8. Oral Trauma Flashcards
1
Q
Most frequently injured teeth in the primary dentition are
A
maxillary primary incisors
2
Q
Peak age of injury to primary teeth is
A
2-4 years (learning to walk)
3
Q
Primary molars are commonly injured by _ trauma
A
indirect trauma (i.e a blow to the underside of the chin cuasing the mandible to strike the maxilla)
4
Q
_% of abused children suffer injuries to the head and neck
A
50
5
Q
Cardinal signs of child abuse are
A
- Injuries with various stages of healing
- Torn Labia frenum
- Repeated injuries
- Clinical presentation doesn’t match history from parents
6
Q
What is the triangle of saftey
A
- Ears
- Side of face
- neck
- Top of shoulders
- *Accidental injuries here are unusual**
7
Q
Look at slide 4 diagram
A
ok
8
Q
Tetanus protection is especially important if the patient’s wound is
A
dirty
9
Q
Tetanus is caused by what
A
a toxin (tetanospasmin) made by clostridium tetani
10
Q
Tetanus vaccine is a series of _ injections and what are the time frames
A
5
- 2 mons
- 4 months
- 6 mo
- 15-18 mo
- 4-6 years
11
Q
What is the name of the tetanus vaccine and what does the name stand for
A
DTap
- Diptheria
- tetanus
- Pertussis
12
Q
tetanus boaster with _ (name of vaccine) is required ever - years
A
Tdap (instead of DTaP)
-11-12 yrs
13
Q
Define infraction
A
Incomplete fracture of enamel without loss of tooth structure
14
Q
Presence of (mobility/tenderness to percusion) with infraction
A
none
15
Q
Tx for infrraction
A
none
16
Q
Define enamel fracture
A
-fracture restricted to enamel (loss of tooth structure)
17
Q
Any damage to the neurovascular supply or permanent tooth germ with enamel fracture
A
no
18
Q
Tx for enamel fracture
A
smooth sharp edges
19
Q
Crown root fracture without pulpal involvement involves what tooth structures
A
enamel, dentin, and cementum
20
Q
Crown root fracture is complicated or uncomplicated
A
Can be either depending if there is pulpal involvement
- Pulpal involvement= complicated
- no pulpal involvement= uncomplicated
21
Q
For a crown root fracture there are two fragments- one of which is
A
mobile
22
Q
What is the treatment for a crown- root fracture without pulpal involvement
A
Depends on the restorability of the mobile tooth fracture
- If large and restorable then remove the mobile fragment and place a coronal restoration on the immobile fragment
- If unrestorable then extract both fragments
23
Q
What is the treatment for a crown- root fracture with pulpal involvement
A
- If large and restorable then remove the mobile fragment, pulp therapy for immobile fragment, place a coronal restoration on the immobile fragment
- If unrestorable then extract both fragments
24
Q
Is there any damage to the neurovascular supply and the permenant tooth bud with a enamel dentin fracture
A
no
25
Treatment for enamel dentin fracture
- Seal dentin with GI
- Fractures exposing dentin in primary teeth have no deleterious effect on the pulp and need not be covered
- Consider restoration for large loss of tooth structure
26
When there is a fractured tooth and soft tissue laceration what should you do
take an X-ray make sure the tooth isn't in the soft tissue
27
Exposure time for this soft tissue X-ray is _% the usual exposure for an intra-oral image
25
28
What are the treatment options for an enamel dentin pulp fracture
pulpotomy
pulpectomy
exo
29
Contraindications for a pulpotomy
- Internal/external root resorption
| - infection of the crypt of the succedaneous tooth
30
Inflammation and overinstrumentation can have when effect on the permenant successors
mild enamel defects
31
Contraindications for a pulpotomy
- Swelling of pulpal origin
- Fistula
- Pathologic mobility
- Pathologic external root resorption
- Internal root resorption
- Periapical or interradicular radiolucency
- Pulp calcifications
- Excessive bleeding from the amputated radicular stumps
* *Need at least 2/3 root remaining
* *Other signs to be cautious of are spontaneous or nocternal pain. Pain to percussion and palpation
32
For a concussion the tooth (is/is not) mobile and (is/is not) displaced
is not for both
33
Is there sulcular bleeding with a concussion
no
34
Describe a concussion
- Tender to percussion
- No mobility
- No displacement
35
Treatment for concussion
none
36
Describe subluxation
- Sensitive to percusion
- Mobile
- No displacement
- Sulculas bleeding
37
Treatment for subluxation
none
- Soft diet for limited time
- Good OH to prevent PDL contamination
- 0.12% chlorhexidine applied to area with cotton swab for one week
38
Most poeple often do not notice when concussion or subluxation occurs unless _ happens
tooth discoloration
39
What events lead to coronal discoloration
-Capillaries in the pulp --> hemorrhage --> blood pigments deposited in dentinal tubules
40
T/F Color change along indicates the tooth should recieve pulp therapy
f
41
When should a discolored tooth recieve pulp therapy
Additional symptoms of infection such as....
