming from necrotic pulp products in the dentinal tubules so going to have to root treat or remove it or if there is no symptoms then we can leave it
Why does delayed exfoliation happen
· Primary tooth may not resorb normally after trauma, extraction is necessary or permanent successor will erupt ectopically
What are the long term effects in permanent teeth
· Enamel defects - most common · Abnormal tooth/root morphology ○ Crown or root dilaceration ○ Crown or root duplication · Delayed eruption · Ectopic tooth position · Arrest in tooth formation · Complete failure of tooth to form (usually if occurred very early on) Odontome formation
What are the enamel defects
hypomineralisation
hypoplasia
What does hypomineralisation present
white or yellow spot but a normal thickness of enamel
What are the tx options for hypomineralisation
§ Leave it
§ Mask with composite
§ Localised removal and restore with composite
§ External bleaching
§ Can do veneers later when gingival level is stabilised
How does hypoplasia present
yellow brown areas and less than normal enamel thickness
What are the tx options for hypoplasia
§ Restore with composite
Porcelain veneer when gingival level stabilised aka at least 16 years
What is the treatment for crown dilaceration
○ Surgical exposure
○ Ortho realignment
○ Improve appearance
What is the treatment for root dilaceration/angulation/duplication
Combined surgical and ortho
What is the treatment of arrest of root development
○ RCT
Extraction
What is the treatment for odotnome
○ Surgical removal
What is the treatment for an undeveloped tooth germ
○ May sequestrate spontaneously
○ May require removal
What can premature loss of primary tooth result in
· Premature loss of primary tooth can result in delayed eruption of about 1 year due to thickened mucos
When should you take a radiograph for delayed eruption
· Take radiograph if greater than 6 month delay compared to contralateral and palpate to see if you can feel the tooth
When does surgical exposure and ortho need done for delayed eruption
if abnormal morphology
