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AU '18 - Peds III exam I > Dental Trauma > Flashcards

Dental Trauma Flashcards

1
Q

how do you approach dental trauma?

A
  1. hx
  2. exam and diagnosis
  3. emergency tx
  4. follow up
  5. definitive tx
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2
Q

what is the first step in approaching dental trauma?

A
  1. any medical referral needed? (loss of consciousness, nausea, etc)
  2. hx (when, where, how)
  3. exam (extra-oral, intra-oral, radiographic exam)
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3
Q

what are the minimum questions you want to ask a patient with dental trauma?

A
  1. did the patient lose consciousness?

2. any vomiting since the injury happened?

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4
Q

dental hart tissue injury

A
  1. crack on teeth
  2. fractured teeth
  3. pulp exposure
  4. color change
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5
Q

supporting tissue injury

A
  1. displacement of teeth
  2. mobility of teeth
  3. mobility of alveolar fragments
  4. occlusion abnormality
  5. percussion sensitivity
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6
Q

T/F: every traumatized tooth needs x-ray

A

true

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7
Q

what type of radiographs should be taken for primary teeth?

A

occlusals

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8
Q

radiographic evidence of pathology 2 weeks after trauma

A

pulpal necrosis

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9
Q

radiographic evidence of pathology 3 weeks after trauma

A

inflammatory resorption (external and internal)

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10
Q

radiographic evidence of pathology 6 weeks after trauma

A

replacement resorption (ankylosis)

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11
Q

short term reactions of teeth to trauma

A
  1. pulpal hyperemia (pulpitis)

2. internal hemorrhage

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12
Q

long term reactions of teeth to trauma

A
  1. pulp canal obliteration (PCO)
  2. inflammatory resorption
  3. replacement resorption (ankylosis)
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13
Q

pulpal hyperemia (pulpitis) may lead to what?

A

may lead to cold sensitivity

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14
Q

internal hemorrhage may lead to what?

A

(transient) discoloration

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15
Q

pulpal necrosis may lead to what?

A

percussion+/peri apical radiolucency

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16
Q

pulp canal obliteration (PCO) may lead to what?

A

yellow discoloration

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17
Q

inflammatory resorption may lead to what?

A

radiographic appearance ~mobility

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18
Q

ankylosis may lead to what?

A

lack of mobility, dull percussion sound

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19
Q

T/F: pulp canal obliteration and pulpal necrosis may be reversible if tx’d early

A

false, usually is NOT reversible

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20
Q

T/F: because pulp canal obliteration and pulpal necrosis are not reversible, that tooth is necrotic and needs RCT

A

false, it does NOT

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21
Q

what does PCO depend on?

A
  1. type of injury

2. stage of root development

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22
Q

T/F: pulpal necrosis subsequent to PCO is common

A

false, is uncommon (1%)

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23
Q

T/F: PCO occurs later than PN

A

true, 12 mos. vs 3 mos.

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24
Q

T/F: PCO increased with bands/resin fixation

A

true

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25
Q

replacement resorption

A
  1. direct union of bone and root
  2. resorption of root and replacement with bone
  3. direct result of loss of vital PDL
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26
Q

main goals in emergency management of dental trauma

A
  1. cover fractured teeth temporarily

2. reposition luxated teeth and stabilize

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27
Q

vitality tests

A
  1. electric pulp test

2. cold test

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28
Q

when are cold test and EPT not reliable?

A

its less reliable in children, open apices, and shortly after trauma

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29
Q

what determines the course of action for traumatized teeth?

A

more than singular findings, changes in signs and symptoms

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30
Q

dental trauma categories

A
  1. fracture injuries

2. luxation injuries

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31
Q

types of fracture injuries

A
  1. enamel infarction (crack)
  2. uncomplicated crown fx
  3. complicated crown fx
  4. uncomplicated crown-root fx
  5. complicated crown-root fx
  6. isolated root fx
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32
Q

tx for class I fractures in PRIMARY teeth

A
  1. do nothing?
  2. smooth rough edges
  3. restore w/ composite?
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33
Q

tx for class I fractures in PERMANENT teeth

A
  1. do nothing?
  2. smooth rough edges
  3. restore w/ composite?
  4. follow up
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34
Q

how long should you wait before you do a follow up?

