trauma to incisors Flashcards
how many 15 year olds suffer from dentoalveolar trauma
4%
what type of trauma is common
dentoalveolar trauma
how do we manage trauma cases
can be complex and long term
what do children with trauma suffer from
it influences oral health related quality of life
children with traumatised incisors can be subject to negative social judgments and teasing
what guidelines do we follow
the international association of dental traumatology
how do we help with dental trauma
keep calm and be reassuring- through a systematic approach
ask parents and child
head injury/loss of consciousness- straight to A&E
what should we fill out if a patient was to come to us for trauma
trauma history and diagnosis form
what do we record on the trauma history form
date of injury location cause KO symptoms of head injury other injuries where is the tooth fragments PMH PSH/PDH
what do we look at in an extra oral exam
gentle palpation
maxilla and mandible
soft tissue lacerations
what do we look for IO
soft tissue and also any lacerations
hard tissue
traumatised temp-TTP,MOBILILTY,DISPLACEMENT,DISCOLOURATION check all teeth
check occlusion
why do we carry out speciality tests
help with accurate diagnosis
act as baseline for followup
can be an indicator from prognosis
what should we also use in special tests
OPT if concern of facial fracture
soft tissue if concern of tooth fragment
what do we need to consider as well as our radiograph
root development stage
assess presence of root fracture
what do we use for special tests
ethyl chloride
EPT
transillumination
test normal teeth as well as damaged teeth
why can sensitivity tests not be accurate
due to the fact its subjective and children will be anxious and in pain
if we do a VT on an immature tooth why might it not be accurate
poorly myelinated nerve fibre
what are the two types of injuries
fractures
luxation
but a tooth can have both types
what are the most minimal enamel fracture
simple
infraction-no loss of enamel but crack extends into the ADJ
what are the treatment options for enamel fracture
- None and monitor
- Desensitising agents
- Unfilled resin
- Composite build-up
how do we repair infractions
unfilled resin or a small composite build up
what were enamel dentine fractures previously called
uncomplicated fractures
what is the treatment for enamel-dentine fracture
composite buildup
or reattach fracture- long term issues as it can dry out the tooth
what were enamel dentine pulp fractures called
complicated enamel dentine fracture
what do we need to consider with complicated enamel dentine fracture
time since damage
degree of contamination
degree of damage
what are the treatment options for enamel dentine pulp fracture
Cvek’s (Partial) Pulpotomy
• Pulpectomy (extirpation, complete removal of the pulp) •Pulp cap(?)
what is Cvek’s (Partial) Pulpotomy
removing the top part of the pulp to remove the infected part - eg 2mm
looking for fresh red pulp which stops bleeding with pressure with a pellet
what is a pulp cap
placing CAOH over the exposed site- not really done anymore
how do we group root fractures
location(cervical,mid, apical)
horizontal/vertical
single and multiple
what are the diagnosis of a root fracture
mobility might be increased
can have an extrusion of a crown
radiographs from two angles
what is the treatment of root fractures
reposition if displaced check position radiographically stabilise the tooth with a flexible splint for 4 wks- if near the cervical areas of the tooth monitor healing for a year if pulp necrosis then RCT
what is a crown root fracture
Fracture line extends
- Below gingival crevice - Below alveolar bone
why can crown root fractures be complex
fragment might be attached
can have multiple fracture lines
difficult to treat and restore-MDT management
how can we treat crown root fractures
fragment removal and gingivectomy orthodontic extrusion of apical fragment surgical extrusion root submergence extraction
what types of luxation do we have
concussion subluxation extrusion lateral luxation intrusion avulsion alveolar fracture
what is a concussion luxation
haemorrhage and oedema in PDL no tearing tender no mobility no displacement
what is the treatment of the concussion laxation
non required
soft diet
avoid contact sports
monitor as IADT guidline
what is subluxation
tearing of PDL blood in the ginigival sulcus tender may have increased mobility no displacement
what is the treatment for subluxation
usually none
can split for comfort if mobile
soft diet no contact sports
monitor
what is extrusion
tearing of PDL
rupture of NVB(neuromuscular bundle)
tooth moves axially out of the socket
what does extrusion look like clinically
looks dropped bleeding tender mobility displacement radiographically
what is the treatment for extrusion
reposition the tooth
stabilise for 2 weeks using a flexible splint
instructions
monitor
what is a lateral luxation
simultaneous rupture and compression of the NVB
tooth moves laterally
fracture of alveolar socket
what does lateral luxation look like clinically
immobile due to locking in bone
sometimes ankylotic sound
gingival haemorrhage
crown may be labially or palatally displaced
gingival haemorrhage
radiographically- widened PDL space best seen on occlusal film check for occlusal interference
what is the treatment for lateral luxation
Reposition the tooth digitally or with
forceps to disengage it from its bony lock and gently reposition it into its original location.
• Stabilize the tooth for 4 weeks using a flexible splint.
• Monitor the pulpal condition.
what is intrusion
crushing of the NVB and PDL
tooth displaced axially
what do we see clinically on intrusion teeth
Clinical crown not fully visible • Often immobile • Sometimes has ankylotic sound • Gingival haemorrhage • Radiographically – loss of PDL space apically • Check – partially erupted teeth?
what is avulsion
tooth knocked out the mouth
how do we deal with avulsion
check age and MH- we only reimplant adult teeth, baby teeth should not be reimplaced
keep the patient calm
pick the tooth up by the crown and avoid touching the root
if dirty- wash gently for 10 seconds
try to replace the tooth and bite on a handkerchief
if not possible then store in a medium eg such as milk or a pot of saliva
seek emergency treatment
what is the treatment of avulsion
open or closed apex
total EO time- if more than 30/60 mins less positive outcome
EO dry time
what is guaranteed with avulsion
unfavourable healing
what is included in unfavorable healing
pulp necrosis
PDL death leading to ankylosis
what are the steps of replacement resorption
death PDL
bone in direct contact with tooth
ankylosis and replacement resorption
what do we need to prescribe when dealing with patients who suffer from avulsion
systemic antibiotics:
tetracycline first choice- doxycycline 2x/day for 7 days at app for dose for patient age and weight
tetanus coverage?
what do we need to consider when prescribing tetracycline
risk of discolouration- many countries tetracycline not recommended for patient under 12
what is the appropriate instead of tetracycline in children
phenoxymethyl penicillin
what instructions do we give patients who have had a reimplanted tooth
soft food for two weeks
no contact sport
brush with soft toothbrush
use chlorhexidine mouth rinse 2x a day for 1 week
what do we do if there is a closed apex avulsion
begin RCT 7-10 DAYS with splint on
what do we do if there is a OPEN apex avulsion
BEGIN act 7-10 DAYS if out of the mouth for 60 mins
close monitoring if less than 60 mins
describe an alveolar fracture
fracture of the alveolar plate segmental mobility of full section several teeth might move together gingival tearing may not respond to VT
what is the treatment of an alveolar fracture
Reposition any displaced segment and then splint.
• Suture gingival laceration, if present.
• Stabilize the segment for 4 weeks.
• If severe fracture, may need to refer to
Maxillofacial department
what are the guidelines for avulsion
4 weeks – Splint removal (2 weeks for <60 mins), clinical and radiographic examination.
• 6-8 weeks – Clinical and radiographic examination.
• 4 months – Clinical and radiographic examination.
• 6 months – Clinical and radiographic examination.
• 1 year – Clinical and radiographic examination.
• 5 years – Clinical and radiographic examination.
explain the severity of fractures
enamel fracture enamel dentine fracture enamel dentine pulp fracture crown root fracture crown root fracture(complicated)
