Trauma to Permanent Incisors Flashcards
1
Q
What percentage of 15 year olds suffer from Dentoalveolar trauma?
A
4%
2
Q
What are the social side effects of incisor trauma?
A
Children ith visible dental differences can be subject to negative social judgment and teasing by their peers
Negative impact on their quality of life
3
Q
When treating a patient with Dentoalveolar trauma whats the first thing you should do?
A
- Keep calm and have a reassuring approach
- Ask the child and the parent
- If the patient has a had injury or loss of consciousness send the patient to A&E
- Have a thorough and systematic approach
4
Q
When taking a history of a patient suffering from Dentoalveolar trauma what should you be trying to find out?
A
- Date of injury
- Location of injury
- Cause of injury
- Did the patient faint or are their any signs of head injury
- Other injuries
- Where is the tooth/ tooth fragments
- Medical history
- Past dental history and social history
5
Q
What would you carry out in your extra oral examination of a Dentoalveolar trauma patient?
A
- Gentle palpations
- Look for maxilla and mandible to see if theres signs of a facial bone fracture
- Look for soft tissue lacerations
6
Q
Give some symptoms of facial bone fracture
A
- Pain on palpations
- Occlusion may be deranged
- Patient can’t open or close their mouth
- May be able to see zygomatic abnormalities
7
Q
What would you carry out in your intra oral examination of a Dentoalveolar trauma patient?
A
- Systematically look at their soft and hard tissues
- Look for soft tissue lacerations
- Look for traumatised teeth: TTP, mobility, discolouration, displaceme
- Check all teeth for other diseases eg caries
- Check ALL anterior teeth
- Check occlusion
8
Q
Alongside history what else is important to do?
A
Special test
9
Q
Give examples of special tests?
A
Radiographs
Senstiviy tests
Transillumination using blue light
10
Q
Which radiographs should we take when treating a patient with incisor trauma
A
- Upper standerd occlusal and peri apicals
- OPTs if you’re concerned with facial fracture
- Soft tissue radiograph if concern of tooth fragment
11
Q
Why is it important to take radiographs when treating a trauma case
A
- Helps to form a diagnosis
- Can assess root development stage
- Can assess presence of root fracture
12
Q
What are the problems associated with a sensitivity test
A
Can be unreliable in children with immature permanent incisors
Children may be anxious and in pain so may react quicker
13
Q
Why is it important to do a sensitivity test?
A
To assess baseline responsiveness
14
Q
Why are sensitivity tests unreliable with immature permanent teeth?
A
They are poorly myelinated nerve fibres
15
Q
Name the 3 types of dental incisor trauma
A
- Fractures
- Luxation
- Both
16
Q
Name the 6 types of dental fractures
A
- Enamel fracture
- Enamel dentin fracture
- Enamel dentine pulp fracture
- Crown root fracture (uncomplicated)
- Crown root fracture (complicated)
- Root fracture
17
Q
Name the 2 types of enamel fractures
A
- Simple
2. Infraction
18
Q
Why are special tests important to take?
A
1; They help you form an accurate diagnosis
2, Acts as a baseline for follow up reviews
3. Can be an indicator of prognosis
19
Q
What is a simple enamel fracture?
A
Simple clean break that minimally gets into the enamel (2-3mm max)
20
Q
What is an infraction enamel fracture?
A
Where there’s no loss of enamel but the crack extends to the ADJ
21
Q
How ca we treat enamel fractures
A
- No treatment and just monitor
- Desensitising agents
- Unfilled resin
- Composite build up
22
Q
What is another name for enamel dentine fractures?
A
Uncomplcated fractures
23
Q
What does uncomplicated mean when we are describing fractures?
A
Means the pulp isn’t involved
24
Q
What are enamel dentine fractures
A
A fracture that only affects the enamel and dentine
25
How can we treat enamel dentine fractures?
1, Composite build up
| 2. Reattach fragment
26
Name the 2 sensitivity tests we can carry out
1. Using ethyl chloride
| 2. Doing at least 2 EPTs for each tooth (and try and have a control tooth)
27
What does complicated mean when we are describing fractures?
Means the pulp is involved in the fracutre
28
What are enamel dentin pulp fractures also called?
Complicated enamel dentine fractures
29
What is an enamel dentine pulp fracture?
A fracture where the enamel dentine and pulp are affected
30
What do we need to consider then dealing with enamel dentine pulp fracture
1. Time since the fracture occurred
2. Degree of contamination
3. Degree of damage
31
What are the treatment options for an enamel dentine pulp fractures?
1. Cvek's partial Pulpotomy
2. Pulpectomy
3. Pulp cap
32
What is the aim of a Cvek’s (Partial) Pulpotomy?
The aim is to preserve the vitality of the pulp by removing the top layer of potentially infected pulp tissue
33
What are you looking for when you first remove pulp tissue during Cvek’s (Partial) Pulpotomy?
Looking for fresh red pulp tissue that bleeds but the bleed is easy to stop with a cotton roll
If it doesn't bleed go another 2 mm §
34
What is a pulp cap?
