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CDH > 4th year > Flashcards

4th year Flashcards

1
Q

how could trauma cause localised recession?

A

non vital –> repeated abscess –> loss of bone around tooth –> localised recession

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2
Q

4 risk factos for trauma?

A
  1. prolcined maxillary incisors
  2. short upper lip
  3. accident prone
  4. MH e.g. epilepsy
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3
Q

how might rheumatic fever effect treatment of avulsions?

A

putting tooth back in mouth reintroduces bacteria - increased risk

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4
Q

4 things to look for e/o in trauma patient?

A
  1. shock
  2. head/other injuries
  3. foreign bodies
  4. bleeding/CSF from nose
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5
Q

what to look for in HT after trauma?

A

bony step deformities

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6
Q

what does percussion of a tooth tell you?

A

periodontal injury

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7
Q

4 tests/signs to assess in trauma

A
  1. mobility
  2. percussion
  3. tooth colour
  4. sensibility - negative may be necrosis or concussed
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8
Q

routine imaging to assess anterior fractures?

A

PA + occlusal

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9
Q

WHO dentoalveolar injury classification splits trauma into which 4 groups?

A
  1. hard tissue/pulp
  2. periodontal tissue
  3. supporting bone
  4. gingiva/oral mucosa
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10
Q

7 types of dental hard tissue/pulp trauma?

A
  1. enamel infarction
  2. enamel fracture
  3. enamel-dentine fracture
  4. complicated crown fracture
  5. uncomplicated crown-root fracture
  6. complicated crown-root fracture
  7. root fracture - apical/middle/coronal
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11
Q

6 types of periodontal tissue trauma classifications?

A
  1. concussion
  2. subluxation
  3. extrusive luxation
  4. lateral luxation
  5. intrusive laxation
  6. avulsion
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12
Q

4 classifications for trauma to supporting bone?

A
  1. comminution of alveolar socket wall
  2. fracture of alveolar socket wall
  3. fracture of alveolar process
  4. fracture of mandible + maxilla
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13
Q

3 classifications of gingiva/oral mucosa trauma?

A
  1. laceration
  2. contusion
  3. abrasion
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14
Q

what is involved in conservative/basic management of tooth trauma?

A 
soft diet 10-14 days
analgesics
use soft tooth brush
corsodyl rinse/gel
antibiotics yes/no
refer to GP if tetanus unsure
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15
Q

how to treat enamel fracture in primary tooth?

A

smooth sharp edges +/- composite
no review
prognosis good

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16
Q

how to treat enamel dentine fracture in primary tooth?

A 
identify location of fragments
smooth sharp edges +/- composite (GIC if not cooperative)
review 6-8 weeks 
radiograph if necrosis suspected 
prognosis depends on associated PDL
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17
Q

2 options to treat complicated crown fractures in primary teeth?

A
  1. partial pulpotomy with non-setting CaOH2 + restoration - review 1 week, 6-8 weeks, 1yr
  2. extracted + review in 1 yr

radiograph if eruption of permanent delayed

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18
Q

how would you treat root fracture in primary tooth that is not displaced?

A

conservatively

review 1wk, 8wk, 1 yr

radiograph if eruption of permanent delayed

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19
Q

how would you treat root fracture in primary tooth that is displaced but not mobile?

A

conservatively

review 1wk, 8wk, 1 yr

radiograph if eruption of permanent delayed

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20
Q

how would you treat root fracture in primary tooth that is displaced + mobile?

A

options:

  1. resposition + splint for 4 weeks
  2. extract coronal fragment + leave apical fragment to absorb

review 1wk, 8wk, 1 yr

radiograph if eruption of permanent delayed

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21
Q

how to treat concussion/subluxation in primary tooth?

A

conservative
review 6-8wks
extract if symptoms develop

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22
Q

how would you treat lateral luxation if no occlusal interference in primary tooth?

A

observe, spontaneous reposition usually 6month

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23
Q

how would you treat lateral luxation if occlusal interface or excessive mobility In primary tooth?

A

reposition + flexible splint 4weeks

or extract if severe

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24
Q

what type of PDL trauma is likely to affect permanent successor?

A

intrusion

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25
Q

how would you treat intrusion trauma in primary tooth?

A

leave + allow spontaneous eruption 6-12month

1 wk, 6-8wks, 1yr

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26
Q

how can radiographs be used to asses intrusion of primary tooth?

A

if apex displaces towards labial bone = tooth apex can be visualised + tooth appears shorter

if apex displaced into developing tooth germ = apex can not be visually + tooth elongated

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27
Q

how would you treat extrusion in primary tooth without any occlusal interference?

A

conservation, allow spontaneous repositioning

review 1wk, 6-8weeks, 1yr

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28
Q

how would you treat extrusion in primary tooth with an occlusal interference?

