Trauma

• Which teeth are mostly affected by trauma?

  Anterior teeth
• What is a significant predisposing factor to dental injury?

  Increased overjet with protrusion of upper incisors
• What should be asked when determining history of accident?

  How/what happened, when did it happen and where?
• Why does it matter when an injury occured?

  The time interval affects prognosis and delayed presentation may be a safeguarding issues
• Why does it matter how/what happened?

  It may not be accidental, there may be other injuries and they might have to go to A&E
• Why does it matter where the injury occured?

  May need a tetanus jab
• What should be asked about in medical history when assessing trauma?

  Bleeding disorders, cardiac disease, epilepsy, allergies and tetanus status
• What is looked for in an extra-oral examination when assessing trauma?

  Signs of shock, swelling, bruising, lacerations and asymmetry
• What is looked for in an intra-oral examination when assessing trauma?

  Soft tissues, hard tissues, occlusion and mobility
• What extra-oral injuries might be found?

  Contusion, abrasion or laceration
• Who should you refer fractures to facial bones to?

  Local maxillofacial unit
• What is a periodontal injury?


  When the tooth has moved by not broken
• What is concussion?

  Tooth as been knocked and is tender but not mobile
• What is subluxation?

  Some of the periodontal ligament fibres have ruptured and the tooth is where is should be but with a bit of mobility
• What is luxation?

  Tooth has moved out of its normal position
• What is extrusive luxation?


  Tooth is hanging down or sticking up
• What is intrusive luxation?

  Tooth has moved into the jaw bone
• What is lateral luxation?

  Tooth has moved buccally or palatally
• What is avulsion?

  Tooth has come out
• What are the classifications of dental injuries?

  Uncomplicated, complicated or root
• What is home care advice after dental trauma?

  Paracetamol up to 4 times a day, soft diet, meticulous oral hygiene with a soft toothbrush, rinse/swab twice daily with chlorhexidine, avoid contact sports
• What should be included in a referral letter?

  Practice contact details

  Letter date

  Name and address of dentist/consultant for referral

  Patient's name, DOB and contact details

  Reason for referral

  Urgency of referral

  General medical history

  Relevant dental and social history

  Clinical/unusual features

  Provisional diagnosis

  Signature and printed name
• How does a concussion respond to sensibility tests?

  Likely to be responsive
• When would a subluxation need a splint?

  If the tooth is excessively mobile
• How is extrusive luxation treated?

  Administer LA, reposition with gentle digital pressure, splint
• What sensibility tests can be used to assess injured teeth?

  Mechanical stimulation, ethyl chloride, electric pulp testing
• How does an extrusive luxation respond to sensibility tests?

  Unlikely to respond
• How does an intrusive luxation respond to sensibility tests?

  Unlikely to respond
• When should a tooth that has experienced an intrusive luxation be allowed to re-erupt?

  If it has an immature root or if there are more than 3mm showing
• How is a lateral luxation treated?

  Administer LA, reposition with gentle digital pressure and splint
• How is a splint attached?

  Each labial surface is etched and bonded, 3mm blob of composite is placed and wire positioned, more composite is placed over the wire and light cured
• What advice should be given on the phone if a child's permanent tooth has fallen out?

  Hold tooth by crown, rinse in milk/saline if dirty, replace in socket with firm pressure, bite gently on cotton pack, can place in milk/saliva and attend dental surgery immediately
• How do you treat a lost tooth if replanted at the scene?

  Clean area, verify correct position, radiograph, administer LA for bleeding, splint, give home care advice, get them to visit GP
• How do you treat a lost tooth if it is not replanted at the scene?

  Handle only by crown, rinse gently with saline, administer LA, irrigate socket with saline, replant firmly, radiograph and splint, give home care advice and advise they visit GP for antibiotics
• How can missing fragments be reattached in uncomplicated crown fractures?

  Composite
• Which material should be used if dentine exposed in an uncomplicated crown fracture?

  Should be covered with GIC
• How long should a splint be used if there is a root fracture in the apical or mid third?

  4 weeks
• How long should a splint be used if there is a root fracture in the coronal third?

  Up to 4 months
• Why should teeth be splinted and repositioned in a root fracture?

  Reduces risk of necrosis and favours healing
• What considerations should be taken with primary dentition and not secondary?

  Bouncy bone allows for some displacement without fracture, root fractures are rare, tooth discolouration is common, underlying successors must be considered