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CSA clinical aspects > CSA trauma to incisors > Flashcards

CSA trauma to incisors Flashcards

1
Q

What can trauma on childs tooth lead to?

A

social judgement and teasing by their peers about their appearance
- Parents of children worries as travel away from work

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2
Q

What is avulsions ?

A

tooth knocked out

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3
Q

guideline on intrusion injuries ?

A

front tooth pushed up in front of gum

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4
Q

How do we manage a child that’s just walked in with trauma?

A
  1. First take a history >informs our diagnosis> informs our prognosis
  2. Carry out examination
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5
Q

How to carry out examination on child?

A
  • start extra orally, maxilla and mandible

- o Carry out intraoral

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6
Q

How do we carry out intra oral examination ?

A

check >

  • Systemic: soft tissues & hard tissues
  • TMJ :May lead to unsymmetrical growth
  • Check all teeth – caries – if going under GA, so don’t have to do it again
  • Check all anterior teeth –
  • Check occlusion –
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7
Q

What can bad occlusion indicate ?

A

TMJ problems

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8
Q

What are 2 special tests?

A

radiographs

sensibility tests > vitality test

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9
Q

What angles are radiographs taken at initial visit>

A
  1. PA or Upper Standard occlusal
  2. 2 PA’S – 15O apart
  3. OPT if any bony fractures are indicated
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10
Q

How to asses root development stage?

A

o If big neurovascular bundle – good prognosis for healing

o If nerve dies – short root forms with thin dentinal walls

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11
Q

What else can we asses from radiographs ?

A

• Assess presence/absence of root fracture

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12
Q

What do we use for vitality tests?

A

Ethyl chloride

EPT testing

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13
Q

What is problems with vitality tests for children?

A

immature teeth- nerve fibres poorly myelinated

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14
Q

How can we get poor prognosis?

A

if tooth becomes non vital

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15
Q

What to look for at injured tooth?

A
  1. Hard tissue injury – enamel/dentine pulp injury
  2. PDL injury
    2 different diagnosis for hard & PDL injuries
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16
Q

What is little incisal tip fracture?

A

enamel only fracture

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17
Q

What is uncomplicated fracture?

A

Enamel – dentine fracture

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18
Q

What is a complicated fracture?

A

Enamel – dentine – Pulp fracture

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19
Q

What is involved in 5. Enamel – dentine – pulp – root fracture

A

cementum

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20
Q

What other fracture can occur?

A

root fracture

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21
Q

What is treatment option for enamel only fracture?

A

desensitising agent if tooth is very sensitive

o Can seal tooth with bond/unfilled resin

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22
Q

How to treat enamel dentine fractures?

A

o Composite build up
o Reattachment fragment if found it
o Seal tubules with glass ionomer if don’t have time for composite build up

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23
Q

How to treat Enamel – dentine – pulp fractures:

A

o Pulp cap
o Pulpotomy – remove contaminated pulp to allow pulp to heal
o Pulpectomy – apexification & canal obturation

24
Q

What to consider with enamel-dentine-pulp fractures ?

A 
o Time since fracture occurred
o Degree of contamination 
o Degree of damage 
o Other injuries that may occurred –
o	Stage of root development
25
Q

What can a combination injury do to prognosis?

A

damage to PDL as well as hard tissues so prognosis worse

26
Q

What are crown root fractures?

A

• Fracture extends from crown to below gingival crevice/ A bone margin

27
Q

What can root fractures be classified as?

A

o Horizontal/Vertical

o May be one single fracture or multiple fractures present

28
Q

How to clinically diagnose fractures?

A

o Mobility is increased

o Extrusion of crown (crown looks higher than other teeth)

29
Q

How to radiographically diagnose fractures?

A

taken from two angles in vertical plane

- Paralleling technique/Anterior occlusal

30
Q

What is root fracture treatment for undisplaced root fracture>

A

o Stable & may be minimal clinical signs of injury

o Do not splint teeth, but to monitor

31
Q

What is treatment for displaced root fracture>

A

o Crown is mobile & interfering with occlusion

o reposition coronal fragment using flexible splint for 4 weeks

32
Q

What are classification of PDL injuries ?

A
  1. Concussion – increasing in severity as we go down
  2. Subluxation
  3. Extrusion
  4. Lateral luxation
  5. Avulsion
  6. Intrusion
  7. Alveolar fracture
33
Q

what is concussion ?

A

bruise to area – haemorrhage/oedema in perio structure but perio ligament fibres are still intact

34
Q

What symptoms during concussion ?

A

o Perio fibres Very tender
o Not displaced
o Not mobile

35
Q

Waht happens if a child has hard tissue injuries as well as PDL?

A

likely to become non-vital

36
Q

What is subluxation ?

A
  • Tearing of periodontal fibres
  • mobility
  • some bleeding around gingival margin
  • no displacement
37
Q

What is extrusion ?

A
  • occlusal displacement of tooth along vertical axis
  • rupture in periodontal fibres and neurovascular bundle
  • Tearing of periodontal ligament
  • look elongated
  • increased mobility of tooth & gingival haemorrhage
  • Occlusal interference
38
Q

What is lateral luxation ?

A

• simultaneous rupture and compression of periodontal ligament

39
Q

What does lateral luxation disrupt?

A

•Disrupts neurovascular supply

  • crown placed palatally
  • gingival bleeding
40
Q

how to tell between extrusion and lateral luxation?

A

during extrusion it is mobile

41
Q

What to do with extrusion?

A

push tooth in with your thumb

42
Q

What to do with lateral luxation?

A

disengage from socket & push it back to original place

43
Q

What is intrusion?

A

tooth displaced vertically upwards

44
Q

What happens during intrusion ?

A
  • extensive crushing of periodontal structures

* disruption of neurovascular bundle

45
Q

Where is intrusion common?

A

primary dentition – because bone very soft – underneath primary teeth are forming permanent teeth

46
Q

How to manage subluxation?

A

identify if fracture in tooth

47
Q

How to manage lateral luxation ?

A

reposition and splint

48
Q

How to manage intrusion ?

A

treated conservatively or reposition and splint teeth

49
Q

What is avulsion?

A

tooth knocked completely out of its socket

50
Q

What does prognosis depend on?

A

extra oral time

• extra oral storage medium

51
Q

What is the effect of dry time?

A

longer is kept dry, less likely healing to occur (30 mins cut off)
• longer time out of mouth – even in milk, less likely to get healing (60 mins cut off)

52
Q

What is replacement resorption?

A

PDL dies, tooth root now in direct contact with bone (no ligament separation)

53
Q

What happens during replacement resorption>

A

body recognises root as foreign body

• bone starts resorbing tooth >root replaced with bone

54
Q

What can replacement resorption cause?

A

ankyloses- fusion of tooth into bone

55
Q

How to manage avulsions?

A 
• Carried out by specialist
• Administer LA
• Irrigate socket – get rid of blood clots 
• Hold tooth by crown only! 
• Gentle resorption – placing back into originally place, should hear click
• Patient bites on cotton wool roll 
• Place a flexible splint 
- dress with Calcium hydroxide
56
Q

What is NEEDED with avulsions?

A

10 day extirpate a closed apex pulp , extirpate before removal of splint

CSA clinical aspects (13 decks)

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