A

usually 4-week

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35
Q

tx for class II fractures in PRIMARY teeth

A
  1. do nothing?
  2. composite/GI “Band-Aid” - then monitor for symptoms
  3. restore w composite/GI?
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36
Q

tx for class II fractures in PERMANENT teeth

A
  1. do nothing?
  2. bond fragment if available
  3. composite/GI “Band-Aid” - then monitor for symptoms
  4. restore w composite/GI
  5. follow up
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37
Q

tx for class III fractures in PRIMARY teeth

A
  1. partial pulpotomy
  2. pulpotomy
  3. pulpectomy
  4. extraction
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38
Q

when should you extract a primary tooth with a class III fracture?

A

comes down to behavior

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39
Q

tx for class III fractures in PERMANENT, young tooth w open apex or closed apex

A
  1. direct pulp cap

2. partial pulpotomy (Cvek technique)

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40
Q

tx for class III fractures in PERMANENT, mature tooth w closed apex

A

pulpectomy

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41
Q

at what age does the apex of maxillary centrals occur?

A

~10 yrs

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42
Q

at what age does the apex of maxillary laterals occur?

A

~11 yrs

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43
Q

at what age does the apex of maxillary canines occur?

A

~13-15 yrs

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44
Q

at what age does the apex of mandibular centrals occur?

A

~9 yrs

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45
Q

at what age does the apex of mandibular laterals occur?

A

~10 yrs

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46
Q

at what age does the apex of mandibular canines occur?

A

~12-14 yrs

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47
Q

Cvek partial pulpotomy criteria for success

A
  1. no clinical signs or symptoms (no fistula, no mobility, no pain)
  2. no radiogrpahic pathology
  3. continued development of immature roots
  4. formation of calcific barriers
  5. sensitivity to elecrical stimulation
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48
Q

sequelae of dental trauma

A
  1. discoloration of tooth
  2. acute pain
  3. abscess or inflammation due to necrosis of tooth
  4. tooth mobility
  5. sensitivity to cold or hot foods
  6. gingival irritation or inflammation
  7. damage to developing tooth (if the injured tooth is a primary tooth)
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49
Q

what should parents watch for after their child experiences dental trauma?

A
  1. watch for it to start hurting (e.g. waking up at night, stops eating and drinking)
  2. color change
  3. swelling (e.g. facial swelling, “pimple” of pus on the gums above the tooth)
  4. tooth getting loose
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50
Q

tx for tooth discoloration in PRIMARY teeth

A

no tx necessary

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51
Q

tx for footh discoloration in PERMANENT teeth

A

vitality tests, radiograph and other signs and symptoms should be considered when formulating tx plan

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52
Q

chin trauma can lead to what?

A
  1. posterior crown fractures
  2. mandibular condylar fractures
  3. cervical spine injury
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53
Q

tx for enamel fracture

A
  1. band-aid temp restoration

2. no tx

54
Q

tx for enamel crack

A

no tx needed

55
Q

tx for enamel-dentin fracture

A

band-aid temp restoration

56
Q

tx for enamel-dentin fracture w pulp exposure

A
  1. pulp cap
  2. Cvek pulpotomy
  3. RCT (open apex vs closed apex)
57
Q

tx for crown-root fracture

A
  1. band-aid
  2. orthodontic extrusion and restoration
  3. extraction, decoronation
58
Q

tx for crown-root fracture w pulp exposure

A
  1. pulp cap
  2. Cvek pulpotomy
  3. RCT (open apex vs closed apex)
  4. orthodontic extrusion and restoration
  5. extraction, decoronation
59
Q

tx of isolated root fracture

A
  1. no tx
  2. splint (if increased mobility) for 4 weeks
  3. splint for 4 months if cervical
60
Q

types of luxation injuries

A
  1. concussion
  2. subluxation
  3. intrusive luxation
  4. extrusive luxation
  5. lateral luxation
  6. avulsion
61
Q

T/F: we often see more than just one type of traumatic injury in a patient

62
Q

what do we always go by based on the type of injury?

A

by the most critical and longest follow up that is recommended based on the type of injury

63
Q

T/F: always take initial x-ray from all traumatized teeth

64
Q

what are our concerns for crown/root fracture injuries?

A
  1. pulp

2. restorability of the tooth

65
Q

what are our concerns for luxation injuries?

