deciduous tooth trauma Flashcards
1
Q
aetiology
A
falls
bumping into objects
non-accidental
2
Q
which injury is commonest?
A
luxation (soft bones)
3
Q
most common tooth affected
A
upper central incisors
4
Q
pt management
A
reassure history exam diagnosis emergency tx advise parent of sequelae to permanent teeth further tx and review
5
Q
injury history
A
when where how any other symptoms lost teeth/fragments
6
Q
MH
A
RF
immunosuppressed/compromised
congenital heart defects
7
Q
DH
A
prev trauma
tx experience
parent and child attitude
8
Q
EO exam
A
laceration
haematoma
haemorrhage/CSF
subconjunctival haemorrhage
bony step deformities
mouth opening
9
Q
IO exam
A
ST (wounds, foreign bodies)
alveolar bone
occlusion - if traumatic need urgent tx
teeth
10
Q
what might tooth mobility indicate?
A
displacement
root #
bone #
11
Q
transillumination
A
shine curing light on teeth
may show # lines in teeth, pulpal degeneration, caries
12
Q
tactile probe test
A
look for horizontal and vertical #s
pulpal involvement
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
14
Q
whats concussion
A
tooth tender to touch but has not been displaced
15
Q
subluxation
A
tooth tender to touch but has not been displaced, has increased mobility
16
Q
lateral luxation
A
tooth displaced usually in a lingual/ labial direction
17
Q
intrusion
A
tooth usually disaplced through the labial bone plate, or it can impinge on the permanent tooth bud
18
Q
extrusion
A
partial displacement of tooth out of socket
19
Q
avulsion
A
tooth is completely out of the socket
20
Q
trauma stamp
7
A
mobility displacement colour TTP sinus p note radiograph
21
Q
what might a dull p note indicate?
A
root #
long-term - ankylosis
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
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
24
Q
reviewing
A
1week, (4 wk for splint removal), 6-8 wk, 1year
- radiographs if required
-
severe intrusion requires another review at 6yo
- to monitor eruption of permanent tooth
25
E# tx
smooth sharp edges
| small Sof Lex disc
26
ED# tx
- **cover** all exposed dentine with composite
- restore tooth with **compostie** or at a later visit
- clinical exam after 6-8 wks
| don't use GI as won't stay on well
27
tx for EDP#
1. Partial pulpotomy
- if v cooperative child
2. Extract
- x-ray: baseline PA + 1year
- review exam: 1wk / 6-8 wk/ 1 year
28
CR# tx
* remove loose coronal fragment
if restorable
- no exposed pulp: cover exposed dentine with GI
- exposed pulp : pulpotomy
if non-restorable
* don't remove any root fragments that are firm
* leave to resorb physiologically
x-ray: baseline PA + 1year
review exam: 1wk / 6-8 wk/ 1 year
29
root fracture tx
- 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
concussion and subluxation tx
observation
31
alveolar bone # tx
* 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
lateral luxation tx
* no occlusal interference - leave to position spontaneously
* occlusal interference - extract / reposition + slpint
33
what will lateral luxation show on xray?
increased PDL space apically
34
is localisation of intrusion parallax?
no as using one radiograph
35
localisation of intrusion radiographs
* PA or
* **lateral premaxilla**
36
using PA to assess direction of displacment - intrusion
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
localisation of intrusion lat premaxilla
identified a direction of displacement as providing a **lateral view**
38
tx for intrusion
allow spontaneous reposition
| usually 6mo - 1 year
39
tx of extrusion
* not interfering with occlusion - spontaneous repositioning
* excessive mobility or extruded **>3mm** - extract
40
tx of avulsion
* radiograph to confirm avulsion
* do not replant
41
long term effects in primary teeth
1. discolouration
2. discolouration and infection
3. delayed exfoliation
42
what does mild grey discoloration tell you
-intra pulpal bleeding
pulp still vital
discolor may recede
43
what does yellow/ opaque discoloration tell u
* **pulp obliteration**/ sclerotic
* response of vital pulp
* pulp is **laying down tertiary dentine** to protect itself
44
discolored tooth with no symptoms - treatment
no treatment
review
45
delayed exfoliation
- **extraction** necessary or permanent successor **will erupt ectopically**
46
discolouration with symptomatic (usually infected and non-vital)
treatment
endo or ext
47
injuries to permanent teeth
**younger child** = bigger chance of damage to permanent teeth - tell parent and record in notes
48
long term effects in permanent teeth
| 7
* enamel defects 44%
* abnormal tooth/root morphology 8%
- C/R dilaceration
- C/R duplication
* delayed eruption 1%
* ectopic tooth position
* arrested development
* **complete failure**of tooth to form
* odontome formation
49
enamel defects
| types x 2
- hypomineralisation
- qualitative defect
- **white**/yellow spot
- normal E thickness
- hypoplasia
- quantitative defect
- yellow/**brown** areas
- reduced thickness
50
hypomineralisation tx options
* no tx
* composite masking +/- localised removing
* tooth whitening
* external bleaching
* (microabrasion)
* ICON - resin infiltration
51
hypoplasia tx options
* no tx
* composite masking
| porcelain veneer when gingival level stabilised (20yrs)
52
whats dilaceration
**abrupt deviation** of the **long axis** of the crown or root portion of the tooth
53
tx of Crown dilaceration
* surgical exposure + ortho realignment
* improve aesthetic restoratively
54
tx of R dilaceration/duplication/angulation
combined surgical and ortho
55
tx of arrest of root development
* RCT ( if favourable root length)
or
* extract
56
odontome tx
surgical removal
57
tx of complete failure of tooth to form
may sequestrate spontaneously or require removal
58
reason of delayed eruption of permanent teeth from primary trauma
* **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
59
tx of delayed eruption of perm
- **radiograph** if >6 mo delay compared to contralateral
- **surgical** exposure and **ortho** alignment may be requierd
| attach gold chain with archwire
60
ectopic tooth tx
- extraction
- surgical exposure and orhto realignment
