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Endo - ABGD - Oral Board Review > Emergencies/Tooth Fractures/Traumtic Injuries > Flashcards

Emergencies/Tooth Fractures/Traumtic Injuries Flashcards

1
Q

What is Barodontalgia?

A
  • Tooth pain caused by an increase or decrease in ambient pressure
  • Usually reported by aircraft personnel and divers
  • Tough to diagnose…pulp testing inconclusive
  • Affects teeth with a vital pulp - defective restoration
  • Look for etiology of chronic pulp inflammation
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2
Q

What is an enamel Infraction?

A

Incomplete fracture (crack) of the enamel without loss of tooth substance

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3
Q

Define an Uncomplicated Crown Fracture…

A

No Pulp Exposure: fracture with loss of enamel only or with loss of enamel and dentin

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4
Q

Define Uncomplicated Crown-Root Fracture…

A

No Pulp Exposure - fracture involving enamel, coronal and redicular dentin, and cementum

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5
Q

Define Complicated Crown Fracture…

A

Pulp Exposure: Fracture involving enamel and dentin with pulp exposure

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6
Q

Define Complicated Root Fracture…

A

Pulp Exposure: Fracture involving radicular dentin, cementum, and pulp; further classified according to coronal fragment displacement

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7
Q

Define Ellis Class I, II, and III tooth fractures…

A
  • Ellis Class I - Enamel Only
  • Ellis Class 2 - Enamel + Dentin
  • Ellis Class 3 - Enamel + Dentin + Pulp
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8
Q

What are signs/symptoms of “Incomplete” Tooth Fracture?

A
  • Biting Pain
  • Hypersensitivity
  • Visible Fracture
  • Narrow Probing Defect
  • Aka…cracked tooth syndrome
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9
Q

What are some possible treatment options for an Incomplete Tooth Fracture?

A
  • Cuspal Protection
  • Endodontics
  • Extraction
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10
Q

What are the most commonly cracked teeth?

A

Mandibular Molars - 70%

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11
Q

Describe observation and treatment for a Vertical Root Fracture…

A
  • Begins in root and moves coronally
  • Oriented F to L
  • Usually previous RCT
  • Narrow probing defect w/sinus tract at base
  • 2 narrow probing defects on opposite sides of root
  • Treatment: Extraction
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12
Q

What is a tooth Concussion?

A
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13
Q

What is tooth Subluxation?

A
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14
Q

What is Tooth Extrusive Luxation?

A
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15
Q

What is Lateral Luxation?

A
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16
Q

What is Intrusive Luxation?

A
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17
Q

What is going on in this picture?

A

Concussion

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18
Q

What is going on in this picture?

A

Extrusive Luxation

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19
Q

What is going on in this picture?

A

Lateral Luxation

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20
Q

What is going on in this picture?

A

Intrusive Luxation

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21
Q

What is the least to most severe in Prognosis?

Extrusive Luxation, Intrusive Luxation, Concussion, Subluxation, Lateral Luxation…

A
  • Concussion
  • Subluxation
  • Extrusive Luxation
  • Lateral Luxation
  • Intrusive Luxation
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22
Q

Describe Surface Resorption…

A

Self Limiting

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23
Q

Describe Inflammatory Resorption…

A

Infection

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24
Q

Describe Replacement Resorption…

A

Ankylosis

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25
Q

Observe Prognosis of Luxation Injuries on Immature Roots…

A
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26
Q

Observe Prognosis of Luxation Injuries of Mature Roots…

A
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27
Q

Which type of luxation injury triggers the highest amount of resorption?

A

Intrusion

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28
Q

Post trauma, pulp may not respond to…

A

Thermal or EPT!

29
Q

How long can it take for the pulp to respond normally post trauma?

A

2 - 10 Months

Initial positive response may revert to negative within 2 months …usually indicates pulp necrosis

30
Q

Is it important to get a baseline thermal test?

A

Yes

31
Q

Which has a better prognosis, immature or mature root post trauma?

A

Immature Root!

32
Q

What is going on in this picture?

A

Calcific Metamorphosis

  • Chamber/canal obliteration by
  • Calcified/fibrous tissue
  • Affects - 25% of luxations
  • More common with immature roots
  • Yellow coronal discoloration
  • Decreased or absent responses to vitality tests
33
Q

Describe what is going on here…

A

Calcific Metamorphosis

  • Diminished canal space evident on radiograph
  • Pulp canal is present
  • Pulp necrosis will develop in - 16% of tooth
  • RCT success rate: 80%
  • Routine Endodontic Intervention NOT Indicated
34
Q

Does Internal Resorption affect a Vital or Non Vital Pulp?

A

Vital Pulp

35
Q

How do you treat Internal Resorption?

A
  • Vital Pulp
  • Not common
  • Inflammatory response
  • Asymtomatic
  • Rule out external resorption
  • “Pink Tooth”
  • Initiate Endo tx ASAP
  • Do Not “Wait and See…”
36
Q

When you have a Traumatic Root Fracture, what 4 radiographs should you take?

A
  1. Perpendicular
  2. Mesial
  3. Distal
  4. Occlusal
37
Q

What is this?

A

Traumatic Root Fracture

38
Q

What are 3 Prognostic Factors for Root Fractures?

