BDS3 Paeds trauma Flashcards

1
Q

What should you check a radiograph for after an enamel fracture?

A

Root development - width of canal and length (mature/ immature)
Comparison with other side
Internal + external inflammatory resorption
PA pathology

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2
Q

What is subluxation and some features of?

A

Injury to PDL.
Tooth TTP
Increased, abnormal mobility but has not been displaced.
Bleeding from gingival crevice may be present

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3
Q

What is the treatment for an enamel-dentine fracture (uncomplicated crown fracture)?

A

Cover all exposed dentine with GI/ composite.
Lost tooth structure an be restored with composite immediately or at a later visit

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4
Q

What is the treatment for enamel, dentine and pulp fracture (complicated crown fracture due to pulp involvement?

A

IMMATURE - Partial pulpotomy/ pulp cap

MATURE - partial pulpotomy, if post required then RCT
Can re-bond tooth fragment if available (after pulp treatment and rehydration)

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5
Q

What is the treatment for a crown-root fracture?

A

If restorable:
- No pulp exposed - remove coronal fragment and restore
- Pulp exposed - pulpotomy or endo treatment
If un-restorable
Extract loose fragments - DON’T DIG

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6
Q

What is the treatment for root fracture?

A

If coronal fragment not displaced - no treatment

If coronal fragment displaced but not excessively
- Leave coronal fragment to spontaneously re-position even if some occlusal interference

Coronal fragment displaced, excessively mobile and interfering with occlusion
- Extract only loose coronal fragment
OR
- Re-position loose coronal fragment +/- splint

Extract

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7
Q

What is the most common injury?

A

Luxation

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8
Q

What are 3 direct sequelae impacts of primary tooth trauma?

A

Discolouration
Infection
Early/ delayed exfoliation - consequences to developing occlusion

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9
Q

What type of trauma injury causes the most disturbance long-term?

A

Intrusion

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10
Q

What are the 7 long-term effects of trauma to primary teeth on permanent teeth?

(alphabetical)

A

Abnormal crown/ root morphology
Arrested development of permanent tooth
Delayed eruption of permanent successor
Ectopic tooth position
Enamel defects to developing permanent tooth
Failure of permanent tooth to form
Odontome formation - benign tumour related to tooth development.

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11
Q

What are the aims of permanent treatment?

A

Apexogenesis
Apexification

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12
Q

What is the aim of a pulpotomy in primary teeth that have experienced trauma (enamel-dentine-pulp fracture)?

A

Aim is to keep vital pulp tissue within the canal to allow for normal root growth (apexogenesis) both in the length of the root and thickness of the dentine.

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13
Q

What percussion note indicates root fracture?

A

Duller percussion note on TTP

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14
Q

What type of special investigation should be done at every trauma appointment?

A

Components of trauma stamp
Includes:
- Mobility
- Colour
- TTP
- Sinus
- Percussion Note
- Radiograph

Do not say trauma stamp in exam - glasgow made up - say components of

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15
Q

Briefly describe the stages of primary trauma exam

A
  1. Reassurance
  2. History
  3. Exam - E/O + I/O, including special investigations and components of trauma stamp
  4. Diagnosis
  5. Emergency treatment
  6. Important information - including homecare.
  7. Book in for appropriate review
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16
Q

What is general homecare for primary trauma?

A

Analgesia - paracetamol
Soft diet for 10-14 days
Brush teeth with soft TB after every meal
Topical chlorhexidine 0.12% mouth-rinse applied topically twice daily for one week
Warn for signs of INFECTION

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17
Q

What are the aims of emergency treatment in primary trauma?

A

Aim to retain tooth vitality
Treat exposed pulp tissue
Reduction and immobilisation of displaced teeth
Tetanus prophylaxis

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18
Q

What are the aims of permanent treatment in primary trauma?

A

Apexogenesis - continued root development
Retain tooth vitality
Normal eruption of permanent teeth

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19
Q

What are the 3 endo options for treatment of an enamel-dentine-pulp fracture primary tooth?

A

Pulp cap
Partial pulpotomy
Full coronal pulpotomy

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20
Q

What is the definition of concussion (soft tissue injury) and what are the clinical findings of this?

A

Injury to tooth’s supporting structures without abnormal loosening of or displacement of the tooth
Tender/ pain on percussion

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21
Q

What is the treatment for subluxation?

A

Normally not required
Splint for 2 weeks if excessive mobility or tenderness when biting

22
Q

What is extrusion and what are the clinical findings of this?

A

Injury where the tooth is displaced axially out of the socket

Tooth appears elongated
Usually displaced palatially
Tooth mobile
Bleeding from gingival sulcus
Likely no response to sensibility testing

23
Q

How should an extrusion injury be treated?

A

Re-position the tooth by gently pushing it back into the socket under LA
Splint for 2 weeks
Monitor pulp
If necrosis - RCT

24
Q

What is lateral luxation?

