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paeds > deciduous tooth trauma > Flashcards

deciduous tooth trauma Flashcards

1
Q

aetiology

A

falls
bumping into objects
non-accidental

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2
Q

which injury is commonest?

A

luxation (soft bones)

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3
Q

most common tooth affected

A

upper central incisors

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4
Q

pt management

A 
reassure
history
exam
diagnosis
emergency tx
advise parent of sequelae to permanent teeth
further tx and review
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5
Q

injury history

A 
when 
where
how
any other symptoms
lost teeth/fragments
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6
Q

MH

A

RF
immunosuppressed/compromised
congenital heart defects

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7
Q

DH

A

prev trauma
tx experience
parent and child attitude

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8
Q

EO exam

A 
laceration
haematoma
haemorrhage/CSF
subconjunctival haemorrhage
bony step deformities
mouth opening
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9
Q

IO exam

A

ST (wounds, foreign bodies)
alveolar bone
occlusion - if traumatic need urgent tx
teeth

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10
Q

what might tooth mobility indicate?

A

displacement
root #
bone #

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11
Q

transillumination

A

shine curing light on teeth

may show # lines in teeth, pulpal degeneration, caries

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12
Q

tactile probe test

A

look for horizontal and vertical #s

pulpal involvement

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13
Q

classification

A 
E# - uncomplicated
ED# - uncomplicated
EDP# - complicated
CR# (pulp involved)
R#
alveolar #
concussion/subluxation
luxation - lateral, intrusive, extrusive
avulsion
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14
Q

trauma stamp

A 
mobility
displacement
colour 
TTP
sinus
p note
radiograph
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15
Q

what might a dull p note indicate?

A

root #

long-term - ankylosis

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16
Q

why aren’t sensibility tests used?

A

pt factors - young child won’t understand/cooperate/may lie to please you
tooth morphology - unreliable results, less root due to resorption. blood vessels and nerves changing

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17
Q

immediate home management

A

soft diet 10-14 days
- can eat anything but chop up and eat with molars
- want some activity after couple days to stimulate PDL cells
brush teeth with soft TB after every meal
topical CHX by parent x2 daily for 1wk - CW rolls to swab

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18
Q

reviewing

A

1,3,6m
- radiographs if possible every 6m
intrusion requires monthly review for 6m then every 6m
- check it isn’t hitting permanent incisor - compare to contralateral tooth

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19
Q

E# tx

A

smooth sharp edges
OR
composite/compomer bandage/Rx - don’t use GI as won’t stay on well

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20
Q

ED# tx

A

composite/compomer bandage/Rx

don’t use GI as won’t stay on well

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21
Q

tx for EDP#

A 
endo if v cooperative child
 - 2mm short of apex
 - not GP as won't resorb
 - use CaOH and Iodoform paste
extract
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22
Q

CR# tx

A

extract coronal fragment
don’t remove any root fragments that aren’t obvious
leave to resorb physiologically

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23
Q

concussion and subluxation tx

A

observation

24
Q

alveolar bone # tx

A

reposition
splint to adjacent teeth 3-4wks
teeth may need ext after alveolar stability has been achieved
only case where a splint would be used in management of primary trauma
- trying to immobilise bone

25
Q

lateral luxation tx

A

no occlusal interference - leave to position spontaneously

occlusal interference - extract

26
Q

what will lateral luxation show on xray?

A

increased PDL space apically

27
Q

is localisation of intrusion parallax?

A

no as using one radiograph

28
Q

localisation of intrusion radiographs

A

PA

lateral premaxilla

29
Q

localisation of intrusion PA

A

compare to contralateral
apical tip appears shorter - displaced toward/through buccal bone
- preferable - away from developing tooth germ
apical tip indistinct and tooth elongated - towards permanent tooth germ

30
Q

localisation of intrusion lat premaxilla

A

identified a direction of displacement as providing a lateral view

31
Q

tx for intrusion

A

labial root displacement - leave to re-erupt
- if no progress after 6m ext - check each month that it is erupting (ankylosis - ext)
palatally - extract

32
Q

tx of extrusion

A

extract

33
Q

tx of avulsion

A

radiograph to confirm avulsion

do not replant

34
Q

long term effects in primary teeth

A

discolouration
discolouration and infection
delayed exfoliation

35
Q

delayed exfoliation

A

primary tooth may not resorb normally after trauma

extraction necessary or permanent successor will erupt ectopically

36
Q

discolouration +/- infection : vital

A

no tx

37
Q

discolouration +/- infection : non-vital and sinus/PAP

A

RCT or ext

38
Q

discolouration +/- infection : non-vital and no sinus/PAP

A

leave and review

39
Q

discolouration +/- infection : opaque

A

no tx

tertiary dentine laid down in pulp chamber, opacity has changed

40
Q

discolouration and vitality

A

immediate - may maintain vitality

intermediate (weeks) - non-vital

41
Q

injuries to permanent teeth

A

related to age of trauma to primary teeth

younger child = bigger chance of damage to permanent teeth - tell parent and record in notes

42
Q

long term effects in permanent teeth

A 
enamel defects 44%
abnormal tooth/root morphology 8%
 - C/R dilaceration
 - C/R duplication
delayed eruption 1%
ectopic tooth position
arrest in tooth formation
complete failure of tooth to form
odontome formation
43
Q

enamel defects

A 
type of defect depends on age
hypomineralisation - white/yellow spot
 - normal E thickness
hypoplasia - yellow/brown areas
 - less than normal thickness
44
Q

hypomineralisation tx options

A 
leave
composite mask
localised removal and restore composite
external bleaching
(microabrasion)
ICON - resin infiltration
45
Q

hypoplasia tx options

A

composite Rx

porcelain veneer when gingival level stabilised (20yrs)

46
Q

tx of C dilaceration

A

surgical exposure
ortho realignment
improve appearance

47
Q

tx of R dilaceration/duplication/angulation

A

combined surgical and ortho

48
Q

tx of arrest of root development

A

RCT or extract

49
Q

odontome tx

A

surgical removal

50
Q

tx of undeveloped tooth germ

A

may sequestrate spontaneously or require removal

51
Q

delayed eruption of permanent teeth

A

premature loss of a primary tooth can result in delayed eruption of about 1yr due to thickened mucosa (protect itself)
take radiograph if >6m delay compared to contralateral
surgical exposure and ortho may be required if abnormal morphology
- normally spontaneous eruption within 18m of uncovering
- if older sometimes use ortho and chain

52
Q

discolouration - immediate/days after

A

pink
blood in dentine tubules
tends to be transient as pulp is still alive and vital tissue repairs itself

53
Q

discolouration - few weeks after

A

grey/brownish
indicates tooth non-vital
happens a few weeks after pulp dies/becomes non-vital
- breakdown of necrotic pulp e.g. haemosiderin, eosin
- leaches into dentinal tubules

54
Q

discolouration - several months after

A

yellow/opaque
pulp canal obliteration - sclerosis
tertiary dentine formation
pulp reacts (odontoblasts) to protect itself

55
Q

long-term complications of primary incisor trauma

A

loss of vitality
abscess risk
may require extraction
delayed exfoliation

56
Q

complications to permanent incisors following primary incisor trauma

A 
delayed eruption
ectopic eruption
damage to crown development
 - hypoplasia
 - hypomineralisation
damage to root development
 - dilaceration

paeds (7 decks)

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