A
  1. Amount of displacement
  2. Re-approximation of segments
  3. Position of the fracture
39
Q

When you have a Traumatic Root Fracture, what are the chances of the Apical segment being necrosed?

A

0%

40
Q

What are some seqelae of a Traumatic Root Fracture?

A

Pulp Necrosis:

  • Coronal Segment: 20-44%
  • Apical Segment: 0 %
  • Calcific Metamorphosis: 69%
  • Middle and Apical 1/3 >> Cervical 1/3
41
Q

What has a better prognosis in a Traumatic Root Fracture, Middle and Apical third, or Cervical?

A

Middle and Apical 1/3 >> Cervical 1/3

42
Q

What are the 4 types of healing of Root Fractures?

A
  • Hard Tissue: 33% (Calcified Tissue)
  • C. Tissue: 36% (Connective Tissue Between Segments)
  • Bone and CT: 8%
  • Non-healing (chronic inflammation (granulation tissue) → 23% RCT!!!
43
Q

What are some Critical Prognostic Factors of Avulsion?

A
  • Extra-oral dry time (preservation of PDL cells)
  • Root Maturity
44
Q

Do we replant primary teeth?

A

No!

45
Q

What is the best Transport Media for Tooth Avulsion?

A
  • Tooth Socket
  • Cell-Preserving Fluid (24-96 hrs)
46
Q

How much time can Milk buy you as a transport medium?

A

6 Hours

47
Q

What Transport Mediums only last for 2 hours?

A
  • Sterile Saline
  • Saran Wrap
  • Saliva
48
Q

What are the worst 2 Transport Media?

A
  • Tap water
  • Back pocket (dry)

* Both of these do not buy you any time…*

49
Q

How do you treat the root surface of an avulsed tooth?

A
  • Determined by exra-oral dry time
  • Think “Preserve PDL Cells”
  • Keep root moist
  • Do not handle root surface
  • Debride gently
50
Q

How do you manage the socket?

A
  • Remove socket coagulum with gentle aspiration
  • Irrigate passively with sterile saline
  • Examine socket…resposition bony fragments
  • Do not curette
  • Replant with light digital pressure
  • Compress alveolar plates
51
Q

If you have a Mature Root with < then 60 minutes of dry time, what do you do?

A
  • Replant - splint
  • Pulpectomy in 7-10 days
52
Q

If you have a Mature Root with > 60 minutes dry time, what do you do?

A
  • Remove PDL/Tissue Tags
  • Soak in NaF for 20 mins
  • Replant - Splint
  • Pulpectomy in 7-10 Days
53
Q

In an Immature Root with < 60 minutes of dry time, what do you do?

A
  • Soak in Doxycycline
  • Replant/Splint
  • Monitor
54
Q

If an Immature root with > 60 minutes of dry time is avulsed, what do you do?

A
  • Remove PDL/Tissue Tags
  • Soak in NaF for 20 mins
  • Replant/Splint
  • RCT before or after
55
Q

What are possible Sequelae of an Avulsion?

One has 4 different types…

A
  • Pulp Revascularization
  • Pulp Necrosis

Resorption

  • Surface
  • Replacement
  • Inflammatory
  • Invasive Cervical
56
Q

How long should you wait after a tooth has been replanted to insert CaOH?

A
  • Wait 7 days following replantation
  • CaOH therapy for 4 weeks
57
Q

What are some additional home care considerations for Avulsion?

A
  • Medical Issues
  • Systemic Antibiotic
  • Chlorhexidine
  • Analgesics
  • Soft Diet
  • Tetanus Status
  • FOLLOW UP ACCORDING TO GUIDELINES
58
Q

What is this?

A
  • Flexible Splint
  • Stabilize teeth throughout
  • Verify Respositioning with Radiograph
59
Q

Which kinds of trauma are optional in regards to splinting?

A

Concussion and Subluxation

60
Q

For Extrusive Luxation, how long do you splint?

A

Up to 2 Weeks

61
Q

If you have Lateral Luxation, how long should you splint?

A

4 Weeks

62
Q

If you have Intrusion, how long should you splint?

A

4 - 8 Weeks if Repositioned

63
Q

How long should you splint after avulsion if dry time < 60 and dry time > 60 minutes?

A
  • Dry Time < 60 Minutes: 2 weeks
  • Dry Time > 60 Minutes: 4 weeks
64
Q

How long should you splint after a Root Fracture?

A

4 Weeks, If Cerivcal - Up to 4 Months!

65
Q

How long should you splint an Alveolar Fracture?

A

4 Weeks

66
Q

What kind of clinical findings would you want to monitor Post Trauma during follow up exams?

A
  • Pulp Test
  • Percussion
  • Palpation
  • Swelling
  • Sinus Tract
  • Periodontium
  • Mobility
  • Color Changes
67
Q

What are some Radiographic Changes you would want to follow up with during a Post Trauma Exam?

A
  • Periradicular Pathosis
  • Marginal Bone Loss
  • Canal Obliteration
  • Root Development
68
Q

What can cause Infraposition like this?

A

Ankylosis

69
Q

When do you Decoronate a crown if it is ankylosed resulting in infraposition?

How does this help?

A
  • Decoronate if > 1 mm
  • Root preseved in alveolar process
  • Helps maintain existing bone volume
  • Enable possible vertical bone growth
  • Replacement resorption of roots continues…

Endo - ABGD - Oral Board Review (14 decks)

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