Emegencies / Trauma Flashcards
What is the acronym SPORT for any medical emergency 🚨
SPORT 🚨
STOP treatment
POSITION patient
OXYGEN*
REASSURE patients and staff
TAKE vitals
What is the different classifications for TOOTH MOBILITY?
MILLER CLASSIFICATION
Class I
Tooth can be moved LESS than 1MM in the buccolingual or mesiodistal direction
Class II
Tooth can be moved 1MM or MORE in the buccolingual or mesiodistal direction
NO mobility in the occlusoapical direction (VERTICAL mobility)
Class III
Tooth can be moved 1MM or MORE in the buccolingual or mesiodistal direction
Mobility in the OCCLUSOAPICAL direction is also present
What are EARLY signs/manifestations of SYNCOPE?
- Moist Pale Skin
- Tachycardia
- Dizziness
What is a DEGLOVING injury?
A degloving injury is a type of AVULSION in which an extensive section of SKIN is completely torn off the underlying tissue, severing its blood supply. It is named by analogy to the process of removing a glove.
FULL THICKNESS MUCOPERIOSTEAL DISPLACEMENT.
What is the most common site for oral injuries inflicted abused children?
1. LIPS 👄 ⬇️ 2. Oral Mucosa ⬇️ 3. Teeth ⬇️ 4. Gingiva ⬇️ 5. Tongue
What is the definition of shock?
The body is unable to circulate blood with adequate oxygenation into the vital organs and the rest of the body.
What is the percentage % of recovery after nerve damage in Third Molar Extractions?
At least 50% spontaneously recover
Permanent Tooth AVULSION
Splint time? Exception?
Closed Apex vs Open Apex?
Splint time: 2 weeks
EODT: 4 weeks
CLOSED apex:
CaOH pulpectomy within 2 WEEKS, followed by Endodontic therapy
OPEN apex:
Monitor for Apexogenesis/Apexification
If a Permanent tooth has been avulsed and has been dry for longer than 60 minutes, what would be the best way to treat the PDL?
Expectations?
- Debride / remove PDL cells with scaler
or
- Place in 2% NaF for 20 minutes before replanting.
Expect: Replacement Resorption
What is the initial drug of choice in the management of Anaphalaxis?
Epinephrine
.01 mg/kg
What is the first signs of Anaphylaxis?
Skin reactions, including hives and itching and flushed or pale skin.
Low blood pressure (hypotension)
Constriction of your airways and a swollen tongue or throat, which can cause wheezing and trouble breathing.
A weak and rapid pulse.
Nausea, vomiting or diarrhea.
Dizziness or fainting.
Increased risk factors for dental trauma in children.
Boys > Girls
Maxillary incisors most common
Increased OJ (>6mm) more often
What are some important things to ask in regards to medical hx in a trauma event?
- Is there any Coagulation Disorders?
- Is Tetanus immunization up to date?
- tdap given 1st year, then boosters at 1.5, 3, 6 years. Then every 4-5 years after. - Is there a Head Injury?
- drowsiness, amnesia, blurred vision
- if so refer to ER for assessment of head injury before dental treatment - Regardless of the injury, ideally radiograph follow ups at 1, 2, and 6 months
Tooth Concussion / Subluxation of PRIMARY teeth
No treatment
Recommend soft diet
Reinforce OHI
Teeth with open apices more likely to remain vital
Follow ups
INTRUSION of PRIMARY tooth
No treatment (hoping) to re-erupt
May damage permanent tooth
- Hypoplasia* = during Apposition (pla-app)
- Hypocalcification* = during Calcification (CC)
- Dilaceration* = During Root formation
Follow ups
same course of action for PERMANENT teeth with OPEN APICES
EXTRUSION of PRIMARY tooth
Greater the distance of extrusion = Greater the chance of severing the Apical vascularization and Pulpal Necrosis.
> 3mm = EXTRACT
If patient is seen before Periapical blood clot, reposition and splint 1-2 weeks, ends treatment.
Follow ups
AVULSION of PRIMARY tooth
Reimplantation of Primary tooth has poor prognosis
<30 minutes
-Replant, flexible splint for 1-2 weeks, antibiotics, and endo treatment.
> 30 minutes
-Extract and Space Maintainer as needed
Root Resorption
Internal vs External
INTERNAL (IRR)
-Odontoblastic layer in pulp is damaged
EXTERNAL (ERR)
-Cementoblastic layer in PDL is damaged
Age associated with most trauma in Months?
36 months
18-36 months?
Possible outcomes of traumatic tooth injury to immature permanent tooth?
- Ankylosis
- PCO (Pulp Canal Obliteration)
- Internal Root Resorption
- No pulp sequelae
Common sequelae on lateral luxation with open apex?
PCO (Pulp canal obliteration)
CN 7 (Facial Nerve) damage most likely due to?
- Electrical Burn
- Deep Cheek Laceration
- Stenson‘s duct (Parotid duct)
- Obicularis Oris (muscles in the lips that encircles the mouth.)
