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Dr Mistry > Week 11- Outcomes of Dental Trauma > Flashcards

Week 11- Outcomes of Dental Trauma Flashcards

1
Q

What tooth trauma’s have high risk of damaging permanent successors?

A
  • Intrusion
  • Avulsion
  • Lateral luxation
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2
Q

What type of traumas are likely with high vs low velocity impact?

A

High velocity: fracture

Low velocity: displacement

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3
Q

What do outcomes of trauma depend on?

A
  • Type and severity of injury
  • Stage of dental development
  • Type of tx
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4
Q

When can outcomes of trauma occur?

A

Days, months or years after trauma has taken place

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5
Q

What should you assess on patient with trauma?

A
  • Soft tissues
  • Visual assessment of tooth position
  • Colour of tooth
  • Mobility
  • Perio
  • Percussion test (sound and ttp)
  • Sensibility test
  • Radiograph
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6
Q

What should you do if pt has lip laceration?

A

Soft tissue radiograph

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7
Q

What are possible outcomes following trauma?

A
  • Nil
  • Pulpal (discolouration, canal obliteration, necrosis)
  • PDL (infection related resorption, ankylosis resorption, surface reparative resorption, transient apical breakdown )
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8
Q

What are the 2 types of infection related resorption?

A
  • Internal inflammatory root resorption
  • External inflammatory root resorption
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9
Q

What is external inflammatory root resorption?

A

Toxins from pulp space > dentine tubules > inflammation and resorption of root surface (punched out lesions on root surface and resorption of bone)

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10
Q

Why should you perform elective pulpectomy after avulsion in mature teeth?

A

Prevent infection related root resorption

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10
Q

Why should you perform elective pulpectomy after avulsion in mature teeth?

A

Prevent infection related root resorption

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11
Q

Are PDL or pulpal issues more concerning?

A

PDL- needs urgent intervention

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12
Q

Is surface reparative resorption significant?

A

Not very clinically significant. Small areas of resorption.

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13
Q

How should transient apical breakdown be managed?

A

More rare and can happen after trauma- will disappear in 6-12 months. If no other signs of pulpal necrosis, don’t do RCT.

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14
Q

9 year old with mild intrusion. How would you manage?

A
  • 1 week: soft tissue
  • 3-4 weeks: PDL (if you see resorption do pulp extirpation to halt resorptive process) Also see if tooth has started to erupt- if it hasn’t, do ortho traction
  • 6-8 weeks: Pulp (if you see discolouration wait 3 months until you do something)
  • 6 months
  • 1 year
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15
Q

9 yr old child with avulsed immature permanent tooth that develops EIRR. How would you manage?

A
  • Replanted tooth and splint for 7-10 days (flexible)
  • 1 week: soft tissue and remove splint
  • 3-4 weeks: IOPA. If EIRR, extirpate and dress
  • 6-8 weeks: take another IOPA and monitor and change dressing
  • Once resorption stable, maybe do obturation
16
Q

What is protocol for mature tooth with severed PDL and pulpal injury?

A

RCT asap

17
Q

What is protocol for immature tooth with severed PDL and pulpal injury?

A

Want root development to continue so don’t
intervene immediately. If you start seeing root resorption after 3-4 weeks, extirpate and dress with CaOH- don’t extrude through apex.

Can place MTA plug and obturate after if prognosis okay and walls aren’t too thin. Could alternatively do stem cell regenerative therapy at apex to see if it grows.

18
Q

What is pulp discolouration often caused by?

A
  • Bruising
  • Pulp canal obliteration
  • Pulp necrosis (grey)
19
Q

How does pulp canal obliteration appear and how should it be treated?

A
  • Yellow darkening
  • Observe- no tx indicated if no signs of infection
  • Reduced response to sensibility test
20
Q

What are characteristics of inflammatory root resorption?

A
  • Colonised by multinuclear giant cells due to microbial products
  • Non vital teeth
  • Damage to PDL
  • Need radiographs
  • Needs RCT
21
Q

What is cervical resorption and how does it appear?

A

Damage to root surface in cervical area caused by infected pulp or periodontium.

  • Clinically: pink near cervical margin
  • Radiograph: resorption in cervical area
22
Q

How is cervical resorption treated?

A
  • Vital tooth- curettage and MTA/CaOH lining followed by resto (can apply TCA to lesion before restoring)
  • Non-vital tooth- RCT and as per vital tooth
23
Q

How is internal root resorption diagnosed and treated?

A
  • Pulp necrosis
  • Clinically: may have pink discolouration of crown
  • Radiographic: resorption in pulp space of internal dentinal wall. Rounded symmetrical radiolucency
  • Tx: RCT
24
Q

What is ankylosis/replacement resorption?

A

Occurs after luxation injury with significant damage to PDL. Repair of bone vs tooth root surface is unbalanced with bone taking over and obscuring PDL space.

25
Q

How is ankylosis resorption diagnosed?

A
  • Ankylotic sound (high pitched, metallic)
  • May appear to be infraoccluded
  • Can be hard to see radiographically in early stages
26
Q

How is ankylosis treated?

A
  • May leave to monitor and allow for it to take over root
  • In non-vital teeth, RCT and dressing
  • Decoronation
27
Q

What are the outcomes of trauma to primary teeth?

A
  • Discolouration
  • Pulp canal obliteration
  • Pulp necrosis
  • Root resorption
28
Q

How should you manage intruded primary tooth?

A

After intrusion, wait 1 month to see if it starts to erupt spontaneously. If not, extract as it can become ankylosed and prevent eruption of permanent successor. Can also become infected and impact the permanent successor.

29
Q

What are some injuries to succedaneous teeth?

A
  • Enamel defects
  • Dilaceration
  • Malformation
  • Odontoma-like-formation
  • Duplication
  • Arrested development
  • Eruption disturbances
30
Q

How should you manage primary asymptomatic slightly loose tooth?

A
  • Do nothing, monitor and tooth may exfoliate naturally (if flares up inform pt to come back)
  • Extract tooth- if child is cooperative
31
Q

When is the only time you would splint in patients with primary dentition?

A

Only splint if there is alveolar fracture you need to stabilise

Dr Mistry (8 decks)

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