A

> 3mm extrusion or excessiv mobility = extract

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29
Q

how would you treat avulsion injury in primary tooth?

A

do not reimplant

review 6-8wks

follow up to monitor eruption of permanents

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30
Q

what type of injury causes comminution of alveolar socket wall

A

crushing

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31
Q

how to treat alveolar fracture?

A

reposition segment
splint for 4 weeks
review 1wk, 4wk, 8wk, 1yr
radiographs 4wk + 8wk

or extract

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32
Q

what is a laceration injury?

A

tear

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33
Q

what is a contusion injury?

A

bruise

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34
Q

what causes an abrasion injury

A

superficial wound caused by rubbing/scraping

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35
Q

6 complications to primary teeth after primary tooth trauma

A
  1. necrosis = discolouration
  2. infection
  3. premature loss
  4. pulpal obliteration = creamy
  5. resorption
  6. arrested development
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36
Q

8 complications to permanent teeth after primary tooth trauma

A
  1. enamel hypoplasia/hypominerlisation
  2. pulp necrosis/infection
  3. irregular/delayed/failed eruption
  4. arrested development
  5. crown/root dilaceration
  6. root duplication
  7. odontome like formation
  8. sequestration of tooth germ
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37
Q

what is crown/root dilaceration?

A

abrupt deviation of long axis of crown/root caused by trauma

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38
Q

management of crown/root dilaceration

A
  1. aim to maintain vitality
  2. seal hypoplastic areas
  3. temporise with composite
  4. if vitality lost RCT +/-MTA
  5. definitive restoration for veneer/crown
  6. possible ortho
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39
Q

what is an IMCA?

A

independent mental capacity advocate

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40
Q

what is domiciliary care?

A

treating in the home

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41
Q

6 important questions to ask pt with trauma?

A
  1. how/when/where
  2. loss of consciousness?
  3. other injuries?
  4. bite disturbances/traumatic occlusion
  5. are teeth in same position?
  6. NAI - does injury match history
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42
Q

what is assessed using the trauma stamp?

A 
mobility
displacemnets
TTP
colour (check palatal not labial)
sinus
thermal - ethyl chloride
radiographs + photographs
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43
Q

treatment of enamel dentine fracture in permanent tooth?

A

locate fragments
composite bandage
definite restoration 3-4wks later
6-8wks + 1yr radiographs + sensibility tests

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44
Q

treatment of complicated crown fracture in permanent tooth depends on what 2 factors?

A

size of exposure + time since exposure

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45
Q

if a pulp exposure is <2mm <24hr in permanent tooth, how do you treat? only if vital

A

direct pulp cap with CaOh2 + composite

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46
Q

if a pulp exposure >2mm or >24hrs in permanent tooth, how do you treat? only if vital

A

pulpotomy - partial of full coronal with CaOH2
composite

monitor 1,3,6 months

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47
Q

what do you use to disinfect tooth before pulp cap/pulpotomy?

A

clean with saline + disinfect with sodium hypochlorite

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48
Q

what is cvek pulpotomy?

A

partial coronal (2-3mm)

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49
Q

when would you have to do a pulpectomy after pulpotomy

A

if can’t stop bleeding or if no bleeding

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50
Q

what is HERS and why do you need to protect it when RCT?

A

hertwigs epithelial root sheath

maps out shape + length of root

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51
Q

what are the 2 options for RCT with open apex?

A
  1. specification - change non-setting CaOH2 every 3 month + check for barrier
  2. obturate with thermoplastic GP +/- MTA - average 9-12months for closure
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52
Q

how thick does MTA need to be apically?

A

4-6mm

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53
Q

what sort of post crown would you use in children

A

fiberoptic post crown - bonded composite down 4-5mm in canal + fibre post

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54
Q

5 treatment options for uncomplicated root fracture?

A
  1. fragment removal + gingival reattachemetn
  2. fragment removal + surgical exposure of sub gingival fracture
  3. fragment removal + orthodontic extrusion
  4. fragment removal + surgical extrusion
  5. extraction
55
Q

difference between uncomplicated + complicated root fracture treatment?

A

same but complicated also needs endo (pulp cap, pulptotomy, extirpation)

56
Q

will root fractures be TTP?

A

yes

57
Q

how do you classify root fractures?

A

apical, middle, coronal

58
Q

signs of root fracture

A

coronal segment mobile
TTP
possible colour change

59
Q

what imaging to use for root fracture

A

PA + occlusal

60
Q

how to treat a non-mobile root fracture?

A

conservative + monitor

61
Q

how to treat a mobile root fracture? permanent

A

flexible splint for 4 weeks

62
Q

how to treat displaced root fracture? permanent

A

reposition coronal portion

flexible splint 4 weeks

63
Q

in a coronal root fracture how long might you need to use a splint for?