- Periapical pathology
- Swelling
- Pathologic mobility
- fistula
- Pain
42
What are the three colors of coronal discoloration
pink-red
yellow
dark (gray-black-brown)
43
Pink tooth discoloration be secondary to...
internal resorption in the pulp chamber
44
What is the treatment for coronal discoloration
follow up and monitor for symptoms of infection
45
Yellow discoloration suggests
partial or complete pulp obliteration (calcific metamorphosis of the dental pulp, progressive canal calcification, dystrophic calcification)
46
Yellow discoloration (PCO) has a (good/bad) prognosis
good
47
T/F: PCO can be seen radiographically without yellow discoloration
t
48
Tx of PCO
- Pathologic process but no deleterious effects
- Usually undergoes normal root resorption
- No Tx unless evidence of necrosis
49
How does the dark coronal discoloration ever come about
hemorrhage of pulp --> RBC lysis and releases hemoglobin. Fe in iron stains tooth dark
50
The dark pigments may be eliminated if...
the pulp remains vital (tooth will remain discolored if non-vital)
51
Over _% of dark discolored primary incisors will remain without X-ray and clinical pathology
70%
52
What is the treatment for dark tooth discoloration
Same for the other discoloration
- watch for symptoms
- signs of necrosis --> pulp therapy/exo
53
(T/F) There is no difference in the fate of the permenant successors with pulp therapy discolored untreated and RCT teeth
t
54
What is avulsion
tooth is completely out of the socket
55
About _% of avulsions results in damage to the successor for a primary incisor
75
56
Reimplantation of a primary tooth (is/is not) recommended and why
Is not because you can damage the permenant tooth
| **Some people will replant with 2-3 mm of the root apex shaved of
57
In avulsion if the tooth is not present what must you rule out and how
aspiration- chest X-ray
58
What patients require antibiotic prophylaxis before dental treatment
- Artificial heart valves
- Infective endocarditis
- Cardiac transplant
- Congenital heart condition
- Unrepaired or incomplete repair
- During the 1st 6 months after a procedure
- Residual defect
59
Intrusive luxation often leads to what other complication
fracture of alveolar socket (labial bone)
| -Rupture of the neurovascular supply
60
Which orientation for intrusive luxation is more favorable and why
labial intrusion of the root because the tooth germ will not be affected
(Palatal intrusion --> toward the permanent tooth)
61
When the root is intruded in the labial direction this means the crown will be inclined in what direction
lingual
62
Radiographically how can you determine the direction of intrusion
Look at the adjacent tooth and the tooth of interest
- If the tooth of interest appears foreshortened relative to the adjacent tooth then the root was labially displaced (permanent successor at minimal risk)
- If the tooth appears elongated the root was intruded in the palatal direction (permanent tooth at risk)
63
What is the tx for a tooth whos root was intruded in the palatal direction
exo
64
_% of intruded teeth are pushed labially
80%
65
Tx for labaially intruded teeth
majority will re-erupt and survive > 36 months
- Thus tx is observe for re-eruption
- Radiographic follow up is recommeneded until the permenant successor erupts
66
Intruded primary teeth with have (vital/non-vital pulps)
vital **unlike permenant teeth
67
T/F The tooth can discolor after intrusion
t (watch for symptoms of infection)
68
What is extrusion
- Partial displacement of the tooth out of its socket
- Increased mobility
- Sensitive to percussion and palpation
- Gingival sulcus bleeding
- No damage to permanent tooth germ
- Severance of neurovascular supple
- Separation of the PDL space and coronal exposure
69
What are the radiographic signs of extrusion
widening of PDL around the apex
70
The higher the chances of pulp necrosis and severance of neurovascular supply the...
more the tooth is out of the alveolar socket
71
Minor extrusion is defiend as
< 3mm
72
What is the treatment for a minor extrusion
careful reposition or spontaneous alignment
73
What is the treatment for a severe extrusion
exo (LA necessary!!)
74
T/F Coronal discoloration may occur with extrusion
t
