trauma-section G

Choose a study mode

Play Quiz
Study Flashcards
Spaced Repetition
Chat to Lesson

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

Why is early treatment important for pulp necrosis in primary teeth?

To prevent damage to the developing permanent successor tooth.

List two possible causes of pink discoloration in teeth.

Intrapulpal hemorrhage and internal coronal resorption.

What radiographic finding is associated with pulp canal obliteration?

Narrowed and indistinct pulp chamber and canal.

What is the most significant effect of trauma to primary teeth on succedaneous permanent teeth?

<p>Damage to the unerupted developing permanent tooth.</p> Signup and view all the answers

If a tooth is suspected of dilaceration how long should you wait before becoming suspicious of impaction?

<p>6 months.</p> Signup and view all the answers

What are the speech considerations with the early loss of primary incisors?

<p>Loss may affect a child's ability to produce 'the/f/v/s' sounds, but typically resolves with age.</p> Signup and view all the answers

What material is best used when performing a pulpectomy on a cooperative child?

<p>A resorbable material such as Vitapex.</p> Signup and view all the answers

Why does grey discoloration occur in teeth with pulp necrosis?

<p>Pulp necrosis leads to chromogenic degradation products.</p> Signup and view all the answers

What is the treatment for root resorption?

<p>Extraction.</p> Signup and view all the answers

What percentage of permanent teeth exhibit enamel defects when there are sequalae?

<p>44%.</p> Signup and view all the answers

How can one differentiate between tooth discoloration due to pulpal necrosis and discoloration due to intra-pulpal bleeding that may still resolve?

<p>Grey discoloration is indicative of pulpal necrosis, especially if it persists. However, mild discoloration could be due to intra-pulpal bleeding in a vital tooth. Clinical signs of infection such as sinus, suppuration, swelling, and tenderness alongside persistent grey discoloration would strongly suggest necrosis.</p> Signup and view all the answers

Explain why pulp necrosis leads to grey discoloration of a tooth.

<p>Pulp necrosis results in the breakdown of pulp tissue, leading to chromogenic degradation products. In cases of trauma, intrapulpal hemorrhage introduces blood into dentinal tubules. As this blood decomposes, it deposits chromogenic blood degradation products, causing the tooth to appear grey.</p> Signup and view all the answers

Describe the management approach for a primary tooth diagnosed with pulpal necrosis, considering different clinical scenarios.

<p>Management involves radiographic review every 3 months to assess for periapical pathology. If there is periapical inflammation, sinus, swelling, or infection, extraction is advised. In cooperative children with motivated parents and no signs of periapical pathology, a pulpectomy using a resorbable material like Vitapex can be considered; otherwise, the tooth is kept under review.</p> Signup and view all the answers

Explain why pulp canal obliteration (PCO) is generally considered a positive sign following trauma to a primary tooth, and outline its typical management.

<p>Pulp canal obliteration, indicated by yellow discoloration, is a sign of tooth vitality. It occurs due to increased odontoblast activity and dentine production. Generally, PCO requires no intervention other than review and reassurance, as these teeth typically resorb normally. Extraction is only considered if radiographic signs of pathosis develop.</p> Signup and view all the answers

Differentiate between pink and yellow tooth discoloration in primary teeth, including their potential causes and management implications.

<p>Pink discoloration can indicate intrapulpal hemorrhage with blood vessel rupture or internal coronal resorption. Yellow discoloration suggests pulp canal obliteration. Pink discoloration requires monitoring for signs of pathosis, potentially leading to extraction. Yellow discoloration generally requires reassurance and monitoring unless pathosis is evident.</p> Signup and view all the answers

What is the recommended treatment for root resorption in primary teeth, and why is this approach generally favored?