A

4 months

64
Q

what type of root fracture has worst + best prognosis?

A

apical best

coronal worst

65
Q

when to review root fractures?

A

4 weeks
6-8weeks
4months
6months

66
Q

what sort of tissue forms in good healing of root fracture?

A

calcified tissue + Connective tissue

not granulation tissue

67
Q

how would you treat pulp necrosis in root fracture?

A

extirpate to fracture line
Caoh2 then MTA/biotine just coronal to fracture line
obturate to fracture line
hard tissue closure of root canal at fracture line 6-12 months

68
Q

5 factors affecting prognosis of fractures?

A
  1. age of child
  2. degree of displacement
  3. associated injuries
  4. time between injury + treatment
  5. presence of infection
69
Q

what is subluxation?

A

injury causing abnormal loosening but without tooth displacement

70
Q

management for subluxation + concussion

permanent

A

occlusal relief
soft diet
possible flexible splint for 2 weeks

71
Q

what does lateral luxation mean has happened to the alveolar plate?

A

fractured

72
Q

how to manage lateral excursion? permanent

A

reposition + flexible splint 4 weeks

73
Q

how to monitor concussion/subluxation/extrusion/lateral luxation/intrusion

A

clinical tests - sensibility
radiographs - for root development, check for internal + external inflammatory resorption

at time of injury
1, 3, 6, months

74
Q

how to manage extrusion of permanent tooth?

A

reposition

flexible splint for 2 weeks

75
Q

how to treat intrusion of permanent tooth?

A

flexible splint 4 weeks to stabilise

endo start within 10days if complete apex

76
Q

when does root closure occur?

A

up to 3 years after eruption

77
Q

guidelines for repositioning closed apice teeth after intrusion

A

<3mm spontaneous - then Orthodontics
3-6mm ortho
>6mm surgical + 4/52 splint

78
Q

guidelines for repositioning open apex teeth after intrusion

A

<6mm ortho

>6mm surgical + 4/52 splint

79
Q

what may prolonged splinting lead to?

A

ankylosing

80
Q

what should you rinse avulsed tooth in?

A

saline/milk/saliva

DO NOT TOUCH ROOT

81
Q

what is EADT?

A

extra alveolar dry time - how long out of mouth

60min threshold - when PDL cells turn from viable to non-viable

82
Q

3 factors for avulsed tooth healing

A

EADT
type of storage
stage of root formation - open root best

83
Q

how to deal with tooth EADT <60mins

A

rinse with saline
replant with fingers
flexible splint 2 weeks

if closed apex = RCT:
extirpate prior to splint removal
Caoh2 4 weeks
obturate +/- MTA

84
Q

if a tooth has an open apex + EADT < 45 mins what might be possible

A

revascularization
begin after 4 days

if no evidence in 2 week, extirpate before splint removal

85
Q

how to deal with tooth closed apex + EASDT >60mins

A

replacement resorption will occur, maintain for space + bone

extirpate within 2 weeks
dress CaOh2 4 weeks
obturate

encourage ankylosis - scape off PDL splint 2-3months

86
Q

how to deal with tooth open apex + EADT >60mins

A

do not reimplant

decorate + retain - best for ankylosed teeth

87
Q

3 presentations of replacement resorption?

A
  1. radiographic absence of PDL space/lamina dura
  2. replacement of root structure by bone
  3. metallic sounds to percussion
88
Q

what initiates replacement resorption?

A

severe damage to PDL

normal repair does not occur, bone directly fused to dentine

89
Q

what is replacement resorption?

A

ankylosis

progressive

tooth gradually resorbed as it is now part of bony remodelling - grown around

90
Q

how to treat a dentoalveolar fracture

A

reposition
flexible but rigid splint for 4 weeks
antibiotics

91
Q

4 type of resorption which are complications of PDL injuries?

A

external resorption
external inflammatory resorption
internal inflammatory resorption
replacement resorption

92
Q

what is transient external resorption?

A

damage to PDL which heals, non-progressive

93
Q

what is external inflammatory resorption?

A

damage to PDL + propagated by diffusion of necrotic pulp tissue via dentinal tubes

progressive

94
Q

what sort of resorption does orthodontics cause?

A

external transient

95
Q

how would you diagnose external inflammatory resorption?

A

root surface indistinct but tramlines of canal still intact

96
Q

how would you treat external inflammatory resorption?

A

extirpate
NS CAOH2
treat until non-progressive then obturate
if progressive - iodoform or CaOH2 every 6 months + plan for pros replacement

97
Q

how would you treat replacement resorption?

A

poor prognosis
not influenced by endo
composite additions if possible or decoronation to maintain bone or extraction

98
Q

what is internal inflammatory resorption?

