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Oral Surgery > Dentoalveolar Trauma & Management > Flashcards

Dentoalveolar Trauma & Management Flashcards

1
Q

% of all bodily injuries?

A

oral regions is 1% of the body but 5% of all bodily injuries

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2
Q

most common facial injuries?

A

dental

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3
Q

implication of the vascular supply to teeth

A

redundant nature of the vascular supply allows most dento-alveolar bony injuries to heal well despite mucosal lacerations and extensive communication

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4
Q

ages 6-50 years old how much dental traums

A

1 in 4 had evidence of dental trauma

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5
Q

incidence of trauma

A

children with primary - 11-30%

children with permanent 5-20%

boys 2x girls

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6
Q

peak incidence of trauma

A

at 2-4 years

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7
Q

second peak incidence of trauma

A

at 8-12 years

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8
Q

most commonly involved teeth

A

maxillary central incisors

maxillary lateral incisors

mandibular anterior teeth

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9
Q

what includes the physical examination THEN?

A
  1. soft tissue
  2. jaw and alveoalar bone
  3. occlusion
  4. teeth
    - infection
    - fracture
    - displacment
    - mobility
    - pulp testing
    - percussion

then go to RADIOGRAPHIC
- examine the presence of any patholgy (root fracture/ extent/ peri-apical pathoses/ size of pulp/ jaw fractures/ tooth fragments)

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10
Q

classification of dento-alveolar injury

A

ellis and davey classification

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11
Q

ellis and davey classification

A

classification of dento-alveolar injury

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12
Q

ellis and davey classification I –> IV

A

I - fracture within enamel

II- fracture of enamel- dentin

III- fracture involving the pulp

IV - fracture involving the roots

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13
Q

peri-apical radiographs help with

A

intrusion or extrusion injuries

  • influences the tx!!
  • impotrant to recognoize
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14
Q

retain or extract has a lot to do with?

A

extent of root development!

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15
Q

size of pulp chamber and root canal implication?

A

larger pulp - increase in infection area - can be bigger?

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16
Q

radiographic examination can show laceration?

A

yes – may be able to see a tooth piece in the lip

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17
Q

radiographic examination can include

A 
periapical
occlusal 
pano -- ghost images appear 
CBCT-- 
medical CT

last two are best ones to look at for trauam

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18
Q

pano implication

A

if trauam in the midline – may be ghost image - not as accurate

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19
Q

medical CT use?

A

wide spread damage to other cranial bones

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20
Q

enamel crown fracture tx and follow up

A

smooth and relieve occlusion

follow up 6 weeks to 1 year and soft diet

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21
Q

enamel and dentin crown fracture tx and follow up

A

RESTORE then smooth and relieve occlusion

follow up 6 weeks to 1 year and soft diet

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22
Q

enamel / dentin / pulp crown fracture tx and follow up

IMMATURE teeth

A

calcium hydroxide and pulp cap or pulpotomy

6 weeks to 1 year

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23
Q

enamel / dentin / pulp crown fracture tx and follow up

mature teeth

A

endodontic tx

6 weeks to 1 year

important to follow up for like presence of cysts

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24
Q

pulp capping when?

A

exposure is SMALL

patient is seen shortly after the injury

patient has no root fracture

tooth is not displaced

no large or deep restorations exist that might indicate chronic inflammation of the pulp

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25
Q

crown root fracture with pulp involvment tx and follow up

A

expose fracture site – gingivectomy

  • ortho extrusion
  • endodontic tx

6 wweeks to 1 year and suggest soft diet

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26
Q

crown root fracture with NO pulp involvment tx and follow up

A

explore the fracture site by gingovectomy
orthodontic extruion

6 weeks to 1 year and soft diets

Difference here is no endo tx needed

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27
Q

vertical root fracture treatment

A

advise extraction

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28
Q

horizontal apical or middle root fracture tx and follow up

A

reposition and stabalize
4 and 8 weeks
then 6 monthts to a year for every five years

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29
Q

horizontal apical third root fracture

A

extract

30
Q

main pulpal responses to trauma

A
  1. hyperemia - acute inflammation
  2. pulpal hemorrhage
  3. pulpal necrosis
  4. calcific metamorphosis
  5. internal resorption – considered a FAILURE
    - vs anklylosis- he said considered a success if that results?
31
Q

reaction of teth to trauma

A

surface resorption

inflammatory resorption

replacement resorption

32
Q

tx to concussion

A

no – just observation only

as there is NO evidence of mobility

  • no displacement
  • no fracture

may be tenderness to percussion

33
Q

subluxation is? tx?

A

loosening the force is absorbed by the tooth without apparent loss of tooth structure

may need occlusal adjustment , observation with vitality testing

like take out of occlusion

34
Q

intrusive luxation is? tx? for immature

A

displacement of the tooth into its alveolus

immature apex – incomplete root development –> allow the tooth to re-erupt - 6-12 months

  • monitor for necrosis
  • if pulpal necorissi - endo treatment with calcium hydroxide

mature root development - has mature apex / complete root development

  • so reposition ro original position and splint
  • ortho extrusion if needed
  • look at other card with more info
35
Q

intrusive luxation is? tx? for mature

A

reposition to original position and splint

ortho exxtrusion (96% incidence of pulpal necrosis)

calcium hydroxide endo treatemtn within 8-12 months likley

52% of incidence of inflammatory replacement resorption

36
Q

hanks balanced salt solution?

