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Questions and Answers

What is the most common injury?

Enamel dentine fracture (uncomplicated as not in pulp)

What type of children do dental traumas usually occur in?

7-10 years old boys with large overjet (>9mm)

What are common causes of dental trauma in children? (Select all that apply)

Falls

Bike accidents

Sports

All of the above (correct)

What history do we need to take for trauma?

When, where, how, symptoms (loss of consciousness, sickness), lost teeth or fragments Signup and view all the answers

What needs to be considered on the medical history when looking at child trauma?

Congenital and acquired heart anomalies, immunosuppression, vaccination status (tetanus) Signup and view all the answers

What do we need to consider on the child's dental history when assessing trauma?

Previous trauma, treatment experience, parent and child attitude Signup and view all the answers

Are antibiotics used in trauma in children?

True Signup and view all the answers

What should we look for on E/O exam in childhood trauma?

Laceration, haematoma, haemorrhage/CSF, sub conjunctival haemorrhage, bony step deformities, mouth opening Signup and view all the answers

What should we look for on I/O exam of trauma?

Soft tissue penetrating wounds, alveolar bone condition, occlusion, tooth mobility Signup and view all the answers

What may be useful to do to check any changes on occlusion?

Ask the patient for a picture of them before injury Signup and view all the answers

What special investigations can we carry out for childhood trauma?

Sensibility tests, radiographs, additional vertical angulation, photographs Signup and view all the answers

What is involved on a trauma stamp chart?

Mobility, displacement, TTP, colour, sinus/tender in sulcus, thermal and electric tests, radiographs Signup and view all the answers

Why should we sensibility test adjacent and opposing teeth?

Due to direct or indirect concussive injuries Signup and view all the answers

Why may sensibility tests be unreliable to assess neural cavity activity?

Transient loss of neuronal response or undifferentiated A delta nerve fibres in young teeth Signup and view all the answers

What finding is frequent during post-traumatic healing, particularly post luxations?

Temporary loss of sensibility Signup and view all the answers

Is lack of response possible without pulp necrosis?

True Signup and view all the answers

How long should you continue sensibility testing following injury?

For 5 years Signup and view all the answers

Arrested root development doesn't necessarily mean loss of vitality - What on a radiograph is a sign of continued vitality?

Root canal obliteration Signup and view all the answers

How long is radiographic monitoring used following injury?

Long term (normal to see transient apical breakdown in the first month) Signup and view all the answers

What are uncomplicated fractures? (Select all that apply)

Crown-root (no pulp) Signup and view all the answers

What are complicated fractures? (Select all that apply)

Crown-root (pulp involved) Signup and view all the answers

What are three types of root fractures?

Apical, middle, and gingival/coronal (displaced and undisplaced) Signup and view all the answers

What does the prognosis of crown and root fracture depend on?

Age of child, type of injury, combination of injuries, time between injury and treatment, presence of infection Signup and view all the answers

What are the aims and principles of treating trauma in emergencies?

Retain vitality by protecting exposed dentine, treat exposed pulp tissue, reduce and immobilize displaced teeth, provide tetanus prophylaxis if indicated Signup and view all the answers

What are the aims and principles of treatment of intermediate trauma?

+/- pulp treatment, restoration such as minimally invasive techniques Signup and view all the answers

What are the aims and principles of treatment of trauma in permanent management?

Apexification, root filling, gingival and alveolar collar modification, coronal restoration Signup and view all the answers

What is infraction?

Incomplete enamel fracture without tissue loss Signup and view all the answers

What investigations should we carry out for enamel or enamel dentine trauma?

1x PA radiograph, evaluate size of pulp chamber & stage of root development, sensibility test Signup and view all the answers

What treatment can we carry out for enamel or enamel dentine trauma?

Ca(OH)2 base if within 0.5mm of pulp, restore with re-bond fragment or composite dressing Signup and view all the answers

How do we monitor enamel or enamel dentine trauma?

Clinical tests (Trauma Stamp), sensibility tests at various intervals for 5 years Signup and view all the answers

Why should we use radiographs during enamel or enamel dentine trauma monitoring?

To assess root development, compare with the other side, and check for resorption Signup and view all the answers

Does an open or closed apex mean better prognosis?

Open Signup and view all the answers

What radiographs are required for EDP#?

PA Signup and view all the answers

What does treatment of EDP# depend on?

Size of exposure and time since exposure. Signup and view all the answers

What does prognosis of EDP# depend on?

Associated luxation injuries Signup and view all the answers

How do you treat a tiny exposure of pulp within 24 hrs?

Direct pulp cap with calcium hydroxide and hermetic seal (composite) Signup and view all the answers

How do you treat a large exposure more than 24 hrs since trauma?

Pulpotomy - partial or full coronal with bioceramic (e.g. biodentine or white MTA) and hermetic seal (composite) Signup and view all the answers

How do you treat a large exposure with no vital tissues remaining in the coronal portion?

Pulpectomy (open apex) - ND CaOH initially, then MTA/biodentine to produce apical stop and then obturate Signup and view all the answers

What is involved in a partial pulpotomy?

Partial pulpotomy involves excising 2-3mm of pulp tissue, applying dressing, and sealing with composite. Signup and view all the answers

After doing partial pulpotomy, if no bleeding/uncontrollable bleeding proceed to full coronal. What is involved in this process?

Excise all pulp in chamber, rinse, apply dressing, hermetic seal with composite. Signup and view all the answers

If there are any signs of non-vitality following check-ups, what should we do?

Pulpectomy Signup and view all the answers

What is the aim of pulpotomy?

Apexogenesis (keep vital pulp tissue within canal to allow normal root growth) Signup and view all the answers

What is involved in the pulpectomy process?

