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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
Q

Describe the management of a closed apex avulsion that has already been replanted.

A
  • clean injured area
  • verify position and apical status (radiograph)
  • place passive, flexible splint for 2 weeks
  • consider antibiotics
  • check tetanus status
26
Q

Describe the management of an open apex avulsion that has already been replanted.

A
  • clean injured area
  • verify position and apical status (radiograph)
  • place passive, flexible splint for 2 weeks
  • consider antibiotics
  • check tetanus status
27
Q

Describe the management of a closed apex avulsion with an EADT <60 mins.

A
  • 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
Q

Describe the management of an open apex avulsion with an EADT <60 mins.

A
  • 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
Q

Describe the management of a closed apex avulsion with an EADT >60 mins.

A
  • 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
Q

Describe the management of an open apex avulsion with an EADT >60 mins.

A
  • 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
Q

Describe the endodontic treatment of a permanent tooth with a closed apex after being replanted.

A
  • 2 weeks
  • intracanal medicament placed
  • calcium hydroxide up to 1 month
  • or corticosteroid/antibiotic paste for 6 weeks
32
Q

What is the follow up for avulsion (closed apex) injuries?

A
  • 2 weeks (splint removal, endodontic treatment begins)
  • 4 weeks
  • 12 weeks
  • 6 months
  • 1 year
  • annually for 5 years
33
Q

What is the follow up for avulsion (open apex) injuries?

A
  • 2 weeks (splint removal)
  • 1 month
  • 2 months
  • 3 months
  • 6 months
  • 1 year
  • annually for 5 years
34
Q

When is it suitable to not replant avulsed teeth?

A
  • child immunocompromised
  • other more urgent injuries requiring emergency treatment
  • very immature apex with EAT > 90 mins
  • very immature lower incisor
35
Q

What is the prognosis for avulsion injuries that are replanted 5 years post trauma?

A

Open apex - low chance of pulp survival
Closed apex - no chance of pulp survival
Both frequently experience root resorption

36
Q

What are the clinical findings associated with dento-alveolar fracture?

A
  • 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
Q

Describe the management of a dento-alveolar fracture.

A
  • reposition displaced segment
  • stabilise with passive and flexible splint for 4 weeks
  • suture any lacerations
  • monitor pulp condition of all teeth
38
Q

What is the follow up for dento-alveolar fracture?

A
  • 4 weeks (splint removal)
  • 6-8 weeks
  • 4 months
  • 6 months
  • 1 year
  • annually for 5 years
39
Q

What advice do you give for dento-alveolar fractures?

A
  • soft diet for 7 days
  • no contact sports
  • careful oral hygiene including chlorohexidine mouthwash 0.12%
40
Q

What is the splint time for subluxation?

A

2 weeks

41
Q

What is the splint time for extrusive luxation?

A

2 weeks

42
Q

What is the splint time for intrusive luxation?

A

4 weeks

43
Q

What is the splint time for avulsion?

A

2 weeks

44
Q

What is the splint time for lateral luxation?

A

4 weeks

45
Q

What is the splint time for root fracture (mid root)?

A

4 weeks

46
Q

What is the splint time for root fracture (apical third)?

A

4 weeks

47
Q

What is the splint time for root fracture (cervical third)?

A

4 months

48
Q

What is the splint time for dento-alveolar fracture?

A

4 weeks

49
Q

What are the different types of chair side splints?

A
  • composite and wire*
  • titanium trauma split*
  • composite
  • orthodontic brackets and wire
  • acrylic
50
Q

What are the different types of lab made splints?

A
  • vacuum formed splint
  • acrylic
51
Q

Describe a composite and wire splint.

A
  • stainless steel wire (0.4mm diameter)
  • must be passive
  • flexible = 1 tooth either side of traumatised teeth
52
Q

Describe titanium trauma splints.

A
  • rhomboid mesh structure
  • allow physiological movement
  • 0.2mm thick
  • secured with composite
53
Q

What are the main post-trauma complications?

A
  • pulp necrosis and infection
  • pulp canal obliteration
  • root resorption
  • breakdown of marginal gingiva and bone
54
Q

Describe pulp canal obliteration.

A
  • 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
Q

What are the different types of root resorption?

A

External
- surface
- IRR
- cervical
- ankylosis RRR

Internal
- IRR

56
Q

Describe external surface resorption.

A
  • superficial resorption lacunae that are repaired with new cementum
  • response to localised injury
  • not progressive
57
Q

Describe external IRR.

A
  • infection related resorption
  • non-vital tooth
  • initiated by PDL damage
  • diagnosed by indistinct root surface with canal intact
  • rapid
58
Q

How do you treat external IRR?

A
  • remove stimulus
  • endodontic treatment
  • non setting CaOH for 4-6 weeks
  • obturate with GP
59
Q

Describe ankylosis RRR.

A
  • 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
Q

How do you treatment ankylosis RRR?

A

Plan loss

61
Q

Describe internal IRR.

A
  • caused by progressive pulp necrosis
  • radiographically, ballooning of canals, root surface intact
62
Q

How do you treat internal IRR?

A
  • 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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