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BDS4 PAEDIATRICS > IADT (permanent teeth) > Flashcards

IADT (permanent teeth) Flashcards

1
Q

What is enamel infarction?

A

Incomplete fracture (crack or crazing) of the enamel
- no loss of tooth structure

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2
Q

What are the clinical findings of enamel infarction?

A
  • crack or crazing seen
  • not TTP (if ttp check for luxation/root fracture)
  • normal mobility
  • positive pulp sensibility tests
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3
Q

What investigations should be done for enamel infarction injuries?

A

PA radiograph
- no radiographic abnormalities should be present

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4
Q

What is the treatment for enamel infarction?

A

No Tx usually required

Severe cases:
- etch and seal with resin to prevent discolouration/bacterial contamination

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5
Q

Follow up for enamel infarction?

A

No follow up required

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6
Q

What are the clinical findings of an enamel fracture (uncomplicated)?

A
  • loss of enamel
  • no visible signs of exposed dentine
  • normal mobility
  • positive to pulp sensibility testing

(if TTP, assess tooth for luxation or root fracture)

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7
Q

What investigations should be done for an enamel fracture (uncomplicated)?

A
  • account for missing fragments
  • PA radiograph
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8
Q

What treatment should be done for an enamel fracture?

A

Tooth fragment available = bond back onto tooth

Otherwise smooth edges and place composite resin restoration

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9
Q

What is the follow up for an enamel fracture?

A

Clinical & Radiographs:
- 6/8 weeks
- 1 year

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10
Q

What would be considered unfavourable outcomes of an enamel fracture?

A
  • symptomatic
  • pulp necrosis and infection
  • apical periodontitis
  • loss of restoration
  • breakdown of the restoration
  • lack of further root development
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11
Q

What are the clinical findings of an enamel-dentine fracture (uncomplicated)?

A
  • fracture that extends into dentine (no pulp)
  • normal mobility
  • positive pulp sensibility tests
  • not TTP
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12
Q

What investigations should be done for an enamel-dentine fracture?

A
  • account for missing fragment
  • PA radiograph
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13
Q

What is the treatment for an enamel dentine fracture?

A

Tooth fragment available = soak fragment in saline to rehydrate it, rebond back onto tooth

Otherwise restore with GIC or composite resin (if within 0.5mm of pulp place a CaOH and GIC lining)

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14
Q

What are the follow up dates after an enamel-dentine fracture?

A

Clinical and Radiographs:
- 6/8 weeks
- 1 year

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15
Q

What would be considered unfavourable outcomes of an enamel-dentine fracture?

A
  • symptomatic
  • pulp necrosis and infection
  • apical periodontitis
  • lack of further root development
  • loss of restoration
  • breakdown of restoration
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16
Q

What are the clinical findings of a complicated crown fracture?

A

Fracture of enamel and dentine with pulp exposure
- normal mobility
- not TTP
- exposed pulp is sensitive to stimuli [air, cold, sweets]

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17
Q

What investigations should be done on a pt who presents with a complicated crown fracture?

A
  • account for missing fragments
  • PA radiograph
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18
Q

What is the treatment for a tooth that has experienced complicated crown fracture?

A

Open apices =
- Partial pulpotomy or pulp capping

Closed apices =
- Partial pulpotomy preferred option
- Root canal treatment

After pulp treated then either rebond tooth fragment OR restore with GIC and composite resin

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19
Q

What are the follow-up dates for a complicated crown fracture?

A

Clinical and Radiographs
- 6/8 weeks
- 3 months
- 6 months
- 1 year

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20
Q

What is an uncomplicated crown-root fracture?

A

A fracture involving enamel, dentine and cementum WITHOUT pulp exposure

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21
Q

What are the clinical findings of an uncomplicated crown-root fracture?

A
  • positive pulp sensibility testing
  • TTP
  • coronal fragment mobile
  • fracture extends sub alveolar
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22
Q

What investigations should be done for an uncomplicated crown root fracture?

A
  • account for any missing fragments
  • PA radiograph + 2 additional radiographs used with parallax
  • CBCT can be considered
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23
Q

What is the initial treatment of a tooth that has experienced uncomplicated crown-root fracture?

A
  • stabilisation of loose fragment to adjacent tooth OR to non-mobile fragment should be attempted
  • or remove mobile fragment and restore tooth with GIC or composite resin
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24
Q

What is the finalised treatment of a tooth that has experienced uncomplicated crown-root fracture?