When you place calcium hydroxide over the exposed site
35
Which treatment plan is caries out more Cvek’s (Partial) Pulpotomy or pulp capping?
Cvek’s (Partial) Pulpotomy as you have a higher chance of pulp surviving is higher
36
Can you carry out Cvek’s (Partial) Pulpotomy on a carious tooth?
Nope only carried on traumatised teeth?
37
How do we classify root fractures?
Based on:
1. Location (cervical, mid, apical)
2. Horizontal/ vertical
3. Single/ multiple
38
Why is the location of a root fracture important?
It dictates the prognosis and how you manage the fracture
39
A root fracture where on the tooth has the most positive prognosis?
Fractures further down towards the apex of the root have a better prognosis than a fracture near the cervical margin
40
Why do root fractures near the apex of the root have a better prognosis?
1. As the fracture Line is further from the oral mucosa so less chances of the fracture site being contaminated
2. Root fractures closer to the gingiva have a wobbly crown which is harder to splint and heal
41
How can we diagnose root fractures?
1. Check mobility as teeth with a root fracture will be more mobile
2. Fractured teeth can have extrusion of crown fragments
3. Need to take radiographs from 2 angles
42
How can treat root fractures?
1. Reposition the coronal segment of the tooth as soon as possible
2. Check position of the root fracture radiographically
3. Stabilise the tooth with a flexible spine for 4 weeks
4. It is advisable to monitor healing for at least 1 year to determine pulpal status
5. If pulp necrosis develops root canal treatment of the coronal tooth segMent to the fracture line is indicated to preserve the tooth
43
What are crown root fractures?
Fracture lines that start at the crown and extends beyond the gingiva or alveolar bone
44
Is prognosis good or bad for crown root fractures and why?
Poor prognosis as it is difficult to restore the tooth due to where the fracture line extends to and moisture control is hard
45
Why are crown root fractures difficult to treat and restore?
1. Can have multiple fracture lines
| 2. Multi disciplinary treatment may be needed alongside ortho and oral surgeons
46
How can we treat crown root fractures?
1. Fragment removal and gingivectomy
2. Orthodontic extrusion of apical fragment
3. Surgical extrusion
4. Root submergence
5. Extraction
47
How is fragment removal and gingivectomy used to treat crown root fractures?
Remove the coronal crown root segment with with subsequent endodontic treatment and restoration with a post-retained crown. This procedure should be preceded by a gingivectomy, and sometimes ostectomy with osteoplasty.
48
How can orthodontic extrusion of the apical fragment help treat crown root fractures?
Removal of the coronal segment with subsequent endodontic treatment and orthodontic extrusion of the remaining root with sufficient length after extrusion to support a post- retained crown.
49
What is Luxation
Damage to the periodontal structures surrounding the tooth
50
Name the 7 different types of Luxation
1. Concussion
2. Subluxation
3. Extrusion
4. Lateral luxation
5. Intrusion
6. Avulsion
7 Alveolar fracture
51
Name the most minor case of Luxation
Concussion
52
What is a concussion Luxation?
```
Where theres Haemorrhage and oedema in periodontal ligament
But:
No PDL tearing
Mild tenderness
No mobility
No displacement
```
53
How can we treat a concussion Luxation?
1. Non required usually
2. Instruct patients to have a soft diet and to avoid contact sport
3. Monitor as per IADT guidelines
54
What is a subluxation Luxation?
Tearing of the periodontal ligament
55
How can we diagnose a subluxation Luxation?
1. Blood in the gingival sulcus
2. Mild tenderness
3. Ma y have increased mobility
4. No displacement
56
How do we treat a subluxation ?
1. Usually no treatment
2. Can split for patient comfort if mobile
3. Instruct patients to have a soft diet and no contact sports
4. Monitor
57
What is extrusion?
1. Tearing of periodontal ligament
2. Rupture of neurovascular bundle
3. Tooth moves axially out of the socket
58
How can we diagnose an extrusion ?
1. Clinically the tooth looks dropped
2. There bleeding
3. Tenderness
4. Increased mobility
5. Displacement (check for occlusal interference)
6. Check for increased periodontal space apically using a radiograph
59
What are the treatment options for extrusion?
1. Reposition the tooth
2. Stabalise the tooth for 2 weeks using a flexible splint
3. Instructions to eat soft food and avoid contact sport
4. Monitor
60
What is lateral Luxation?
1. Simultaneous rupture and compression of the neurovascular bundle
2 .Tooth moves laterally
3. Fracture of alveolar socket
61
How can we diagnose lateral Luxation?
1. Often immobile due to locking in bone
2. Sometimes has ankylotic sound
3. Gingival haemorrhage
4. Crown may be labially or palatally displaced
5. Check for widened PDL space best seen on an occlusal film radiograph
6. Check for occlusal interference
62
How can we treat lateral Luxation?
1. Reposition the tooth digitally or with forceps to disengage it from its bony lock and gently reposition it into its original location
2, Stabilize the tooth for 4 weeks using a flexible splint
3. Monitor the plural condition
63
What is intrusion?