A

can maintian PDL osmolarity , pH and cell metabolite

natural pH of 7.2, osmolality of 32 mosm

ot is a collective group of salts rich in bicarbonate ions, formulated by microbiologists
- used as a buffer system in cell culture media and aid in maintaining the optimum physiologic pH - roughly 7-7.4 for cellular growth

37
Q

extrusive luxation

A

tooth is displaced coronally

tooth should be repositioned and splinted for 2 weeks

64% incidence of pulpal necrosis

7% incidence of external resorption

38
Q

lateral luxation

A

can occur in a buccal, lingual, mesial or distal direction

results in fracture of the alveolar bone

the tooth should be manually repositioned and non-rigidly splinted for 4-8 weeks

39
Q

lateral luxation follow up

A

monitor the need for endo tx.

if tooth is displaced more than 5mm endodontic treatemtnis indicated

40
Q

most common for alvulsed teeth

A

ages 7-10 years

maxillary central incisor is most common

most important factor for long term prognosis – amount of vital periodontal fibers remaining of the tooth surface prior to replantation

41
Q

most important factor for long term prognosis for alvusion

A

amount of vital periodontal fibers remaining of the tooth surface prior to replantation

42
Q

factors to consider before replanting avulsed teeth

per Andreason and hjortig hansen

A
  1. tooth should be free of advanced periodontal disease
  2. alveolar socket shuold be reasonably intact
  3. no orthodotnic contraindication
  4. extra alveolar period should be considered
  5. stage of root development
43
Q

details of periodontla ligament cells

A

healing takes 3-4 weeks

pdl cells are necrotic in teeth that have been extra-oral for 120 minutes or more

hank’s balanced solutoin can maintain pdl osmolarity and pH and cell metabolite

44
Q

whole milk?

A

can be used for transport medium if needed

  • short term storage use up to 6 hours
  • better than saliva (not as good as hanks)
  • avulsed needs to be placed in it within 15 minutes - but DOES NOT PREVENT CELL DEATH
45
Q

TX FOR ALVUSION within 2 hours with open apex

A

within 2 hours

  • replant as soon as possible
  • do NOT remove PDL

transport in Hanks solution or whole milk

place in 1mg / 20ml doxycycline solution for five minutes – higher rate of pulpal revascularization

do NOT remove blood clot from socket

monitor for endo tx

semi rigid splint for 10-14days

take tooth OUT of occlusion

46
Q

importance of history for dealing with dental trauma

A

unaccounted for AVULSED TEETH or tooth fragments – SUSPICION OF ASPIRATION

need to aucultation of the chest to rule out wheezing or labored breathing

47
Q

Andreasen classification?

A

also accepted for classification of dentoalveolar injury

accepted like the ellis and davey classification of dento-alveolar injuries

48
Q

infraction

A

no fracture of enamel - like doesnt completely break the enamel

49
Q

general under problems and consequences

A
  1. malocclusion
  2. loss of space
  3. altered etehtics
  4. dysfunctino
50
Q

treatment of alvusion

A

within 2 HOURS / open apex

semi rigid splint for 10-14 days

take tooth out of occlusion

51
Q

pdl cells are necrotic when?

A

in teeth that have been extra-oral for 120 minutes or more

52
Q

doxycycline solution used?

A

In tx for AVULSION

place in 1mg / 20ml doxycycline solution for five minutes – higher rate of pulpal revascularization

53
Q

prophylaxis for alvusion?

A

tetanus prophylaxis could be considered

54
Q

post op for avulsion

A

antibiotic coverage for 7-10 days

soft diet

chlorohexidine mouth rinse 2x day

oral hygeine instructions

55
Q

tx of alvusion if it has been MORE than 2 hours

A

open apex or closed

  • necrotic pdl should be removed
  • scraped off
  • soaked in sodium hypochlorite for 30 minutes

endo tx – cleaning and shaping (extra orally - in hand)

56
Q

risks associated with avulsion

A

ankylosis increases with prolonged splinting

external resorption increases with rigid splints

57
Q

implication of rigid splints and prolonged splinting

A

prolonged – ankylosis can develop

rigid – external resorption can occur

58
Q

stabalization period using splint for mobile teeth

A

7-10 days

59
Q

stabalization period using splint for tooth displacement

A

2-3 weeksk

60
Q

stabalization period using splint for root fracture

A

2-4 months

61
Q

stabalization period using splint for avulsed (mature)

A

7-10 days

62
Q

stabalization period using splint for avulsed (immature)

A

3-4 weeks

63
Q

dentoalveolar fracture

A

fracture of the alvolar bone involving one or more teeth

64
Q

tx of dentoalveolar fracture

A

reduction ofo the alveolar segment (closed or open)

stabalization with splint (4-6 weeks)

closure of mucosal laceration

check occlusion

65
Q

post op tx for detoalveolar fracture

A

antibiotics for 7-10 days
chlorohexidine 2 times day / one week

soft diet

follow up

66
Q

luxation in primary?

A

reposition or remove

67
Q

extrusion in primary?

A

reposition or remove

68
Q

intrusion in primary?

A

remove if contacting permanent tooth or re -eruption has not started in 408 weeks

remove if infection is also present

allow to erupt if not contacting permanent tooth

69
Q

root fracture in primary if apical third?

middle or cervical third?

A

apical third – observation

middle or cervical third - removal without damaging permanent

70
Q

long term follow up?

A

YES – required – since some complications can occur months or years later

Oral Surgery (26 decks)

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