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Yr 4 - CCD2 > Dental Trauma > Flashcards

Dental Trauma Flashcards

1
Q

what classification is used for dental trauma?

A

Traumatic Dental Injuries

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2
Q

What 6 different fractures can occur to the tooth - describe each

A

infraction
- incomplete fracture/crack of the enamel
- no loss of tooth substance
- tx: desensitising agents, seal with unfilled resin

enamel
- fracture w/ loss of tooth substance only on the enamel

enamel-dentine
- fracture w/ loss of tooth substance
- only on the enamel and dentine
- AKA uncomplicated crown fracture

enamel-dentine-pulp
- fracture involving enamel, dentine and exposing the pulp
- AKA complicated crown fracture

crown-root
- fracture involving enamel, dentine and cementum
- pulp may or not be involved
- if pulp not involved = uncomplicated crown root fracture
- if pulp involved = complicated crown root fracture

root
- fracture involves dentine, cementum and pulp
- can be horizontal/vertical or displaced/non-displaced
- if it is unstable and displaced - use a flexible splint for 4 weeks

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3
Q

what are 7 injuries that can occur to the periodontal tissues?

A
  • concussion
  • subluxation
  • extrusion
  • lateral luxation
  • alvulsion
  • intrusion
  • alveolar fracture
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4
Q

what is a Concussion to the perio tissues?

A
  • an injury to tooth supporting structures
  • remains intact without mobility or displacement
  • but has marked reaction to percussion - bit sensitive to forces
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5
Q

what is SubLuxation?

A
  • an injury to the tooth supporting structures
  • creates mobility
  • no displacement
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6
Q

what is Extrusion?
- what happens to the PDL cells and the neuromuscular bundle on either side of the tooth?
- what is the prognosis
- tx

A

partial displacement of tooth out of its socket

one side = PDL cells crushed
other side = PDL cells are stretched or torn

neurovascular bundle is crushed

prognosis
- usually will interfere with the occlusion and become non-vital
= extraction

tx
- reposition the tooth
- physiological splint for 3-4 weeks
- antibiotics and CHX

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7
Q

what is Lateral Luxation?
- tx?

A
  • tooth has displaced in a direction other than axially (not up or down into the socket)
  • alveolar socket fractures

tx:
- reposition the tooth
- physiological splint for 3-4 weeks
- antibiotics and CHX

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8
Q

what is Intrusion?
- what happens to the neuromuscular bundle and the PDL cells
- what is the management of the tooth?
- prognosis

A

when the tooth has displaced into the alveolar bone (goes deeper into the socket)

  • alveolar socket fractures
  • neuromuscular bundle and PDL cells will be crushed

management
- leave it unless:
- has a interference with the perm. successor
- infected
- will fail to re-erupt (3-6 months)
- can then orthodontically or surgically extrude

prognosis
- most will become necrotic

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9
Q

what is Avulsion?
- what is the management in children and adults?

A

the tooth has completely displaced out of its socket

in children
- DO not reimplant
- can lead to ankylosis
- risks damage to the permanent tooth

in adults
- re implant and place a splint

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10
Q

what is Replacement Resorption

A

when an avulsed tooth has been re-implanted and the root is replaced by bone tissue

  1. the PDL is damaged/destroyed
  2. bone is in direct contact with tooth
  3. ankylosis -
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11
Q

3 reasons to do special investigations.

A
  • make an accurate diagnosis
  • can be an indicator for the prognosis of the tooth
  • act as a baseline for follow up appts
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12
Q

what special investigations can you do?

A
  1. vitality testing - EPT or ethyl chloride
    - only in traumatised permanent teeth
  2. percussion - + or +++
  3. mobility - grading
  4. colour - discolouration?
  5. transillumination - use comp curing light to look for infarction lines
  6. radiographs
    - assess root development or fracture
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13
Q

why are vitality tests in children unreliable?

A
  • anxiety
  • pain
  • immature tooth has poorly myelinated nerve fibres
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14
Q

what are the aims of treatment?

A

treat pain
restore function
restore aesthetic
prevent further damage to successor

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15
Q

what are the factors of conducting treatment?

A

patient behaviour
parents choice
medical history

the type of injury

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16
Q

what would be the effect of losing one primary incisor early on?

A

the speech isn’t really hindered
the occlusion is still maintained

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17
Q

whats the advice following subluxation/concussion

A
  • keep a soft diet
  • take analgesics for pain
  • monitor the pain
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18
Q

Lateral Luxations:
when should you leave it
when should you extract

A

leave it:
- stable
- doesn’t interfere with the occlusion
- can become repositioned

extract it:
- unstable
- slightly extruded
- interferes with occlusion

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19
Q

what should you do if there has been a fracture, but no plural exposure?

A

leave it
smooth it over
restore with composite

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20
Q

what should you do if there has been a fracture with pulpal exposure?

A

either
- extract
- pulp cap
- pulpotomy/pulpectomy

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21
Q

when would you do a pulp cap?

A

if it is a small exposure
- has happened recently

  • to protect and preserve the pulp
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22
Q

what is a pulpotomy and its 2 types?

A

partial removal when the pulp is injured but not severe enough to remove it all

  1. partial aka Cvek Pulpotomy
    - removes the inflamed coronal portion of the pulp
  2. cervical
    - removes the entire coronal pulp
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23
Q

describe the technique for a partial pulpotomy.