1. Crushing of neurovascular bundle and periodontal fibres
| 2. Tooth displaced axially into the bone
64
How can we diagnose intrusion
2. Clinical crown not fully visible
2. Often immobile
3. Sometimes has ankylotic sound
4. Gingival haemorrhage
5. Check for loss of PDL space apically on a radiograph
6. Check that the tooth isn't just partially erupted
65
What determines the treatment option for an intrusion luxation?
1. Check if theres an open or closed apex
2. Patient age needs to be considered
3. Intrusion severity
66
How would you treat a permeant tooth suffering from intrusion?
1. Spontaneous repositioning
2. Orthodontic repositioning
3. Surgical repositioning
67
When would we Spontaneously reposition a tooth suffering from intrusion?
1. Open apex up to 7mm
| 2. Closed apex of upto 3mm
68
When would we orthodontically reposition a tooth suffering from intrusion?
1. Open apex more than 7mm
| 2. Closed apex 2-7mm
69
When would we surgically reposition a tooth suffering from intrusion?
1. Open apex of more than 7mm
| 2, Closed apex greater than 7mm
70
What is avulsion?
The the tooth is knocked out of the mouth
71
Name on elf the few real emergencies in dentistry
Avulsion (when the tooth is knocked out of the mouth)
72
When dealing with a case of avulsion what should you do?
a1. Check the age and medical history of the patient
2. Keep the patient cal
3. Find the tooth and pick it BY THE CROWN
4. If the tooth is dirty since under cold running water
73
If a patient calls saying they have knocked their tooth out what should you do?
1. Keep the patient calm
2. Tell the patient to hold the tooth by the CROWN not root
3. If the tooth is dirty wash it gently under cold running water
4. Try to encourage the patient. parent to replant the tooth
5. If the tooth can't be re implanted then place the tooth in a suitable storage medium eg milk
6. Seal emergency dental treatment immediately
74
What is the treatment of avulsion dependent on?
1. Open closed apex
2. Total extra oral time
3. Extra oral dry time
75
After how much dry time is the likelihood of the tooth healing 0%
30 minutes
76
After how much wet time is the likelihood of the tooth healing 0%
60 min
77
When is unfavourable healing guaranteed?
1. When extra alveolar time is one 60 mins
2. When time in an extra alveolar medium exceeds 60 mins
3. When extra alveolar dry time is over 30 mins
78
What can unfavourable healing lead to ?
Pulpal necrosis
79
What causes replacement resorption?
1. Death of the periodontal ligament
2. This leads to bone directly contacting with the tooth
3. Which leads to infra occlusion and repalcemtn resorption
80
Is replacement resorption good or bad?
Bad as the bone has fused to the tooth becoming ankylosed
81
What are the benefits of replacement resorption?
Buys us time but if you leave it going on for too long the tooth will end up in the buccal surface leading to a permanent bony defect that's hard to fix
82
What should you expect to happen with any tooth that has been out of the mouth for more than 60 mins?
Ankylosis will occur
83
Does closed or open apex have a poorer prognosis?
Closed apex
84
Broadly describe how you'd manage avulsion ?
1. Give LA
2. Rinse out the socket and the tooth
3. Digitally re implant the tooth
4. Check clinically and radiographically that the oath is in the right tplace
5. Apply a physiological splint (soft wire) to the tooth with composite for 2-4 weeks
6, Give systemic antibiotics
85
Name the antibiotics wit administer to help treat tooth avulsion
Tetracycline is the first choice (2 times a day for 7 days)
86
What are the negatives of Tetracycline
Cant prescribe to children under 12
| Can lead to staining
87
What can we prescribe to children under 12 instead of Tetracycline?
Phenoxymethyl Penicillin (Pen V) or amoxicillin,
88
What instructions do we give to patients after we have re implanted their tooth
1. Soft food for 2 week
2. No contact spirt
3. Brush teeth with a soft tooth brush after meals
4. Use chlorhexidine (0.1 %) mouth rinse twice a day for 1 week.
89
What do you need to check with the patient if their avulsed tooth has been in contact with soil?
Check to see if thieve had their tetanus shot and booster
90
What are the chances of the pulp surviving in an avulsed tooth with a closed apex?
0%
91
What are the chances of the pulp surviving in an avulsed tooth with an open apex?
30%
92
How do we go about treating an avulsed tooth with a closed apex?
Begin endodontic treatment 7-10 days with the splint still on
93
How do we go about treating an avulsed tooth with an open apex?
Begin endodontic treatment 7-10 days if the tooth was out the mouth for more than an hour
If under an hour then just monitor the tooth
94
What is an alveolar fracture
Fracture of the alveolar plate
| Teeth can sometimes remain in the socket
95
How can we diagnose an alveolar fracture?
1. Segmental mobility of full section of bone
2. Several teeth may move together at the same time
3. Displacement +/ occlusal interference
4. Gingival tearing and bleeding
5. Teeth may or may not respond to vitality test
96
What is the treatment of an alveolar fracture?
1. Reposition any displaced segment and then splint.
2. Suture gingival laceration, if present.
3. Stabilize the segment for 4 weeks.
4. If severe fracture, may need to refer to
Maxillofacial department
