Traumatology

Question 1

• Oro-facial injuries account for 5% of all bodily injuries (Andersson 2013)
• Incidence of dental injuries is 1-3% in children
• M>F
  Diagnosis and assessment: What Further information required regarding the injury:

Answer 1

1. When did it happen
2. Where did it happen
3. How did it happen
4. Any lost of consciousness
5. Previous injuries
6. Immediate management of the injury
7. Concomitant injuries
8. Medical history

Question 2

Clinical exam:

E/O

Answer 2

• Inspection and palpation of E/O structures

Question 3

Clinical exam:

I/O

Answer 3

• Mobility
  o 0-3 scale:
  ♣ 0- no abnormal looseness
  ♣ 1- movement facial-lingually or mesio-distally, less than 1mm
  ♣ 2- movement facial-lingually or mesio-distally, more than 3mm
  ♣ 3- movement facial-lingual, mesio-distal and axially
• Percussion sound
  o Tapped horizontally on the labial/facial surface
• Tenderness to percussion
  o Tapping on the incisal edge
  o Tenderness immediate post trauma indicates injury to supporting structures and PDL.
  o Persistent tenderness in the follow-up period indicates infection.

Question 4

• Responsiveness to sensibility test

Answer 4

o Temporary lost of sensibility occurs due to blood supply:
♣ torn (concussion and subluxtion)
♣ severed or ruptured (extrusion/lateral luxatation)
o This could lead to:
♣ Pulpal edema * torn blood supply
- which results in negative response to pulp sensibility testing and may take 10-14 days before a positive response can be obtained
♣ Tooth dislocation and subsequent rupture of the neurovascular supply
- 3 months in immature teeth for positive response
- several years in mature teeth with closed apex for positive response.

o The negative response is NOT an indication of pulpal necrosis but of PULPAL DAMAGE.
o True vitality testing requires equipment capable of monitoring pulpal blood flow, that is, laser Doppler flow meters (LDM)

Question 5

Sensibility test

Answer 5

o Cold test:
♣ CO2 snow – 78
♣ Diflourodichloromethane -50
♣ More reliable than electric pulp testing for immature teeth
o EPT
♣ Teeth with open apices will generally react to a higher threshold value than teeth with closed apices.
♣ Bastos et al. found:
• electric pulp testing most reliable in the long-term follow up for pulpal diagnosis. However, cold testing is recommended over electric pulp testing in young individuals (i.e., open apical foramen)

Question 6

Colour change

Answer 6

o Andresen : reversible color change can occur at the time of injury
o Malmgren and Hubel: discoloration disappeared from 4 weeks to 6 months after injury in root fractured teeth

Question 7

Radiographic assessment

Answer 7

• assess stage of root development
• Any injuries to the root of the tooth and supporting PDL
• The extent of the displacement is illustrated by the widening of the PDL space in lateral and extrusive luxation.
• IADT- Three different angle of PA and one occlusal view
• ASE- 2 pa and 1 occlusal