Oro-Facial Trauma

What role may a dental hygienist have in dental trauma?

They may be the first point of contact

Why is effective diagnosis and management important?

It leads to better patient outcomes

Why do traumatic dental injuries require close follow-ups?

To monitor healing and identify complications

What percentage of dental trauma cases involve children?

5%

What is the most common dental trauma injury in children?

Enamel-dentine fracture

What are common causes of dental trauma in children?

Falls, biking and skating accidents

Which injuries are more common in the primary dentition?

Luxation injuries

What dental feature increases the risk of trauma?

7–10 years

What three questions should be asked when taking a trauma history?

When, where and how did the injury occur

What should be checked in the patient's medical history after dental trauma?

Head injury, loss of consciousness and other injuries

What should be assessed during an extra-oral examination?

Lacerations, abrasions, mouth opening, bony step deformities, swelling and the TMJ

What should be assessed during an intra-oral examination?

Soft tissues, alveolar bone, occlusion and teeth

What should be recorded on a dental trauma chart?

Colour, mobility, sinus presence, tenderness to percussion and palpation, and pulp test results

What thermal test can be used during trauma assessment?

Endo Frost

Which pulp tests may be used after dental trauma?

Thermal testing and electrical pulp testing

Which radiographs may be used to assess dental trauma?

Periapical (PA) and occlusal radiographs

What is a dental fracture?

A fracture involving the crown or root of a tooth

What is a luxation injury?

Disruption or damage to the periodontal ligament or surrounding bone, causing displacement of the tooth

What is an avulsion injury?

Complete displacement of a tooth from its socket

What is an enamel fracture?

A fracture affecting the enamel of the tooth

What is an enamel-dentine fracture?

A fracture extending into the dentine, with loss of tooth structure

What is an enamel-dentine fracture with pulp exposure?

A fracture involving enamel and dentine that exposes the pulp

What is another name for a crown fracture with pulp exposure?

A complicated crown fracture

Why can a fracture with pulp exposure be painful?

The pulp is exposed, causing considerable pain

What is a crown-root fracture?

A fracture involving both the crown and root

What is an uncomplicated crown-root fracture?

A crown-root fracture without pulp exposure

What is a complicated crown-root fracture?

A crown-root fracture with pulp exposure

How should an enamel fracture in a primary tooth be managed?

Monitor the tooth

How should an enamel-dentine fracture in a primary tooth be managed?

Cover the exposed dentine with GIC or composite

How can a primary tooth fracture with pulp exposure be managed?

Pulpotomy or extraction under local anaesthetic

What is the initial approach to a primary crown-root fracture?

Assess the tooth, remove the fractured fragment and assess restorability

What are the treatment options for a primary root fracture?

Monitor or extract the coronal segment

What should be assessed in a root fracture?

Displacement and mobility

What is an alveolar fracture?

A fracture involving the alveolar bone

How is mobility assessed in an alveolar fracture?

Check the mobility of the affected segment

Which areas can an alveolar fracture affect?

Buccal, palatal or lingual areas

What may an alveolar fracture involving multiple teeth require?

Specialist input and possible splinting

What is concussion?

The tooth is tender but has not been displaced

How is concussion managed?

Monitor, reassure, advise a soft diet and gentle brushing

What is subluxation?

The tooth is tender and has increased mobility but no displacement

What is a common sign of subluxation?

Bleeding from the gingival crevice

How is subluxation managed?

Monitor, reassure, advise a soft diet and gentle brushing

What is lateral luxation?

Displacement of a tooth in a lingual, palatal or buccal direction

What may lateral luxation cause?

Interference with the bite

How is lateral luxation assessed?

Assess displacement, occlusion and mobility

What are the treatment options for luxation injuries in primary teeth?

Monitoring or extraction

What is intrusion?

A tooth being pushed into the alveolar bone

Why is intrusion in a primary tooth concerning?

It may affect the developing permanent tooth

How is intrusion in a primary tooth managed?

Assess severity and position, then monitor for spontaneous repositioning

How long can repositioning after intrusion take?

6–12 months

When should an intruded primary tooth be followed up?

At intervals of 1 week, 6–8 weeks, 6 months and 1 year

What is extrusion?

