Class notes
Dental Trauma - Dental Surgery BDS
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A complete set of notes on all dental trauma teaching from the Dental Surgery BDS course at Cardiff University. All 5 years are covered.
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Primary DentitionSoft Tissue Injury
● Contusion (bruise)
● Laceration (cut)
● Abrasion (graze)
● Inflammation
● Tx: clean & debride (saline), assess for FB (STRG), reposition displaced tissues, suture
# Crown
● #E: leave/grind/dress
● #ED: cover exposed DT w GIC/flowable composite
● #EDP: partial pulpotomy, non-setting CaOH2, GIC. XLA if can’t tolerate
# Crown-Root
● XLA
# Root
● Can’t splint (lack of cooperation, small tooth size) - leave alone if no displacement
● Infection/displacement → XLA coronal fragment, let apical fragment resorb
Extrusion
● Leave (no occlusal interference) / reposition & splint (co-operative) / XLA
(interference/resorption)
Lateral Luxation
● Most common (bone resilience)
● Leave (away from tooth germ) & tongue repositions (2-4m) / XLA (towards germ)
● Labial inclination of crown indicates roots are palatally displaced towards germ
Intrusion
● Leave (away from tooth germ) & re-erupts (2-4m) / XLA (towards germ)
Avulsion
● Don’t replant (+++ risk necrosis)
Follow Up
● 1m, 2m, 1yr - annually until exfoliation
Complications
● Necrosis: sinus, PA RL, root resorption, may be black
- ⅓ displaced incisors will necrose
- No symptoms → monitor
● Pulp obliteration: yellow crown
● Ankylosis: stays/sinks when growing
, Damaged Permanent Incisors
● Likely if: intrusion, avulsion, < 3yr (primary long roots, permanent not fully mineralised)
● Effects: hypomineralisation (brown/white patch), hypoplasia (dents), dilaceration,
odontoma formation, disturbed eruption
Splints
● Require: good OH, good access (tests/RCT), away from GM, easily placed/removed
● Suck-down: good for lots of teeth/mixed dentition/missing teeth. Bad for OH
Permanent Dentition
H&E
● Head injury: assess for altered mental state, vomiting, LOC, clear fluid from
nose, bleeding from ear → A&E
● Analgesics: type, timings & dose to check for potential accidental overdose →
contact A&E for advice
● Facial fractures: swelling, visual changes (double vision, restricted eye movement, pain
on upward gaze), mandibular malocclusion or step deformity
● ST wounds: FB presence (take STRG). If not actively bleeding, stabilise dental injury
first
● Disturbed bite = luxation, # alveolar process/jaw/TMJ
● Reaction to temp change = exposed dentine
● Mobility: indiv teeth (severed vascular supply)/groups of teeth (# alveolar process)
● Percussion: TTP (PDL damage), high & metallic = locked in bone (LL, intrusion)
● Sensibility: inconsistent due to incomplete roots/post-trauma
Wound Healing
● Cells move into trauma area (MP, endothelial, FB)
● Vascular loops formed in stroma (collagen, FB)
● Speed in PDL/pulp = 0.5mm/day
Separation
● Ltd cellular damage, req cleavage of collagen & IC substance, faster
● In PDL: new collagen unites PDL fibres (1w), principal fibres healing (2w)
● In pulp: if severed vascular supply, ingrowth starts after 4d
Crushing
● Extensive cellular & IC damage → MP/oclasts remove damaged tissue →
repair
● CMB & Ep. rests of Malassez lost (protective) → MP/oclasts remove
PDL/cementum → root resorption
# Crown
● #E: grind/restore w composite
● #ED: restore to seal DT w composite/veneer/fragment
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