Trauma

Question 1

as far as trauma goes, what should you as the dentist record?

Answer 1

• spontaneous pain
• reaction to thermal change
• disturbances in occlusion
• extraoral wounds and palpation of facial skeleton
• injuries to intraoral soft tissues
• mobility of teeth or alveolar fragments
• sensitivity to percussion
• abnormalities in occlusion
• vitality tests

Question 2

what is the radiographic evidence of pathology at 2 weeks?

Answer 2

pulpal necrosis

Question 3

what is the radiographic evidence of pathology at three weeks?

Answer 3

inflammatory resorption (external and internal)

Question 4

what is the radiographic evidence of pathology at 6 weeks?

Answer 4

replacement resorption (ankylosis)

Question 5

reaction of teeth to trauma involving internal hemorrhage?

Answer 5

pulpal hyperemia (pulpitis)

Question 6

reaction of teeth to trauma involving pulp canal obliteration

Answer 6

pulp necrosis

Question 7

is pulp necrosis subsequent to pulp canal obliteration a common finding?

Answer 7

no (1%)

Question 8

does pulp canal obliteration or pulp necrosis appear first?

Answer 8

pulp necrosis is before obliteration

Question 9

what does pulp canal obliteration depend on?

Answer 9

• type of injury

- stage of root development

Question 10

what is the etiology of inflammatory resorption?

Answer 10

• surface resorption of cementum exposing dentinal tubules
• pulp necrosis
• toxic products from the pulp provoke an inflammatory response in the PDL

Question 11

what is replacement resorption?

Answer 11

• direct union of bone and root
• resorption of root and replacement with bone
• direct result of loss of vital PDL

Question 12

a displacement of the tooth INTO the alveolar bone. this is often accompanied by comminution or fracture of the alveolar socket

Answer 12

intrusive luxation (central dislocation)

Question 13

a partial displacement of the tooth OUT of the socket

Answer 13

extrusive luxation

peripheral dislocation, partial avulsion

Question 14

a displacement of the tooth in a direction other than axially
-this is accompanied by comminution or fracture of the alveolar socket

Answer 14

lateral luxation

Question 15

a complete displacement of the tooth out of its socket

Answer 15

exarticulation

complete avulsion

Question 16

what are treatment alternatives in class III fractures of primary teeth?

Answer 16

• direct pulp capping
• CaOH pulpotomy
• pulpectomy

Question 17

how successful are CaOH partial pulpotomies?

Answer 17

96% success with pulps exposed 1 hour to 90 days

Question 18

what is the technique for CaOH partial pulpotomy?

Answer 18

• gently remove dentin and pulp to 1-2mm
• use copious irrigation
• cover pulp with CaOH

Question 19

what are the properties of mineral trioxide aggregate?

Answer 19

• high pH (similar to CaOH)
• exceptional sealing properties
• hardens within hours enabling canal obturation

Question 20

what is the criteria for successful pulp therapy on traumatized teeth?

Answer 20

1. absence of clinical signs and symptoms (fistula, mobility, pain)
2. completion of root development
3. absence of radiographic signs of necrosis

Question 21

an injury to the tooth supporting structures without abnormal loosening or displacement of the tooth but with marked reaction to percussion

Answer 21

concussion

Question 22

an injury to the tooth-supporting structures with abnormal loosening, but without displacement of the tooth

Answer 22

subluxation

Question 23

what is the treatment for concussion?

Answer 23

• inform patient and parent about potential sequelae

- monitor

Question 24

what is the tx for subluxation?

Answer 24

• DO NOT splint
• Follow up in 2 weeks
• radiograph at one month

Question 25

what is the tx for intrusive luxation with an OPEN apex

Answer 25

- if less than 7mm, allow spontaneous repositioning - ---if no movement in 3 weeks reposition orthodontically - if more than 7mm, reposition surgically

Question 26

what is the tx for intrusive luxation with a CLOSED apex

Answer 26

- if less than 3mm, allow spontaneous respositioning - if 3-7mm, extrude tooth orthodontically (ASAP) - if more than 7mm, surgically reposition tooth

Question 27

what is the treatment for extrusive luxation?

Answer 27

- reposition tooth ASAP (best if within 2 hrs) - light splint for 2 weeks - remove pulp and fill with CaOH within 7-14 days - CHX - complete endo fill in 2 months if no inflammatory reaction

Question 28

what is the treatment with lateral luxation?

Answer 28

- reposition tooth ASAP (best if within 2 hrs) - light splint for 3-4 weeks - remove pulp and fill with CaOH within 7-14 days - CHX - complete endo fill in 2-4 months if no inflammatory resorption

Question 29

what is the tissue of most concern when dealing with an avulsed tooth?

Answer 29

PDL | healing without resorption *most critical factor

Question 30

what is the tx for an avulsed tooth?

Answer 30

- management at site of injury (reimplant immediately) - transport media - management at dental office - adjunctive drug therapy considerations - endo treatment - restoration of the avulsed tooth

Question 31

what are the recommended transport (storage) media for an avulsed tooth?

Answer 31

- socket (immediate reimplantation) - cell culture medium - milk - physiologic saline - saliva

Question 32

what is the maximum extraoral (dry time) that a tooth can be out of the socket?

Answer 32

less than one hour * handle by crown, gently reimplant * splint * remove pulp in 7-14 days

Question 33

what is the management of the soft tissues of an avulsed tooth?

Answer 33

tightly suture any soft tissue lacerations particularly in the cervical region

Question 34

as far as splints go, what is recommended and what is contratindicated?

Answer 34

good to use: fish line, acid etch resin, soft arch wire, ortho brackets, suture as last resort bad to use: circuferential wire *maintain splint for 7-10 days, longer if tooth demonstrates excessing mobility

Question 35

what is splinting home care?

Answer 35

- no biting on splinted teeth - soft diet - maintenance of good oral hygiene

Question 36

what is the endodontic tx for an avulsed tooth with less than one hour dry time?

Answer 36

- remove pulp in 7-14 days - place CaOH - obturate canal in 2-12 months

Question 37

what is the objective of managing an avulsed immature tooth?

Answer 37

revitalize severed pulp * best chance if reimplanted in 20 minutes (max 60) * soak in doxycycline solution for 5 minutes * reimplant and splint * recall every 3-4 weeks

Question 38

what are some additional considerations for avulsed teeth?

Answer 38

- require follow-up for at least 5 years - DO NOT reimplant primary teeth - potential complications include - --inflammatory resorption - --replacement resorption - --tooth submergence