A
  1. LA and isolation
  2. remove 2mm plural tissue
  3. achieve haemostasis
  4. apply non setting calcium hydroxide
  5. apply hard setting lining
  6. restore
24
Q

what is a pulpectomy?
- once you have done a pulpectomy, what are the two tx options to follow?

A

complete removal of the dental pulp

  1. apexification - when an open apex
    - encourages calcification of the apex
    - once apex has formed, canal = permanently sealed
  2. canal obturation
    - fill and seal the canal
25
how do you encourage apexification following pulpectomy?
- establish the working length - chemo-mechanical prep - filing, sodium hypochlorite, dress with calcium hydroxide - reassess and re-dress every 3 months - permanently obturate once hard apical barrier has formed (9-12 months)
26
what are the problems with apexification?
- final root filling is difficult - the root is predisposed to fracture - there is no natural increase in root dimension aka no increase in length or width = less support for the tooth
27
discolouration - what is the aetiology of a grey tooth? - what is the aetiology of a yellow tooth?
grey tooth - likely to be a haemorrhage - will gradually resolve yellow tooth - pulp canal obliteration - pulp becomes hardened or calcified - response is to lay down dentine
28
when a tooth is traumatised, what kind of damage may it lead to in the permanent successor?
- dilaceration of the crown or root = a bend - root duplication - partial or total root failure development - discolouration - odontoma like formation - abnormal growth
29
what are the advantages and disadvantages of replanting a tooth?
advantages - aesthetic - space maintenance - maintain the options - implant, bone is preserved - prevents restorative tx disadvantages - infra occlusion - tooth is below the occlusal plane - loss of gingival contour - tooth will be lost - multiple appts to correct the spacing
30
how do you reimplant a tooth?
LA irrigate the socket hold the tooth by the crown reposition it gently pt to bite down on cotton wool roll place a flexible splint 7-10days
31
after re-implanting, if a tooth is not vital after 10 days then what?
begin extirpation, removing the pulp and perform a root canal tooth ALWAYS extirpate a closed apex tooth as this tooth will not be able to regenerate the pulp anyway - prevents necrosis and infection - dress with calicium hydroxide - replace every 3 months
32
what teeth do you not implant?
primary teeth - risks of further trauma to permanent tooth germ
33
why do you splint teeth after trauma?
aesthetics patient comfort facilitate normal occlusal loading stabilised injured tooth to allow PDL re-attachment and bony healing
34
what would be the ideal characteristics of a splint?
- physiological - stable - allows good OH - allows access to tooth - easy to apply - cheap
35
2 pros of physiological splinting
- promotes periodontal healing - reduces the risk of replacement resorption
36
how do you place a splint? - how long should the wire be?
- LA - choose the correct length of orthodontic wire - cement the wire to the support teeth - place composite onto luxated tooth, reposition and cement the wire should be from the midline on the adjacent tooth to the luxated tooth
37
what 3 types of resorption may occur post-injury?
surface resorption - reversible root resorption infection related resorption replacement resorption - ankylosis
38
in what circumstance would you get inflammatory resorption?
- if the pulp is necrotic - the toxins diffuse through dentinal tubules - compromises the PDL = inflam resorption
39
what 2 factors affect how the PDL heals?
- the type of injury sustained - the maturity - determines the amount of blood supply to the PDL
40
risk factors for dental trauma
inadequate lip coverage class III occlusion male prev history of trauma epilepsy special needs sports tongue piercing
41
history for avulsed tooth
what was the tooth stored in how long was it dry how long before it was re-implanted
42
what comes under the examination
soft tissues: lacerations, brusing hard tissues - occlusion - luxation - direction of injury - fracture - alveolar fracture where are the fragments - inhaled or in the soft tissues? trauma checks - pulp testing,
43
6 trauma checks
mobility percussion colour sensibility tests - not on paeds radiographs - pa and occlusal transillumination
44
whats the aim of regular sensibility testing
can see if there has been any vitality changes over time
45
what special tests do you not do on paeds?
ethyl chloride EPT = not reliable
46
management for: luxation avulsion fractured crown fractured crown w/pulp fractured root
luxation - reduce and splint avulsion - re-implant, splint and expirate asap if mature fractured crown - restore fractured crown w/pulp - restore and maybe pulpotomy fractured root - maintain vitality or extract
47
benefits of splinting
stabilises the tooth in position allows time for reattachment of PDL fibres and revascularisation of the pulp minimise further damage from normal oral functions
48
what comes under a review appointment?
symptoms checks radiograph remove sprint assess prognosis
49
negative outcomes of trauma to the: PDL, patient and pulp
PDL - bone loss - mobility - surface root resorption - infection related root resorption - replacement root resorption - gingival recession patient - tooth loss - dental anxiety - aesthetics - multiple appts pulp - discolouration - loss of vitality - pain
50
what is a TURNER TOOTH
adult tooth has a crown defect because of trauma to the baby tooth
51
positive outcomes of trauma: PDL, patient and pulp
PDL - continued root growth - minimal root resorption - fracture healing - intact PDL patient - happy - good aesthetic - retained tooth pulp - no pain - maintains vitality - positive plural response
52
when do you remove a splint?
2 weeks
53
when do you review the pulp?
6-8 weeks
54
when do you review bone trauma?
review and splint removal at 4 weeks
55
likelihood on the outcome of pulpal fracture on baby teeth?
to xla going to affect the successor
56
Who is my favourite person?
SRIYA

Yr 4 - CCD2 (19 decks)

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