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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

Dentalhard tissue and pulp

E# - uncomplicated
ED# - uncomplicated
EDP# - complicated
CR# (pulp involved)
R#

Supporting tissue

alveolar #
concussion/subluxation
luxation - lateral, intrusive, extrusive
avulsion
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14
Q

whats concussion

A

tooth tender to touch but has not been displaced

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15
Q

subluxation

A

tooth tender to touch but has not been displaced, has increased mobility

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16
Q

lateral luxation

A

tooth displaced usually in a lingual/ labial direction

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17
Q

intrusion

A

tooth usually disaplced through the labial bone plate, or it can impinge on the permanent tooth bud

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18
Q

extrusion

A

partial displacement of tooth out of socket

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19
Q

avulsion

A

tooth is completely out of the socket

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20
Q

trauma stamp

7

A 
mobility
displacement
colour 
TTP
sinus
p note
radiograph
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21
Q

what might a dull p note indicate?

A

root #

long-term - ankylosis

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22
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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23
Q

immediate home management

A
  • analgesics
  • warning re signs of infection
  • 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
  • CHX 0.12% MW by parent x2 daily for 1wk - CW rolls to swab
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24
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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25
Q

E# tx

A

smooth sharp edges

small Sof Lex disc

26
Q

ED# tx

A
  • cover all exposed dentine with composite
  • restore tooth with compostie or at a later visit

don’t use GI as won’t stay on well

27
Q

tx for EDP#

A
  1. Partial pulpotomy
    • if v cooperative child
  2. extract
28
Q

CR# tx

A
  • remove loose coronal fragment

if restorable

  • no exposed pulp: cover exposed dentine
  • exposed pulp : pulpotomy

if non-restorable

  • don’t remove any root fragments that are firm
  • leave to resorb physiologically
29
Q

root fracture tx

A
  • coronal fragment not displaced
    • no tx
  • coronal frag displaced but not excessively mobile
    • leave coronal frag to spontaneously reposition even if some occlusal interference
  • coronal frag displaced, excessively mobile and interfering with occlusion
    • extract only the loose coronal frag OR
    • reposition the loose coronal frag +/- splint
30
Q

concussion and subluxation tx

A

observation

31
Q

alveolar bone # tx

A
  • reposition
  • flexible splint to adjacent teeth 4wks
  • teeth may need ext after alveolar stability has been achieved

only case where a splint would be used in management of primary trauma

32
Q

lateral luxation tx

A
  • no occlusal interference - leave to position spontaneously
  • occlusal interference - extract / reposition + slpint
33
Q

what will lateral luxation show on xray?

A

increased PDL space apically

34
Q

is localisation of intrusion parallax?

A

no as using one radiograph

35
Q

localisation of intrusion radiographs

A
  • PA or
  • lateral premaxilla
36
Q

using PA to assess direction of displacment - intrusion

A

compare to contralateral

Favourable / away from tooth germ

  • apical tip seen
  • tooth appears shorter
  • displaced toward/through labial bone plate

Unfavourable / towards tooth germ

  • apical tip indistinct and
  • tooth elongated -
37
Q

localisation of intrusion lat premaxilla

A

identified a direction of displacement as providing a lateral view

38
Q

tx for intrusion

A

allow spontaneous reposition

usually 6mo - 1 year

39
Q

tx of extrusion

A
  • not interfering with occlusion - spontaneous repositioning
  • excessive mobility or extruded >3mm - extract
40
Q

tx of avulsion

A
  • radiograph to confirm avulsion
  • do not replant
41
Q

long term effects in primary teeth

A
  1. discolouration
  2. discolouration and infection
  3. delayed exfoliation
42
Q

what does mild grey discoloration tell you

A

-intra pulpal bleeding
pulp still vital
discolor may recede

43
Q

what does yellow/ opaque discoloration tell u

A
  • pulp obliteration/ sclerotic
  • response of vital pulp
  • pulp is laying down tertiary dentine to protect itself
44
Q

discolored tooth with no symptoms - treatment

A

no treatment
review

45
Q

delayed exfoliation

A
  • extraction necessary or permanent successor will erupt ectopically
46
Q

discolouration with symptomatic (usually infected and non-vital)
treatment

A

endo or ext

47
Q

injuries to permanent teeth

A

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

48
Q

long term effects in permanent teeth

7

A
  • enamel defects 44%
  • abnormal tooth/root morphology 8%
    • C/R dilaceration
    • C/R duplication
  • delayed eruption 1%
  • ectopic tooth position
  • arrested development
  • complete failureof tooth to form
  • odontome formation
49
Q

enamel defects

types x 2

A
  • hypomineralisation
    • qualitative defect
    • white/yellow spot
    • normal E thickness
  • hypoplasia
    • quantitative defect
    • yellow/brown areas
    • reduced thickness
50
Q

hypomineralisation tx options

A
  • no tx
  • composite masking +/- localised removing
  • tooth whitening
    • external bleaching
    • (microabrasion)
    • ICON - resin infiltration
51
Q

hypoplasia tx options

A
  • no tx
  • composite masking

porcelain veneer when gingival level stabilised (20yrs)

52
Q

whats dilaceration

A

abrupt deviation of the long axis of the crown or root portion of the tooth

53
Q

tx of Crown dilaceration

A
  • surgical exposure + ortho realignment
  • improve aesthetic restoratively
54
Q

tx of R dilaceration/duplication/angulation

A

combined surgical and ortho

55
Q

tx of arrest of root development

A
  • RCT ( if favourable root length)

or

  • extract
56
Q

odontome tx

A

surgical removal

57
Q

tx of complete failure of tooth to form

A

may sequestrate spontaneously or require removal

58
Q

reason of delayed eruption of permanent teeth from primary trauma

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 delaycompared to contralateral

59
Q

tx of delayed eruption of perm

A
  • radiograph if >6 mo delay compared to contralateral
  • surgical exposure and ortho alignment may be requierd

attach gold chain with archwire

60
Q

ectopic tooth tx

A
  • extraction
  • surgical exposure and orhto realignment

paeds (7 decks)

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