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Paeds > BDS3 Paeds trauma > Flashcards

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
Complete failure of permanent tooth to form
Delayed eruption of permanent successor
Ectopic tooth position
Enamel defects to developing permanent tooth
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
Q

In what case, is a lateral luxation injury LIKELY to spontaneously re-vascularise?

A

When the root is incompletely formed

However, if pulp becomes necrotic and signs of inflammation - specialist endo treatment should be started.

26
Q

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

A

Tooth forces INTO socket in an axial direction and locked into bone.

Crown appears shortened
Bleeding from gingivae
Ankylotic, high, metallic percussion tone.

27
Q

What is the treatment for an intrusion with immature root formation?

A

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
Q

What is the treatment for an intrusion with mature root formation?

A

<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
Q

What are the signs of non-vitality?

A

Discolouration
Negative response to sensibility
TTP depends on if there is infection

30
Q

What is the splinting time for a lateral luxation injury?

A

4 weeks

31
Q

How should lateral luxation injury be treated?

A

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
Q

What endo treatment should be carried out for lateral luxation injuries with IMMATURE root formation?

A

Spontaneous re-vascularisation may occur

If necrosis - RCT. Need to use MTA or other medicament to induce apical barrier.

33
Q

What endo treatment should be carried out for lateral luxation injuries with MATURE/ COMPLETE root formation?

A

Pulp will likely become necrotic.

RCT - use CaOH or cortico-steroid anti-biotic as intra-canal medicament

34
Q

What is splinting time for subluxation injury?

A

2 weeks

35
Q

What is splinting time for extrusion injury?

A

2 weeks

36
Q

What are the review times for extrusion, intrusion and lateral luxation injuries?

A

2wks, 4wks, 8wks, 12wks, 6m, 1yr, then yearly for 5 years

37
Q

What are review times for sub-luxation injuries?

A

2wks, 12wks, 6months, 1yr

38
Q

What guidelines should be followed for tx. options for trauma injuries?

A

IADT 2020 guidelines
International association dental trauma

39
Q

What is the treatment for IMMATURE intrusion injuries?

A

Allow for spontaneous re-positioning = if pulp necrosis = RCT
If no re-eruption within 4 weeks - ortho
Monitor pulp condition

40
Q

General FAVOURABLE radiographic signs for permanent paeds trauma?

A

Intact lamina dura
No signs of PA pathology
Continued root development
No signs of root resorption

41
Q

General UNFAVOURABLE outcomes permanent paeds trauma?

A

Symptomatic
Ankylosis
Pulp necrosis
Infection
Root resorption - e.g. external/ internal

42
Q

Which two injuries are likely to have a high, ankylotic, metallic percussion note?

A

Lateral luxation and intrusion

43
Q

If enamel-dentine fracture and exposed dentine is within 0.5mm of pulp (pink shining through) what should you do?

A

Place a CaOH lining and cover with GI

44
Q

Clinical findings of a root fracture?

A

Coronal segment may be mobile and displaced
TTP likely
Bleeding from gingival crevice
Pulp testing may be negative

45
Q

4 things that determine the prognosis of the traumatised tooth

A

Type of fracture occurred
If tooth is mature vs. immature - finished forming
Mobility of the tooth
Vitality of pulp

46
Q

What do you need to discuss with parent when discussing child’s traumatised tooth

A

Inform them of complications - pain, discolouration, infection
Any damage to adjacent teeth
Inform them of prognosis
Inform them of treatment options

47
Q

What advice would you give over the phone to a patient with an avulsion of a permanent tooth?

A

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
Q

What should you check for patient arriving to practice that has had an avulsion?

A

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
Q

What type of splint should be used for avulsions?

A

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
Q

What types of healing are there following a root fracture?

A

Calcified tissue union
Connective tissue healing
Combination of both

51
Q

What is regarded as non-healing tissue in a root fracture?

A

Granulation tissue

52
Q

Difference between flexible and rigid splint?

A

Flexible - 1 tooth either side of traumatised
Rigid - 2 teeth either side of traumatised

Paeds (8 decks)

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