A

initiated by pulp turning non-vital

progressive

99
Q

how would you diagnose internal inflammatory resorption?

A

tramlines of root canal indistinct + root surface intact

100
Q

how would you treat internal inflammatory resorption?

A

extirpate
NS CAOH2
treat until non-progressive then obturate
if progressive - iodoform or CaOH2 every 6 months + plan for pros replacement

101
Q

apart from resorption what is another complication of PDL damage?

A

pulp canal obliteration

102
Q

what is pup canal obliteration?

A

progressive - hard tissue formation within pulp cavity following trauma - gradual narrowing of pulp chamber/canal

103
Q

how would you treat pulp canal obliteration?

A

conservatively - no prophylactic obturation as pulp only becomes necrotic in small number

104
Q

how to treat arrested root development following trauma?

A

treat like open apex to form calcific barrier

CAOH2/MTA/biodentine

105
Q

6 signs of oral malignancy

A
  1. unexplained swelling
  2. unusual bone loss/bony expansion
  3. abnormal tooth mobility
  4. abnormal eruption patterns associated with bone loss
  5. non-healing ulcer
  6. spontaneous bleeding from gingivae
106
Q

3 orally relevent side effects of chemotherapy/BMT?

A

anaemia
thrombocytoenia
leukopenia

107
Q

what the local and systemic ways of stopping bleeding for patient with thrombocytopenia?

A

local - pressure/surgicel/tranexamic acid

systemic - platelet infusion

108
Q

oral manifestation of acute myeloid leukaemia?

A

gingival swelling

109
Q

ulceration + mucositis may develop how many days after chemo + radiotherapy?

A 
chemo = 3-10
radio = 12-15
110
Q

long term dental complications of malignancies in children?

A 
microdontia
root stunting
hypodontia
hypoplasia
delay exfoliation
malalightpment of permanent teeth
facial growth
111
Q

how does radiotherapy effect salivary flow?

A

decreased
starts 14hrs post treatment
can last 2 years post treatment

112
Q

dental complications of chemo/radio

A 
mucosistis
ulceration
immunosuppression - more infection
xerstomia - taste changes, dysphagia
increased bleeding
113
Q

oral signs of graft versus host disease ? following BMT

A

ulcers + white patches - commonly FOM

114
Q

what epilepsy drug can cause gingival overgrowth?

A

phenytoin

115
Q

cystic fibrosis is a disorder of which glands?

A

exocrine glands

116
Q

2 main groups of congenital heart disease

A

acyanotic

cyanotic shunt

117
Q

consequences of infra occluded primary tooth

A

tipping of adjacent teeth

over eruption of opposing tooth

118
Q

which primary teeth do you balance

A

always Cs, sometimes Ds, never Es

119
Q

which teeth do you not compensate

A

primary teeth

120
Q

what is balancing + compensation

A 
compensation = extracting tooth in opposing arch
balancing = extorting other side to stop midline shift
121
Q

when not to balance primary first molars?

A

spaced dentition
cooperative patient - balance if midline shift occuds

balance if under GA

122
Q

5 reasons for 6s impacting Es

A
  1. crowding
  2. large 6
  3. familia tenancy
  4. small maxilla
  5. hall crown technique - increases medial-distal length of E
123
Q

management options for impacted 6s on Es

A
  1. await spontaneous disimpaction - high caries risk
  2. insert separator to attempt disimpaction
  3. reduction of distal surface of E
  4. extraction of E - most common
124
Q

3 reasons 6s were be classed as low prognosis

A
  1. moderate/severely hypominerlaised with post eruptive breakdown/sensitivity/pain
  2. caries extending 2/3 into dentine
  3. 2 surface restoration in place
125
Q

in child - if poor prognosis 6s, class 1 with no crowding - what would your treatment be?

A

extract 6 + compensate with maxillary if needed

126
Q

in child - if poor prognosis 6s, class 1 with crowding or class 2 with no crowding- what would your treatment be?

A

delay extraction until Orthodontics

use space to correct crowding/overjet

127
Q

in child - if poor prognosis 6s, class 3 or class 2 with crowding- what would your treatment be?

A

seek specialist advice

128
Q

ideal time to extract mandibular 6s

A

9.5 years - when 7s bifurcating

129
Q

when should you palpate for canines?

A

9years onwards

130
Q

when must you extract Cs?

A

before age of 11

131
Q

radiographic appearance of dentinal dysplasia type 1

A

‘rootless teeth’

132
Q

characteristics of dentinal dysplasia type 2

A

primary teeth look like DI
permanent teeth normal
thistle shaped pulp chambers + pulp stones

133
Q

which dentinogenesis imperfecta is associated with odontogenic imperfecta

A

1

134
Q

which drugs should be avoided in renal disease

A

paracetamol
penicillin
tetracycline

CDH (4 decks)

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