A
  1. PDL

2. vitality of the tooth

66
Q

what are other factors in tx planning a traumatized tooth?

A
  1. permanent teeth vs primary teeth

2. permanent teeth: mature vs immature apex

67
Q

what is a key determinant for successful tx?

68
Q

concussion

A
  • an injury to the tooth-supporting structures without abnormal loosening or displacement of the tooth but with marked reaction to percussion
  • aka tooth gets “bumped”
69
Q

tx for concussion of PRIMARY teeth

A
  1. no emergency tx
  2. discuss potential sequelae w parents
  3. monitor for symptoms
70
Q

tx for concussion of PERMANENT teeth

A
  1. no emergency tx
  2. discuss potential sequelae w parents
  3. monitor for symptoms
  4. follow up
71
Q

subluxation

A

an injury to the tooth-supporting structures w abnormal loosening, but without displacement of the tooth

72
Q

tx for subluxation of PRIMARY teeth

A
  1. no emergency tx
  2. monitor for symptoms
  3. tooth may tighten
73
Q

tx for subluxation of PERMANENT teeth

A
  1. no emergency tx
  2. monitor for symptoms
  3. tooth may tighten
  4. follow up
74
Q

how long should you wait before follow up of subluxation?

A

follow up in 2-4 weeks

75
Q

how long after subluxation accident should you take a radiograph?

76
Q

intrusive luxation

A

displacement of the tooth into the alveolar bone

77
Q

what is intrusive luxation accompanied by?

A

comminution or fracture of the alveolar socket

78
Q

when should an extraoral lateral film be taken?

A

intrusive luxation

79
Q

tx for labially displaced intrusion of PRIMARY teeth

A

if tooth was displaced labially (toward or through labial bone plate), then allow spontaneous re-eruption

80
Q

occlusal x-ray of labially displaced intrusion of PRIMARY teeth

A

shortening

81
Q

tx for tooth displaced into developing bud intrusion of PRIMARY teeth

A

if tooth displaced into developing tooth bud, then extract

82
Q

occlusal x-ray of tooth displaced into developing tooth bud intrusion of PRIMARY teeth

A

elongation

83
Q

at what age is the greatest risk for injuries to developing teeth?

84
Q

type of injuries to developing teeth

A
  1. discoloration
  2. enamel hypoplasia
  3. crown to root dilaceration
  4. arrested development
  5. disturbance in eruption
85
Q

tx for intrusion of permanent teeth w/ OPEN apex ≤ 7 mm

A

spontaneous eruption

86
Q

tx for intrusion of permanent teeth w/ OPEN apex > 7 mm

A

orthodontic or surgical repositioning

87
Q

tx for intrusion of permanent teeth w/ CLOSED apex < 3 mm

A

spontaneous eruption

88
Q

tx for intrusion of permanent teeth w/ CLOSED apex 3-7 mm

A

orthodontic or surgical repositioning

89
Q

tx for intrusion of permanent teeth w/ CLOSED apex > 7 mm

A

surgical repositioning

90
Q

follow up of intrusion of PERMANENT teeth

A
  1. pulpectomy

2. complete gutta percha fill in 2 months if no inflammatory resorption

91
Q

pulpectomy of intrused permanent teeth

A

remove pulp and fill with CaOH within 7-14 days

92
Q

extrusive luxation

A

a partial displacement of the tooth out of its socket

93
Q

tx for minor (< 3 mm) extrusion of PRIMARY teeth

A
  1. reposition (but don’t splint)

2. spontaneous alignment

94
Q

tx for severe extrusion of PRIMARY teeth

95
Q

tx for extrusion of PERMANENT teeth

A
  1. reposition w digital pressure (two-digit technique)
  2. flexible splint for 2 weeks
  3. rx chlorhexidine mouth rinse
96
Q

follow up of extrusion of PERMANENT teeth

A
  1. pulpectomy

2. complete gutta percha fill in 2 months if no inflammatory resorption

97
Q

follow up after pulpectomy of extrusion of permanent teeth

A

remove pulp and fill with CaOH within 7-14 days

98
Q

lateral luxation

A

a displacement of the tooth in a direction other than axially

99
Q

what is lateral luxation accompanied by?