Partial displacement of a tooth out of its socket, making it appear elongated

What is avulsion?

Complete displacement of a tooth from its socket

Where might an avulsed primary tooth become embedded?

In the lips, cheeks or tongue

What is another risk when a tooth is avulsed?

Aspiration into the lungs

Should an avulsed primary tooth be replanted?

No

Why should an avulsed primary tooth not be replanted?

• To protect the permanent adult tooth developing directly underneath

• Risk of infection

• Ankylosis

How should a patient with an avulsed primary tooth be managed?

Reassure the patient and assess for associated injuries

What are the main principles of managing primary dental trauma?

Conservative management, a soft diet, pain relief and reducing anxiety

When may primary dental trauma require urgent referral?

When the injury is severe

What is pulp necrosis?

Death of the dental pulp

What are common complications of primary dental trauma?

Pulp necrosis, infection, discoloration, inflammatory resorption, ankylosis and delayed exfoliation

What is ankylosis?

Fusion of the tooth to the surrounding bone

Why can ankylosis make extraction difficult?

The tooth is fused to the surrounding bone

How can primary tooth trauma affect permanent teeth?

It can cause enamel defects in the developing permanent tooth

What is hypomineralisation?

A defect involving reduced mineralisation of the enamel

What is enamel hypoplasia?

Incomplete development or reduced formation of enamel

What is an enamel infraction?

An incomplete fracture or crack in enamel without loss of tooth structure

What is the expected mobility in an enamel infraction?

Normal mobility

What is an enamel fracture in a permanent tooth?

Trauma affecting enamel only

What is an enamel-dentine fracture in a permanent tooth?

A fracture extending into the dentine

What is an enamel-dentine fracture with pulp exposure?

A fracture involving enamel and dentine that exposes the pulp

How can an enamel fracture in a permanent tooth be managed?

Smooth or restore it, for example with composite, and monitor

How should an enamel-dentine fracture in a permanent tooth be managed?

Restore it as soon as possible

When should a permanent tooth with a crown fracture be followed up?

At 6–8 weeks and then at 1 year

What treatment may be used for a crown fracture with pulp exposure?

Partial pulpotomy or pulp capping

What should be done initially for a permanent crown-root fracture?

Stabilise the loose fragment and assess the extent of the fracture

What are possible treatments for a permanent crown-root fracture?

Root canal treatment (RCT), orthodontic extrusion or surgical extraction

Which tissues are involved in a root fracture?

Dentine, pulp and cementum

What shapes can root fractures take?

Horizontal, oblique or both

Which parts of the root can be fractured?

The coronal, middle or apical third

What should be assessed in a permanent root fracture?

Mobility and tooth position

What should be monitored after a permanent root fracture?

Healing and pulp status

What is an alveolar fracture in permanent dentition?

A fracture of the alveolar bone that may extend into adjacent bone

What can an alveolar fracture cause?

Occlusal disturbances

How is a permanent alveolar fracture managed?

Reposition and stabilise the segment with a passive flexible splint for 4 weeks

What is concussion in a permanent tooth?

The tooth is tender but has not been displaced

How is concussion managed in a permanent tooth?

Monitor, reassure, advise a soft diet and gentle brushing

What is subluxation in a permanent tooth?

The tooth has increased mobility and tenderness but no displacement

What is a common sign of subluxation?

Bleeding from the gingival crevice

How is subluxation managed?

Monitor, reassure, advise a soft diet and gentle brushing

What is lateral luxation in a permanent tooth?

Displacement of the tooth in a lingual, palatal or buccal direction

What may lateral luxation cause?

Interference with the bite

What is intrusion in a permanent tooth?

The tooth is pushed into the alveolar bone

What sound may an intruded permanent tooth produce on percussion?

A metallic or ankylotic sound

How may an intruded tooth respond to pulp sensibility tests?

It may show no response

Why might an intruded tooth become immobile?

It may be locked into the surrounding bone

How long can repositioning after intrusion take?

6–12 months

When should an intruded permanent tooth be followed up?

At 1 week, 6–8 weeks, 6 months and 1 year

What is extrusion in a permanent tooth?

Partial displacement of the tooth out of its socket in an incisal direction