Podcast
Questions and Answers
What is the most common injury?
What is the most common injury?
Enamel dentine fracture (uncomplicated as not in pulp)
What type of children do dental traumas usually occur in?
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)
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?
What history do we need to take for trauma?
What needs to be considered on the medical history when looking at child trauma?
What needs to be considered on the medical history when looking at child trauma?
What do we need to consider on the child's dental history when assessing trauma?
What do we need to consider on the child's dental history when assessing trauma?
Are antibiotics used in trauma in children?
Are antibiotics used in trauma in children?
What should we look for on E/O exam in childhood trauma?
What should we look for on E/O exam in childhood trauma?
What should we look for on I/O exam of trauma?
What should we look for on I/O exam of trauma?
What may be useful to do to check any changes on occlusion?
What may be useful to do to check any changes on occlusion?
What special investigations can we carry out for childhood trauma?
What special investigations can we carry out for childhood trauma?
What is involved on a trauma stamp chart?
What is involved on a trauma stamp chart?
Why should we sensibility test adjacent and opposing teeth?
Why should we sensibility test adjacent and opposing teeth?
Why may sensibility tests be unreliable to assess neural cavity activity?
Why may sensibility tests be unreliable to assess neural cavity activity?
What finding is frequent during post-traumatic healing, particularly post luxations?
What finding is frequent during post-traumatic healing, particularly post luxations?
Is lack of response possible without pulp necrosis?
Is lack of response possible without pulp necrosis?
How long should you continue sensibility testing following injury?
How long should you continue sensibility testing following injury?
Arrested root development doesn't necessarily mean loss of vitality - What on a radiograph is a sign of continued vitality?
Arrested root development doesn't necessarily mean loss of vitality - What on a radiograph is a sign of continued vitality?
How long is radiographic monitoring used following injury?
How long is radiographic monitoring used following injury?
What are uncomplicated fractures? (Select all that apply)
What are uncomplicated fractures? (Select all that apply)
What are complicated fractures? (Select all that apply)
What are complicated fractures? (Select all that apply)
What are three types of root fractures?
What are three types of root fractures?
What does the prognosis of crown and root fracture depend on?
What does the prognosis of crown and root fracture depend on?
What are the aims and principles of treating trauma in emergencies?
What are the aims and principles of treating trauma in emergencies?
What are the aims and principles of treatment of intermediate trauma?
What are the aims and principles of treatment of intermediate trauma?
What are the aims and principles of treatment of trauma in permanent management?
What are the aims and principles of treatment of trauma in permanent management?
What is infraction?
What is infraction?
What investigations should we carry out for enamel or enamel dentine trauma?
What investigations should we carry out for enamel or enamel dentine trauma?
What treatment can we carry out for enamel or enamel dentine trauma?
What treatment can we carry out for enamel or enamel dentine trauma?
How do we monitor enamel or enamel dentine trauma?
How do we monitor enamel or enamel dentine trauma?
Why should we use radiographs during enamel or enamel dentine trauma monitoring?
Why should we use radiographs during enamel or enamel dentine trauma monitoring?
Does an open or closed apex mean better prognosis?
Does an open or closed apex mean better prognosis?
What radiographs are required for EDP#?
What radiographs are required for EDP#?
What does treatment of EDP# depend on?
What does treatment of EDP# depend on?
What does prognosis of EDP# depend on?
What does prognosis of EDP# depend on?
How do you treat a tiny exposure of pulp within 24 hrs?
How do you treat a tiny exposure of pulp within 24 hrs?
How do you treat a large exposure more than 24 hrs since trauma?
How do you treat a large exposure more than 24 hrs since trauma?
How do you treat a large exposure with no vital tissues remaining in the coronal portion?
How do you treat a large exposure with no vital tissues remaining in the coronal portion?
What is involved in a partial pulpotomy?
What is involved in a partial pulpotomy?
After doing partial pulpotomy, if no bleeding/uncontrollable bleeding proceed to full coronal. What is involved in this process?
After doing partial pulpotomy, if no bleeding/uncontrollable bleeding proceed to full coronal. What is involved in this process?
If there are any signs of non-vitality following check-ups, what should we do?
If there are any signs of non-vitality following check-ups, what should we do?
What is the aim of pulpotomy?
What is the aim of pulpotomy?
What is involved in the pulpectomy process?
What is involved in the pulpectomy process?
What are the properties of MTA?
What are the properties of MTA?
What are some definitive coronal restoration options?
What are some definitive coronal restoration options?
What does the prognosis of a root fracture depend on?
What does the prognosis of a root fracture depend on?
What should we examine for a root fracture?
What should we examine for a root fracture?
What sensibility testing should we do for root fractures?
What sensibility testing should we do for root fractures?
What radiographs should be used for root fractures?
What radiographs should be used for root fractures?
How should we treat an undisplaced immobile tooth with root fracture?
How should we treat an undisplaced immobile tooth with root fracture?
How should you treat a displaced and mobile tooth with root fracture?
How should you treat a displaced and mobile tooth with root fracture?
Which type of fracture requires longer splinting for stability?
Which type of fracture requires longer splinting for stability?
What may we see on a healing root injury radiograph?
What may we see on a healing root injury radiograph?
What may we see on a non-healing root injury radiograph?
What may we see on a non-healing root injury radiograph?
What is pulpal prognosis affected by?
What is pulpal prognosis affected by?
What is hard tissue union affected by?
What is hard tissue union affected by?
How should we treat apical and middle third fractures?
How should we treat apical and middle third fractures?
How should you treat the distal fragment of a root fracture?
How should you treat the distal fragment of a root fracture?
What are some options for crown root fractures?
What are some options for crown root fractures?
What requirements need to be met for extrusion?
What requirements need to be met for extrusion?
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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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