A

comminution or fracture of the alveolar socket

100
Q

types of lateral luxation

A
  1. retrusion

2. protrusion

101
Q

retrusion of PRIMARY teeth w no occlusal interference

A

spontaneous repositioning

102
Q

retrusion of PRIMARY teeth w occlusal interference

A

must be repositioned (but do not splint) or extracted

103
Q

protrusion of PRIMARY teeth

A

extract (contact w developing tooth bud)

104
Q

tx for lateral luxation of PERMANENT teeth

A
  1. reposition w digital pressure
  2. flexible splint for 4 weeks
  3. rx chlorhexidine mouth rinse
105
Q

avulsion

A

a complete dispalcement of the tooth out of its socket

106
Q

tx for avulsion of PRIMARY teeth

A

NEVER re-implant primary teeth

107
Q

ultimate goal of tx for avulsion of PERMANENT teeth

A

PDL healing without root resorption

108
Q

what is the most critical factor of tx for avulsion of PERMANENT teeth?

A

maintaining an intact and viable PDL on the root surface

109
Q

tx for avulsion of PERMANENT teeth

A
  1. reimplant ASAP
  2. flexible splint for 2 weeks
  3. medications
110
Q

prognosis of an avulsed permanent teeth depends on what?

A
  1. open apex vs closed apex

2. dry time

111
Q

if the avulsed tooth is contaminated, what should you do?

A

rinse w saline

112
Q

if the avulsed tooth cannot be replanted, what should the tooth be placed in?

A

best transport medium available

113
Q

transport media

A
  1. Hank’s balanced salt solution (HBSS)
  2. MILK
  3. saline
  4. saliva (buccal vestibule)
  5. water, if none above available
114
Q

management of root surface of avulsed permanent tooth

A
  1. objective is to maintain PDL cell vitality
  2. keep moist in HBSS
  3. do not handle root surface
  4. gently remove persistent debris
115
Q

what should be done if a clot is present in the avulsed socket of a permanent tooth?

A

use saline irrigation

116
Q

T/F: you should curette the socket of an avulsed permanent tooth

A

false, do NOT curette

117
Q

what should you do if the alveolar bone of an avulsed permanent tooth socket has collapsed?

A

use blunt instrument to reposition

118
Q

what should you do after replantation of permanent teeth in an avulsed socket?

A

manually compress bony plates after implantation

119
Q

T/F: you should tightly suture any soft tissue lacerations, particularly in the cervical region

120
Q

what can be used for splinting after reimplanting an avulsed permanent tooth?

A
  1. use fishline/acid-etch resin
  2. soft arch wire/resin
  3. ortho brackets with passive arch wire
  4. suture as last resort
121
Q

how long should a splint be maintained for after reimplanting an avulsed permanent tooth?

A

up to 2 weeks, longer if tooth demonstrates excessive mobility

122
Q

home care instructions after splinting avulsed permanent teeth

A
  1. no biting on splinted teeth
  2. soft diet
  3. good oral hygeine
123
Q

follow up for avulsion of PERMANENT teeth

A
  1. pulpectomy: remove pulp and fill with CaOH within 7-14 days
  2. complete gutta percha fill in 2-12 months
124
Q

when would you not have to complete the gutta percha fill of an avulsed permanent tooth?

A

no need to complete endo if tooth becomes ankylosed

125
Q

follow up for avulsion of IMMATURE PERMANENT teeth

A
  1. replant and splint as with mature teeth

2. recall every 3-4 weeks

126
Q

best prognosis for avulsed IMMATURE PERMANENT teeth is if reimplanted within what time frame?

A

within 20 minutes

127
Q

if avulsed IMMATURE PERMANENT teeth show signs of necrosis, what should be done next?

A

extirpate pulp and do revascularization procedure

128
Q

how do you revascularize IMMATURE PERMANENT teeth of an avulsed socket?

A
  1. stimulate bleeding through apex
  2. place MTA on top of clot
  3. allows continued root development and root wall thickening
129
Q

what injuries need emergency tx and should be stabilized as soon as possible?

A
  1. avulsion
  2. extrusion
  3. lateral luxation
130
Q

clinical signs of aspiration

A
  1. no syms
  2. initial choking and coughing
  3. irritating cough
  4. wheezing
  5. unilateral obstructive emphysema
  6. atelectasis
  7. pulmonary supparation

AU '18 - Peds III exam I (2 decks)

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