<p>For all forms of primary root resorption, extraction is generally advised. This is because root resorption in primary teeth, especially if accelerated or pathologic, can compromise the tooth's structural integrity and potentially affect the eruption of the permanent successor. Extraction eliminates these potential complications.</p> Signup and view all the answers

Explain the phenomenon of delayed exfoliation in primary teeth and its association with ankylosis.

<p>Delayed exfoliation refers to the prolonged retention of a primary tooth beyond its expected shedding time. Ankylosis, a rare condition where the tooth root fuses to the bone, is a cause of delayed exfoliation. However, in most ankylosed primary teeth, spontaneous resorption by erupting permanent successors eventually occurs.</p> Signup and view all the answers

Describe the potential long-term effects of trauma to primary incisors on the developing permanent successors, and why early parental counseling is important.

<p>Trauma to primary incisors can cause various sequelae in permanent successors, including enamel defects like hypomineralization, crown dilaceration, root duplication, and disturbances in root formation. Early parental counseling is crucial to inform parents about these potential irreversible damages and to ensure timely monitoring and intervention if complications arise during mixed dentition.</p> Signup and view all the answers

Define dilaceration in the context of tooth development, and explain the clinical suspicion criteria and management approach.

<p>Dilaceration is defined as an abrupt deviation or bend in the long axis of the crown or root of a tooth. Clinically, suspect dilaceration in a tooth that has failed to erupt within 6 months of its contralateral counterpart. Management depends on severity and may involve orthodontic/surgical realignment or extraction, requiring a multidisciplinary team approach.</p> Signup and view all the answers

Outline the primary causes of disturbances in tooth eruption, and briefly describe the general treatment strategy.

<p>Disturbances in tooth eruption can be caused by thickening of connective tissue over the tooth germ, ectopic eruption due to lack of guidance, or impaction due to crown or root malformations. The general treatment strategy involves surgical exposure of the tooth, often combined with orthodontic alignment to guide the tooth into its correct position.</p> Signup and view all the answers

When diagnosing pulpal necrosis, grey discoloration is often a key indicator. However, what other condition might cause similar discoloration, and how would you differentiate it from necrosis?

<p>Intra-pulpal bleeding can also cause discoloration. Necrosis should be suspected if the discoloration persists.</p> Signup and view all the answers

Why is early intervention crucial in cases of pulpal necrosis in primary teeth?

<p>To prevent damage to the developing permanent successor.</p> Signup and view all the answers

What radiographic or clinical signs might indicate that a tooth with pulp canal obliteration requires extraction?

<p>Radiographic signs of pathosis, such as periapical radiolucency, indicate that extraction may be necessary.</p> Signup and view all the answers

A child presents with a primary incisor displaying yellow discoloration. What is the most likely cause, and what non-invasive management strategy is typically employed?

<p>Pulp canal obliteration is the likely cause. Management involves keeping the tooth under review and reassurance.</p> Signup and view all the answers

Following trauma to a primary incisor, a pink discoloration appears. What are the two possible causes of this discoloration?

<p>Intrapulpal hemorrhage with rupture of blood vessels or internal coronal resorption.</p> Signup and view all the answers

What specific sounds are primarily affected by the early loss of maxillary incisors in children?

<p>The 'the/f/v/s' sounds.</p> Signup and view all the answers

What is the recommended treatment for primary teeth exhibiting any form of root resorption?

<p>Extraction.</p> Signup and view all the answers

What is the most significant effect from primary tooth trauma on the unerupted developing permanent tooth?

<p>Damaging sequelae to the unerupted developing permanent tooth.</p> Signup and view all the answers

If a permanent successor tooth fails to erupt within six months of its contralateral tooth, what specific dental anomaly should be suspected?

<p>Dilaceration</p> Signup and view all the answers

Delays in eruption may be due to thickening of connective tissue over the developing tooth germ. What is the recommended treatment?

<p>Surgical exposure along with orthodontic alignment.</p> Signup and view all the answers

Flashcards

Pulpal Necrosis

Most common complication of pulpal necrosis, diagnosed from grey discoloration; may be due to intra-pulpal bleeding.