A

Displacement of a tooth in socket in a direction other than axially.
Usually associated with an alveolar fracture

25
In what case, is a lateral luxation injury LIKELY to spontaneously re-vascularise?
When the root is incompletely formed However, if pulp becomes necrotic and signs of inflammation - specialist endo treatment should be started.
26
What is intrusion and what are the clinical findings of this?
Tooth forces INTO socket in an axial direction and locked into bone. Crown appears shortened Bleeding from gingivae Ankylotic, high, metallic percussion tone.
27
What is the treatment for an intrusion with immature root formation?
Spontaneous re-positioning may occur independent of degree of intrusion If NO re-eruption within 4 weeks - ortho Monitor pulp condition Spontaneous re-vascularisation may occur If pulp becomes necrotic - specialist endo ASAP.
28
What is the treatment for an intrusion with mature root formation?
<3mm: Spontaneous repositioning If no re- eruption within 8 weeks: reposition surgically and splint for 4 weeks OR reposition orthodontically before ankylosis develops 3 -7mm: Reposition surgically (preferably) or orthodontically >7mm: Reposition surgically
29
What are the signs of non-vitality?
Discolouration Negative response to sensibility TTP depends on if there is infection
30
What is the splinting time for a lateral luxation injury?
4 weeks
31
How should lateral luxation injury be treated?
Re-position tooth - feel for apex at gingivae and push down. Then push back into socket. Splint 4 weeks Monitor pulp - re-evaluate 2 weeks post-injury - endo tx. according to results
32
What endo treatment should be carried out for lateral luxation injuries with IMMATURE root formation?
Spontaneous re-vascularisation may occur If necrosis - RCT. Need to use MTA or other medicament to induce apical barrier.
33
What endo treatment should be carried out for lateral luxation injuries with MATURE/ COMPLETE root formation?
Pulp will likely become necrotic. RCT - use CaOH or cortico-steroid anti-biotic as intra-canal medicament
34
What is splinting time for subluxation injury?
2 weeks
35
What is splinting time for extrusion injury?
2 weeks
36
What are the review times for extrusion, intrusion and lateral luxation injuries?
2wks, 4wks, 8wks, 12wks, 6m, 1yr, then yearly for 5 years
37
What are review times for sub-luxation injuries?
2wks, 12wks, 6months, 1yr
38
What guidelines should be followed for tx. options for trauma injuries?
IADT 2020 guidelines International association dental trauma
39
What is the treatment for IMMATURE intrusion injuries?
Allow for spontaneous re-positioning = if pulp necrosis = RCT If no re-eruption within 4 weeks - ortho Monitor pulp condition
40
General FAVOURABLE radiographic signs for permanent paeds trauma?
Intact lamina dura No signs of PA pathology Continued root development No signs of root resorption
41
General UNFAVOURABLE outcomes permanent paeds trauma?
Symptomatic Ankylosis Pulp necrosis Infection Root resorption - e.g. external/ internal
42
Which two injuries are likely to have a high, ankylotic, metallic percussion note?
Lateral luxation and intrusion
43
If enamel-dentine fracture and exposed dentine is within 0.5mm of pulp (pink shining through) what should you do?
Place a CaOH lining and cover with GI
44
Clinical findings of a root fracture?
Coronal segment may be mobile and displaced TTP likely Bleeding from gingival crevice Pulp testing may be negative
45
4 things that determine the prognosis of the traumatised tooth
Type of fracture occurred If tooth is mature vs. immature - finished forming Mobility of the tooth Vitality of pulp
46
What do you need to discuss with parent when discussing child's traumatised tooth
Inform them of complications - pain, discolouration, infection Any damage to adjacent teeth Inform them of prognosis Inform them of treatment options
47
What advice would you give over the phone to a patient with an avulsion of a permanent tooth?
Re-assure patient Hold the tooth by the crown - do not touch the root Check if the root is intact If intact re-implant into socket If you can't re-implant, place tooth in milk/ saliva Come into dental practice ASAP
48
What should you check for patient arriving to practice that has had an avulsion?
How and where the accident happened When tooth was avulsed - how long has it been outside the mouth Account for tooth/ tooth fragments if patient does not have it Ensure no soft tissue injuries Has the patient had their tetanus immunisation
49
What type of splint should be used for avulsions?
Depends on how long it has been outside the mouth - EADT - extra-alveolar dry time <60 minutes - flexible splint 2 weeks >60 minutes - flexible splint 4 weeks
50
What types of healing are there following a root fracture?
Calcified tissue union Connective tissue healing Combination of both
51
What is regarded as non-healing tissue in a root fracture?
Granulation tissue
52
Difference between flexible and rigid splint?
Flexible - 1 tooth either side of traumatised Rigid - 2 teeth either side of traumatised