Involves rubber dam, access, irrigation, diagnostic radiograph, drying canal, Ca(OH)2 dressing, review and obturation. Signup and view all the answers

What are the properties of MTA?

Sets in a wet environment, good sealing properties, easy to visualize radiographically, not soluble, some antibacterial properties Signup and view all the answers

What are some definitive coronal restoration options?

Composite dowel core, bonded composite, crown, avoid post crown Signup and view all the answers

What does the prognosis of a root fracture depend on?

Age of child, degree of displacement, time between injury and treatment, presence of infection Signup and view all the answers

What should we examine for a root fracture?

Mobility, position/displacement, TTP, colour, occlusion Signup and view all the answers

What sensibility testing should we do for root fractures?

Ethyl chloride / endo frost, electric pulp test Signup and view all the answers

What radiographs should be used for root fractures?

PA and upper standard occlusal Signup and view all the answers

How should we treat an undisplaced immobile tooth with root fracture?

Advise soft diet and monitor vitality Signup and view all the answers

How should you treat a displaced and mobile tooth with root fracture?

Reposition, apical/middle third = flexible splint for 4 weeks; coronal third = flexible splint for 4 months Signup and view all the answers

Which type of fracture requires longer splinting for stability?

Coronal third fractures Signup and view all the answers

What may we see on a healing root injury radiograph?

Calcified tissue union across fracture line, connective tissues Signup and view all the answers

What may we see on a non-healing root injury radiograph?

Granulation tissue (usually associated with loss of vitality) Signup and view all the answers

What is pulpal prognosis affected by?

Other injuries such as coronal enamel dentine fracture Signup and view all the answers

What is hard tissue union affected by?

Non-vitality, original displacement of coronal part Signup and view all the answers

How should we treat apical and middle third fractures?

Extirpate to fracture line, dress with Ca(OH)2 then MTA/biodentine just coronal to fracture line, obturate to fracture line Signup and view all the answers

How should you treat the distal fragment of a root fracture?

Often requires no treatment as it remains with PL, absorbs; however, if this infects use antibiotics or do apicectomy Signup and view all the answers

What are some options for crown root fractures?

Extract coronal portion or root-fill, extrude root and restore Signup and view all the answers

What requirements need to be met for extrusion?

Good oral hygiene, low caries rate, sufficient adjacent teeth, eventual position - crown/root ratio Signup and view all the answers

Study Notes

Dental Trauma Classification and Management

Most Common Injury: Enamel dentine fracture, uncomplicated (not involving pulp).

Demographics

Age Group: Dental traumas frequently occur in children aged 7-10 years.
Gender Prevalence: Boys are more commonly affected.

Aetiology of Dental Trauma

Common causes include falls, biking, skateboarding, sports activities, and fights.

History Taking for Trauma

Essential information includes the timing and location of the injury, symptoms like loss of consciousness, and any lost teeth or fragments.
Consider environmental factors like soil, which may necessitate tetanus awareness.

Medical History Considerations

Important to evaluate for congenital and acquired heart anomalies, immunosuppression.
These medical conditions are not contraindications for treatment but may require antibiotic prophylaxis.
Ensure up-to-date tetanus vaccination status.

Dental History Assessment

Look for previous trauma, treatment experiences, and attitudes of both the child and parent.

Antibiotic Use in Trauma

Evidence supporting antibiotic use in luxation injuries is limited; however, avulsion injuries may warrant prophylaxis based on the medical history.

Extraoral and Intraoral Examination

Extraoral: Check for lacerations, hematomas, hemorrhage, and bony deformities.
Intraoral: Inspect for penetrating wounds, mobility of teeth, and signs of fractures.

Sensibility Testing

Required for adjacent and opposing teeth due to potential concussive injuries.
Sensibility tests may yield unreliable results due to transient neuronal response loss or undifferentiated nerve fibres in young teeth.

Healing and Monitoring

Temporary loss of tooth sensibility is common after trauma; lack of response can occur for months.
Regular sensibility testing should continue for five years post-injury.

Radiographic Monitoring

Long-term monitoring is essential; note transient apical breakdown in the first month after injury.

Fracture Classifications

Uncomplicated Fractures: Involve enamel, enamel-dentine, and crown-root (no pulp involvement).
Complicated Fractures: Involve enamel-dentine-pulp and crown-root (pulp involved).

Root Fracture Types

Classifications include apical, middle, and coronal fractures, which can be displaced or undisplaced.

Treatment Principles in Emergencies

Focus on preserving vitality, treating exposed pulp, and immobilizing displaced teeth.
Consider tetanus prophylaxis if applicable.

Treatment Approaches to Trauma

Emergency: Aim for vitality retention, treat exposed pulp.
Intermediate: May involve pulp treatment or minimally invasive restorations.
Permanent Management: Options include apexification, root filling, or gingival modifications.

Pulp Injury Treatment

Direct Pulp Cap: For small exposures within 24 hours using calcium hydroxide.
Pulpotomy: For larger exposures after 24 hours, partial or full coronal treatment needed.

Pulpal Prognosis Factors

Influenced by the age of the child, tooth maturity, the combination of injuries, and treatment timing.

Root Fracture Management

Monitor teeth and treat mobility and displacement.
Use flexible splints for coronal fractures for longer durations.

Final Prognosis Considerations

Prognosis varies with the age of the child, displacement, and the presence of other injuries.
Assess clinical indicators like vitality, integrity, and healing patterns through radiographs.

Restorative Options

For crown-root fractures, treatment options involve extracting the coronal portion, root filling, and possible mucoperiosteal flap use to maintain alveolar bone structure.

Summary of Treatment Approaches

Emphasize the need for maintaining oral health, assessing for caries risk, and ensuring a good coronal/root ratio for tooth preservation strategies.

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