Why grey discoloration occurs

Pulp necrosis leads to chromogenic degradation products, intra-pulpal haemorrhage following trauma, failure to remove pulp fully and pulp horns following extirpation.

Diagnosis of pulpal necrosis

Radiographic findings are required to provide definitive diagnosis. Colour alone does is not indication for treatment.

Pulp canal obliteration

Presents with yellow discolouration of the crown. Due to increased activity of odontoblasts and excess dentine production.

Signup and view all the flashcards

Pink discolouration causes

Intrapulpal haemorrhage with rupture of blood vessels as a result of injury. Internal coronal resorption.

Signup and view all the flashcards

Dilaceration Definition

Describes abrupt deviation of long axis of crown or root (a bend).

Signup and view all the flashcards

Yellow-brown discoloration

Injury during development of coronal segment of tooth can result in enamel hypoplasia or hypocalcification as white or yellow brown discolouration of enamel.

Signup and view all the flashcards

Delayed exfoliation Definition

Ankylosis is very rare effecting 0.8-4% of located teeth. In cases of ankylosis spontaneous resorption by erupting permanent successors is noted to take place in most cases.

Signup and view all the flashcards

Management of Pulpal Necrosis

Radiographic review every 3 months; extraction advised if periapical inflammation, sinus, swelling, or infection is evident; pulpectomy with resorbable material (e.g., Vitapex) in cooperative children.

Signup and view all the flashcards

Speech Problems and Primary Incisors

Maxillary incisors enable production of 'the/f/v/s' sounds, premature loss may affect this but will decrease with age.

Signup and view all the flashcards

Pulp Canal Obliteration Management

Keep under review and reassure. Extract if there are radiographic signs of pathosis. 1st line cosmetic intervention: vital tooth bleaching.

Signup and view all the flashcards

Root Resorption Definition

Is a rare presentation following trauma but is more commonly noted in discoloured primary teeth following trauma. Extraction is advised for all forms of primary root resorption.

Signup and view all the flashcards

Injuries to developing permanent teeth

Injury to successor tooth has been reported 12-69% of primary trauma, most significant effect from primary trauma is the damaging sequalae to the unerupted developing permanent tooth.

Signup and view all the flashcards

Disturbance in Eruption Causes

Delays in eruption may be due to thickening of connective tissue over developing tooth germ, ectopic eruption due to lack of guidance. Treatment: surgical exposure along with orthodontic alignment.

Signup and view all the flashcards

Radiographic appearance of pulp canal obliteration

Pulp chamber and canal radiographically appear narrowed and indistinct.

Signup and view all the flashcards

Treatment of Pink Discoloration

Monitoring unless other signs indicate pathosis, extraction is indicated.

Signup and view all the flashcards

Sequelae affecting permament teeth

Enamel defects is the most common at 44%

Signup and view all the flashcards

Study Notes

  • Pulpal necrosis is a common complication

Definition

  • Diagnosed by grey discoloration, it may also be due to intrapulpal bleeding, if it persists, necrosis should be suspected
  • Mildly discolored teeth can still be vital
  • Clinical signs of infection include sinus, suppuration, swelling, and tenderness
  • Early treatment is important to prevent damage to the developing successor

Why Grey Discoloration Occurs

  • Pulp necrosis leads to chromogenic degradation products
  • Intrapulpal hemorrhage after trauma causes blood to enter dentinal tubules, decompose, and deposit chromogenic blood degradation products
  • Failure to fully remove pulp and pulp horns during extirpation can also lead to grey discoloration

Diagnosis

  • Requires radiographic findings for definitive diagnosis
  • Color alone is not an indication of treatment
  • Follow-up to detect additional symptoms will help formulate treatment plan

