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4th yr- CCD2- Trauma Symposium > Acute Management of Dental Trauma > Flashcards

Acute Management of Dental Trauma Flashcards

1
Q

What does TDI stand for

A

Traumatic dental injury

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2
Q

What is a key question we need to ask when I patient comes in with a TDI

A

Ask about head injury

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3
Q

When should we send a child to the emergency ward

A

If they suffer from reduced consciousness or blacks out at the time of the accident

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4
Q

When should a head CT be taken following a TDI

A
  1. Suspicion of non accidental injury
  2. Post traumatic seizure with no history of epilepsy
  3. Any suspected open of depressed skull fractures
  4. Any sign of basal skull fractures
  5. Focal or neurological deficits such as change in vision
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5
Q

Give soem signs of basal skull fractures

A
  1. CSF leakage from ear or nose

2. Battle signs (bruising around the orbit)

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6
Q

What approach should we use when examining teeth following TDI

A

Use proformas (tables)

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7
Q

What do Proformas allow you to do

A
  1. Record dental information systemically

2. Allow for comparisons chronologically and between different teeth

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8
Q

Talk through how you’d carry out your examination following a TDI

A

Start outside to inside

  1. Check general appearance
  2. Maxilla and mandible
  3. Skull general
  4. Intra oral
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9
Q

What do we look for when taking an intra oral exam

A
  1. Systematic soft tissues
  2. Hard tissues
  3. Check anterior teeth canine to canine
  4. Occlusion
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10
Q

Give examples of special test we can take to aid diagnosis

A
  1. Mobility
  2. TTP
  3. Transillumnation
  4. Ethyl chloride
  5. Electric Pulp Test
  6. Radiographic report
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11
Q

What does treatment in the acute phase depend on

A
  1. Age of child
  2. Type of injury
  3. Concomitant injuries (most severe first)
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12
Q

Name common TDIs seen in practice

A
  1. Avulsion
  2. Luxation injuries
  3. Extrusion
  4. Intrusion
  5. Lateral luxation
  6. Displaced root fractures
  7. Complicated crown fractures
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13
Q

Which of the TDIs is known as the one true dental emergency

A

Avulsion

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14
Q

In which age group is an avulsion injury most common in

A

7-10 year olds

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15
Q

Avulsion accounts for what percentage of all dentoalveolar trauma

A

0.5-16%

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16
Q

Why is avulsion known as the one true dental emergency

A

As the acute management directly affects the prognosis of the tooth

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17
Q

What advice have we given the lay person if they see a child undergo an avulsion injury

A

Pick it
Lick it
Stick it

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18
Q

What is an avulsion injury

A

When a tooth is knocked out

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19
Q

When should we NOT replant a tooth that has been knocked out

A
  1. Primary teeth
  2. Other injuries requiring emergency care
  3. Patients with impaired immunity
  4. Patients at risk of infective endocarditis
  5. Very immature permanent incisors
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20
Q

How do we treat avulsion

A
  1. LA
  2. Suction socket gently
  3. Gently rinse with saline
  4. Reimplant holding the crown
  5. Gentle pressure
  6. Splint wire / composite
  7. Radiograph to confirm position
  8. Antibiotics and keep splint for 2 weeks
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21
Q

Following avulsion which teeth have the best prognosis

A

When the tooth has been immediately re implanted (within 15 mins)

22
Q

What is the prognosis for immature teeth that have been implanted within an hour of avulsion

A
  1. Viable bur compromised cells
  2. Pulpal healing may occur via regeneration
  3. Need to monitor
23
Q

What is the prognosis for immature teeth that have been implanted after an hour of avulsion

A

Non viable PDL cells

will need to refer to specialist

24
Q

What is the prognosis for teeth that have been implanted within 15 mins of avulsion

A

Good however may need to initiate RCT on a mature tooth within 2 weeks

25
What is the prognosis for mature teeth that have been implanted within an hour of avulsion
Pulp will not survive so need to extirpate ASAP (within two weeks of trauma)
26
What is the prognosis for mature teeth that have been implanted after an hour of avulsion
PDL and pulp non viable Extirpate ASAP (within two weeks of trauma) Refer to specialist
27
What instructions should we give to patient and parents following injury
1. Good oral hygiene is a must 2. Avoid contact sports 3. Chlorhexidine 0.2% mouthwash twice a day fro 7 days 4. Soft diet
28
What is a luxation injury
the tooth is dislocated within the socket but maintains some attachment
29
What are the main stages of luxation injury management
1. Reposition 2. Splint 3. Review portion radiographically 4. Keep under review
30
What is an extrusion injury
An injury to the tooth characterized by partial or total separation of the periodontal ligament resulting in loosening and displacement of the tooth.
31
How do we manage an extrusion injury
1. LA 2. Gentle reposition digitally if fresh injury 3. Splinting
32
What is an intrusion injury
apical displacement of a tooth into alveolar bone.
33
How common are intrusion injuries
Account for 0.3-1.9% of all TDIs
34
What does the prognosis of an intrusion injury depend on
Severity of intrusion and development of root
35
How do we manage an intrusion injury of an immature root apex
1. Allow re eruption without intervention 2. If no movement in a few weeks undergo orthodontic repositioning 3. If more than 7mm intrusion consider surgical repositioning
36
What does management of a intrusion injury of mature root apex depend on
Depends on how much movement
37
How do we manage a less than 3mm intrusion injury of a mature root apex
1. Allow re eruption without intervention | 2. If no movement in a few weeks undergo orthodontic repositioning
38
How do we manage a 3-7mm intrusion injury of a mature root apex
Surgical or orthodontic repositioning
39
How do we manage a more than 7mm intrusion injury of a mature root apex
LA Surgically reposition Splint
40
What is a lateral luxation injury
happens when the alveolar bone fractures and the periodontal ligament separates
41
How do we treat lateral luxation
LA Reposition via re engaemtn from position in bone to original location Radiograph Splinting for 4 weeks
42
How do we treat a displaced root fracture
Like any other luxation injury
43
What are the treatment options avail fro a complicated crown fracture
1. Pulp capping 2. Cvek pulpotomy 3. Coronal pulpotomy
44
What is the treatment of a complicated crown fracture dependent on
Degree of damage and root development
45
When would we decide to pulp cap a complicated crown fracture
Small exposure within 24 hours
46
When would we decide to do a cvek pulpotomy for a complicated crown fracture
When the exposure is larger than a pinpoint Up to 4 days post exposure Either incomplete or complete root development seen
47
When would we decide to do a coronal pulpotomy for a complicated crown fracture
If exposure is larger than a pinpoint | Site is contaminated or fracture is more than 4 days
48
What are the different restoration options for a crown fracture
1. Re attaching old fragment of tooth 2. Restore using composite 3. Glass ionomer bandage
49
What is restoration option for a crown fracture dependent on
Ability of child and degree of tooth loss
50
Which TDIs require immediate management
1. Avulsion 2. Complicated root fracture 3. More luxated luxation injuries eg extrusion, lateral luxation, intrusion 4. Displaced root fracture
51
Which TDIs are not as critical
1. Concussion 2. Sub luxation 3. Infarction 4. Enamel fracture 5. E-D fracture 6. non displaced root fracture
52
Which patients need immediate onwards referral
1. Patients sustaining a head injury 2. Uncooperative child 3. Significant medical history 4. Multiple complex injuries 5. If you cannot reposition or splint appropriately

4th yr- CCD2- Trauma Symposium (7 decks)

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