What is important for successful outcome of APEXIFICATION in traumatic tooth injury?
Marginal Seal
What is important for successful outcome of APEXOGENESIS in Avulsed tooth injury?
Time of Injury
Following severe trauma, the earliest a reliable test (cold, heat, percussion,…) can be done to check nerve viability is?
3 months
Which sport has the highest incidence of Trauma?
Basketball 🏀
What is the Minimum adequate thickness for a mouthguard?
3mm
What arch should a mouth guard be made for?
How many teeth should it cover?
What is the exception?
Should cover all the teeth all the teeth in th arch (except 3rd Molars)
Maxillary arch in most all cases
Class III, Mandibular arch*
What type of suture material do you want for deep lacerations?
Why?
You want ABSORBABLE sutures:
VICRYL sutures: Absorbable
Silk and Nylon: Non-absorbable
What is the difference in clinical findings between a human bite and a dog bite?
HUMAN BITES:
Compress the tissue causing contusion, abrasions, and lacerations of tissue.
DOG BITES:
Cause avulsion of tissue.
What are mouthguards by type?
What is the most common?
Type 1: Custom Fit (Best)
Type 2: Boil and Bite (most common)
Type 3: Stock Mouthguards (must be held in place my clenching teeth together to have any benefit)
What is the most common complication on Permanent Teeth in INTRUSION Trauma
- Pulp necrosis (Closed Apex)
1. PCO (Open Apex)
What is the most common complication in permanent teeth in EXTRUSION trauma?
Pulp Necrosis
PCO
What is the most common PRIMARY trauma?
Luxation
What is a complication that cannot be treated Avulsion?
Replacement resorption, ANKYLOSIS
When do you expect to see a periapical lesion after trauma?
Depends what kind of trauma
3 weeks
What is the initial action in wound healing?
Platelet Aggregation
What is the most common material used in making mouthguards?
EVA
Ethylene-Vinyl-Acetate
Which sports requires the use of a mouthguard?
Hockey 🏒
Lacrosse
Wrestling 🤼♀️
When is tetanus needed when suffering ma dirty wound?
If not within 5 years
If needed give booster within 48 hours
According to WHO:
The type of tetanus prophylaxis that is required following injury depends on the nature of the lesion and the history of previous immunizations. However, no booster is needed if the last dose of the primary series, or of subsequent booster injections, was given less than 5 years ago for dirty wounds or less than 10 years ago for clean wounds.
Long term complications of a burn injury?
Treatment?
Microstomia
Appliance needed to prevent contracture
Worn 6-12 months
Edema: May last a week, eventually necrotic tissue will slough off in 3 weeks
What suture would you use if tension-less contact is impossible?
Mattress suture
The horizontal mattress suture is an everting suture technique that spreads tension along a wound edge. This technique is commonly used for pulling wound edges together over a distance, or as the initial suture to anchor two wound edges (holding sutures).
The advantages of the vertical mattress suture are that it provides closure for both deep and superficial layers, and also allows perfect eversion and vertical opposition of the superficial skin edges.
If a laceration is through and through, what do you suture first?
Muscle
If a tooth is avulsed (Central maxillary incisor) when should you do a interdental Transplant (autotransplantation)
When root is 3/4 formed
Autogenous tooth transplantation, or autotransplantation, is the surgical movement of a tooth from one location in the mouth to another in the same individual. Once thought to be experimental, autotransplantation has achieved high success rates and is an excellent option for tooth replacement.
Autotransplantation of teeth with an immature open root apex is more favourable than those with a closed root apex.
Usually, mandibular first or second premolars are appropriate in mesiodistal dimension to replace lost central incisor, although later an adequate reconstruction of the crown with composite resin or artificial crown according to anatomy is needed.
In a laceration involving the skin, mucosa, and inside oral tissue,which do you suture first?
Skin first
Why is water a bad storage medium for an avulsed tooth?
Hypotonic
A hypotonic solution is any solution that has a lower osmotic pressure than another solution. In the biological fields, this generally refers to a solution that has less solute and more water than another solution.
where the solution outside the cell has a lower solute concentration than the cell fluid, water will move into the cell towards the higher solute concentration. The less concentrated outside solution is termed hypotonic.
In a subluxation trauma, where the tooth is mobile but not displaced, what is the recommended treatment?
2 week splint
Most predictive of Pulp always necrosis in a crown fracture?
Concomitant LUXATION injury
The primary factor related to pulp healing events after crown fracture appears to be COMPROMISED PULP CIRCULATION due to concomitant luxation injuries.
An associated damage to the periodontal ligament significantly increased the likelihood of pulp necrosis from 0% to 28%
Which suture causes the most inflammation?
- Silk (braided)
Followed by chromic/gut/vicryl
Lastly, polypropelyne.
Most common crown fracture in primary dentition?
Enamel only
Adult bite inter-canine width?
3 cm
Where is the most common jaw fracture in children?
Condole
Soft tissue injury that removes pieces of tissue is called?
Avulsion
Yellow color change to a tooth post-trauma should be treated initially as:
Observe