Management

  • Review radiographically every 3 months to assess for periapical pathology
  • Extraction is advised if there is evidence of periapical inflammation, sinus, swelling, or infection
  • If extraction is not advised the tooth is kept under review
  • A pulpectomy can be performed with cooperative children and motivated parents
  • A resorbable material such as Vitapex is the obturation material of choice

Space Loss

  • There is no evidence to suggest significant space loss after primary incisor loss, so space maintenance is not needed

Speech Problems

  • Maxillary incisors enable the production of 'the/f/v/s' sounds
  • Premature loss of primary teeth may affect a child's ability to speak, but this decreases with age and eruption of permanent incisors
  • This is transient and will resolve

Pulp Canal Obliteration

  • Presents with a yellow discoloration of the crown
  • Caused by increased odontoblast activity and excess dentine production
  • It is a sign that the tooth is vital and most teeth will resorb normally, so no intervention is required

Radiographically

  • The pulp chamber and canal will appear narrowed and indistinct

Management

  • Requires review and reassurance
  • Extraction is advised if there are radiographic signs of pathosis
  • Vital tooth bleaching is a first line cosmetic intervention

Other Color Changes: Pink

  • Can indicate intrapulpal hemorrhage with the rupture of blood vessels as a result of injury or internal coronal resorption
  • Monitor unless other signs indicate pathosis, in which case extraction is indicated

Tooth Discoloration Overview

  • Non-vital/pulp necrosis presents as grey discoloration
  • Pulp canal obliteration presents as yellow discoloration
  • Pink discoloration indicates intrapulpal hemorrhage or internal coronal resorption

Root Resorption

  • A rare presentation that follows trauma, but is more commonly noted in discolored primary teeth after trauma
  • Extraction is advised for all forms of primary root resorption

Delayed Exfoliation

  • Ankylosis is rare, affecting 0.8-4% of located teeth
  • Spontaneous resorption by erupting permanent successors is noted in most ankylosis cases

Injuries to Developing Permanent Teeth

  • Injury to a successor tooth has been reported in 12-69% of primary trauma cases
  • The most significant effect is damage to the unerupted developing permanent tooth
  • Trauma to the primary dentition can cause irreversible damage to permanent teeth, especially since anterior teeth develop in close proximity to the apex of primary incisors
  • Parents must be informed of potential complications that can occur in mixed dentition
  • Trauma can cause displacement of germ squeezing out epithelial root sheath, resulting in crown or root malformation, which ranges from mild to severe and depends on age and injury

Age and Type of Injury

  • Children under 3 are likely to present with effects
  • Intrusion causes more disturbances
  • Avulsion can cause damage if the apex is pushed toward the permanent tooth just before exfoliation
  • Injury during development of the coronal segment of a tooth can result in enamel hypoplasia or hypocalcification, appearing as white or yellow-brown discoloration of enamel
  • This is only seen clinically after eruption
  • Lesions may also present with enamel hypoplasia

Dilaceration

  • An abrupt deviation of the long axis of the crown or root (a bend)
  • Dilacerated teeth often impact and fail to erupt
  • Suspicion should be raised if a tooth fails to erupt within 6 months of its contralateral tooth

Management

  • Based on severity: orthodontic/surgical realignment or extraction
  • MDT approach recommended: Oral Surgeon, pediatric dentist, and orthodontist

Disturbance in Eruption Causes

  • Delays can result from thickening of connective tissue over the developing tooth germ, ectopic eruption due to lack of guidance, or impaction with malformations of the crown or root

Disturbance in Eruption Treatment

  • Surgical exposure with orthodontic alignment

Other Malformations

  • e.g., odontomas
  • Treat with extraction

Sequalae

  • Primary teeth: Discoloration, infection, delayed exfoliation
  • Permanent teeth: Enamel defects (44%), abnormal tooth/root morphology (8%), delayed eruption (1%)

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Quiz Team

Related Documents

More Like This

Use Quizgecko on...
Browser
Open
Browser
Browser