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BDS3 PAEDIATRICS > 4 - Dental trauma III > Flashcards

4 - Dental trauma III Flashcards

1
Q

What are the different impacts dental trauma can have on surrounding tissue?

A
  • separation injury, cleavage of structures
  • crushing injury, cells become damaged which leads to slower healing
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2
Q

What is the follow up for concussion injuries?

A

Clinical and radiographic follow up
- 4 weeks
- 1 year

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3
Q

What are the radiographic findings for a concussion injury?

A

No abnormality

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4
Q

What is the follow up for subluxation injuries?

A

Clinical and radiographic follow up
- 2 weeks (splint removal)
- 12 weeks
- 6 months
- 1 year

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5
Q

What are the radiographic findings for a subluxation injury?

A

No abnormality

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6
Q

What are the radiographic findings for an extrusion injury?

A

Increased PDL space, tooth not seated

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7
Q

What are the radiographic findings for a lateral luxation injury?

A

Widened PDL space

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8
Q

What are the radiographic findings for an intrusion injury?

A

PDL space not visible, CEJ more apical

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9
Q

What are the clinical findings for an extrusion injury?

A
  • tooth appears elongated
  • usually displaced palatally
  • mobile
  • bleeding from gingival sulcus
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10
Q

What are the clinical findings for a lateral luxation injury?

A
  • tooth appears displaced in socket
  • immobile (locked into bone)
  • high ankylotic percussion note
  • bleeding doom gingival sulcus
  • root apex may be palpable in sulcus
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11
Q

What are the clinical findings for an intrusion injury?

A
  • crown appears shortened
  • bleeding form gingiva
  • high ankylotic percussion note
  • immobile
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12
Q

What is the treatment for a subluxation injury?

A
  • no treatment
  • splint if excessively mobile for 2 weeks, passive flexible
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13
Q

What is the treatment for an extrusion injury?

A
  • reposition tooth under LA
  • splint for 2 weeks, passive flexible
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14
Q

What is the treatment for a lateral luxation injury?

A
  • reposition tooth under LA
  • splint for 4 weeks, passive flexible
  • endodontic evaluation at 2 weeks
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15
Q

What is the treatment for an intrusion injury?

A

Immature roots
- spontaneous repositioning
- if no re-eruption orthodontic repositioning

Mature roots
- <3mm, spontaneous repositioning (if no eruption, surgical or orthodontic repositioning)
- 3-7mm, reposition surgically or orthodontically
- >7mm, reposition surgically
- ALWAYS begin RCT within 2 weeks

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16
Q

How do you reposition an intrusion injury orthodontically?

A

Fixed orthodontic wire placed on adjacent teeth, orthodontic elastic placed on intruded tooth

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17
Q

How do you reposition an intrusion injury surgically?

A

Forceps and splint

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18
Q

What is the follow up for intrusion injuries?

A

Clinical and radiographic (as well as clinical photographs)
- 2 weeks
- 4 weeks (splint removal)
- 8 weeks
- 12 weeks
- 6 months
- 1 year
- annually for next 5 years

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19
Q

What is the follow up for lateral luxation injuries?

A

Clinical and radiographic
- 2 weeks (endodontic evaluation)
- 4 weeks (splint removal)
- 8 weeks
- 12 weeks
- 6 months
- 1 year
- annually for next 5 years

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20
Q

What is the follow up for extrusion injuries?

A

Clinical and radiographic
- 2 weeks (splint removal)
- 4 weeks
- 8 weeks
- 12 weeks
- 6 months
- 1 year
- annually for next 5 years

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21
Q

What are the clinical findings for an avulsion injury?

A
  • tooth totally displaced from socket
  • socket is empty or filled with coagulum
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22
Q

What are the critical factors in an avulsion injury and its treatment?

A
  • extra alveolar dry time (EADT)
  • extra alveolar time (EAT)
  • storage medium
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23
Q

What is the advice you’d give when a tooth has been avulsed?

A
  • ensure it is a permanent tooth
  • hold by crown
  • encourage replanting of the tooth immediately
  • if the tooth is dirty rinse in milk or saliva
  • bite on gauze to hold in place
  • if not replanted, place in storage medium
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24
Q

What is the best storage medium?

A
  1. milk
  2. hank’s balance salt solution
  3. saliva
  4. saline
  5. water
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25
Describe the management of a closed apex avulsion that has already been replanted.
- clean injured area - verify position and apical status (radiograph) - place passive, flexible splint for 2 weeks - consider antibiotics - check tetanus status
26
Describe the management of an open apex avulsion that has already been replanted.
- clean injured area - verify position and apical status (radiograph) - place passive, flexible splint for 2 weeks - consider antibiotics - check tetanus status
27
Describe the management of a closed apex avulsion with an EADT <60 mins.
- PDL cells may be viable - remove debris - Hx and examination with tooth in storage medium - replant with LA - place passive and flexible splint for 2 weeks - consider antibiotics - check tetanus status
28
Describe the management of an open apex avulsion with an EADT <60 mins.
- potential for spontaneous healing - remove debris - Hx and examination with tooth in storage medium - replant with LA - place passive and flexible splint for 2 weeks - consider antibiotics - check tetanus status
29
Describe the management of a closed apex avulsion with an EADT >60 mins.
- PDL cells likely non-viable - remove debris - Hx and examination with tooth in storage medium - replant with LA - place passive and flexible splint for 2 weeks - consider antibiotics - check tetanus status
30
Describe the management of an open apex avulsion with an EADT >60 mins.
- PDL cells likely non-viable and ankylosis related root resorption highly likely - remove debris - Hx and examination with tooth in storage medium - replant with LA - place passive and flexible splint for 2 weeks - consider antibiotics - check tetanus status
31
Describe the endodontic treatment of a permanent tooth with a closed apex after being replanted.
- 2 weeks - intracanal medicament placed - calcium hydroxide up to 1 month - or corticosteroid/antibiotic paste for 6 weeks
32
What is the follow up for avulsion (closed apex) injuries?
- 2 weeks (splint removal, endodontic treatment begins) - 4 weeks - 12 weeks - 6 months - 1 year - annually for 5 years
33
What is the follow up for avulsion (open apex) injuries?
- 2 weeks (splint removal) - 1 month - 2 months - 3 months - 6 months - 1 year - annually for 5 years
34
When is it suitable to not replant avulsed teeth?
- child immunocompromised - other more urgent injuries requiring emergency treatment - very immature apex with EAT > 90 mins - very immature lower incisor
35
What is the prognosis for avulsion injuries that are replanted 5 years post trauma?
Open apex - low chance of pulp survival Closed apex - no chance of pulp survival Both frequently experience root resorption
36
What are the clinical findings associated with dento-alveolar fracture?
- complete fracture from buccal to palatal bone in the maxilla or buccal to lingual surface of mandible - segment mobility, several teeth moving together - occlusal disturbance - gingival laceration
37
Describe the management of a dento-alveolar fracture.
- reposition displaced segment - stabilise with passive and flexible splint for 4 weeks - suture any lacerations - monitor pulp condition of all teeth
38
What is the follow up for dento-alveolar fracture?
- 4 weeks (splint removal) - 6-8 weeks - 4 months - 6 months - 1 year - annually for 5 years
39
What advice do you give for dento-alveolar fractures?
- soft diet for 7 days - no contact sports - careful oral hygiene including chlorohexidine mouthwash 0.12%
40
What is the splint time for subluxation?
2 weeks
41
What is the splint time for extrusive luxation?
2 weeks
42
What is the splint time for intrusive luxation?
4 weeks
43
What is the splint time for avulsion?
2 weeks
44
What is the splint time for lateral luxation?
4 weeks
45
What is the splint time for root fracture (mid root)?
4 weeks
46
What is the splint time for root fracture (apical third)?
4 weeks
47
What is the splint time for root fracture (cervical third)?
4 months
48
What is the splint time for dento-alveolar fracture?
4 weeks
49
What are the different types of chair side splints?
- composite and wire* - titanium trauma split* - composite - orthodontic brackets and wire - acrylic
50
What are the different types of lab made splints?
- vacuum formed splint - acrylic
51
Describe a composite and wire splint.
- stainless steel wire (0.4mm diameter) - must be passive - flexible = 1 tooth either side of traumatised teeth
52
Describe titanium trauma splints.
- rhomboid mesh structure - allow physiological movement - 0.2mm thick - secured with composite
53
What are the main post-trauma complications?
- pulp necrosis and infection - pulp canal obliteration - root resorption - breakdown of marginal gingiva and bone
54
Describe pulp canal obliteration.
- response of a vital pulp - progressive hard tissue formation within pulp cavity - gradual narrowing of chamber and canal, can be partial or total - common in luxation
55
What are the different types of root resorption?
External - surface - IRR - cervical - ankylosis RRR Internal - IRR
56
Describe external surface resorption.
- superficial resorption lacunae that are repaired with new cementum - response to localised injury - not progressive
57
Describe external IRR.
- infection related resorption - non-vital tooth - initiated by PDL damage - diagnosed by indistinct root surface with canal intact - rapid
58
How do you treat external IRR?
- remove stimulus - endodontic treatment - non setting CaOH for 4-6 weeks - obturate with GP
59
Describe ankylosis RRR.
- replacement root resorption - initiated by severe damage to PDL - bone cells repair faster than PDL fibroblasts - common in severe luxation or avulsion - no obvious PDL space on radiograph
60
How do you treatment ankylosis RRR?
Plan loss
61
Describe internal IRR.
- caused by progressive pulp necrosis - radiographically, ballooning of canals, root surface intact
62
How do you treat internal IRR?
- remove stimulus - endodontic treatment - non setting CaOH for 4-6 weeks - obturate with GP - if progressive, plan loss

BDS3 PAEDIATRICS (11 decks)

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