A

Options available:
- orthodontic extrusion of non-mobile fragment + restoration
- surgical extrusion
- RCT and restoration if pulp become necrotic
- root submergence
- extraction
- autotransplantation

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25
Q

What is the follow up schedule for a tooth that has experienced an uncomplicated crown-root fracture?

A

Clinical and Radiograph evaluations:
- 1 week
- 6/8 weeks
- 3 months
- 6 months
- 1 year
- yearly for at least 5 years

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26
Q

What would be considered unfavourable outcomes of a tooth that has experienced an uncomplicated crown-root fracture?

A
  • symptomatic
  • discolouration
  • pulp necrosis and infection
  • apical periodontitis
  • lack of further root development in immature teeth
  • loss/breakdown of restoration
  • marginal bone loss & periodontal inflammation
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27
Q

What is a complicated crown-root fracture?

A

a fracture involving enamel, dentine and cementum WITH pulpal exposure

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28
Q

What are the clinical findings of a complicated crown-root fracture?

A
  • positive pulp sensibility tests
  • TTP
  • coronal fragment mobile
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29
Q

What investigations should be done on a tooth with a complicated crown root fracture?

A
  • account for missing fragment
  • on PA radiograph + additional radiograph for parallax [can be occlusal]
  • CBCT can be considered
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30
Q

What initial treatment should be done for a tooth with a complicated crown-root fracture while Tx plan is being formulated?

A

Stabilise loose fragment to adjacent teeth or to non-mobile fragment

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31
Q

What is the finalised treatment for a tooth that has experienced a complicated crown-root fracture?

A

Incomplete root formation/open apices = partial pulpotomy indicated with non-setting CaOH + restore

Mature teeth/closed apices = RCT + restore with composite/GIC

Restorative options:
- composite restoration
- orthodontic extrusion & restoration
- surgical extrusion & restoration
- root submergence
- extraction
- autotransplantation

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32
Q

What is the follow up schedule for a tooth that has experienced a complicated crown-root fracture?

A

Clinical and Radiographic =
- 1 week
- 6/8 weeks
- 3 months
- 6 months
- 1 year
- annually for 5 years

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33
Q

What are the clinical findings of a root fracture?

A

Fracture of root involving dentine, cementum and pulp:
- coronal segment may or may not be mobile/displaced
- potential TTP
- potential bleeding from gingival sulcus
- initial negative pulp sensibility results

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34
Q

What investigations should be done for a suspected root fracture?

A
  • PA / occlusal radiographs + parallax
  • CBCT if required
35
Q

What is the treatment for a tooth that has experienced root fracture?

A

If displaced =
- coronal fragment repositioned & checked radiographically
- stabilise mobile coronal segment with passive/flexible splint 4 weeks
- if fracture is located cervically splint may be required for up to 4 months
- monitor pulp status
- if pulp becomes necrotic perform RCT of coronal segment

In mature teeth where cervucal fracture line is located above the alveolar crest + coronal fragment is very mobile =
- remove coronal fragment, RCT tooth and restore with a post-retained restoration

36
Q

What is the follow-up schedule of a tooth that has experienced a root fracture ? [mid-third or apical fracture]

A

Clinical and Radiographic Evaluations:
- 4 weeks [splint removal]
- 6/8 weeks
- 6 months
- 1 year
- annually for 5 years

37
Q

What is the follow-up schedule of a tooth that has experienced a root fracture ? [cervical third fracture]

A

Clinical and Radiographic Evaluations:
- 6/8 weeks
- 4 months [splint removal]
- 6 months
- 1 year
- annually for 5 years

38
Q

What would be considered unfavourable outcomes for a tooth that has experienced root fracture?

A
  • symptomatic
  • extrusion and/or excessive mobility of coronal segment
  • radiolucency at fracture line
  • pulp necrosis and infection
39
Q

What are the clinical findings of an alveolar fracture?

A
  • segment mobility & displacement with several teeth moving
  • occlusal disturbances and misalignment
  • no response of teeth to pulp sensibility testing at area of fracture
40
Q

What is the treatment for an alveolar fracture?

A
  • reposition displaced segment
  • stabilise segment by splinting teeth with a passive + flexible splint for 4 weeks
  • suture any gingival lacerations
  • monitor pulp condition of all teeth involved to determine if RCT is necessary
41
Q

What is the follow up schedule after an alveolar fracture?

A
  • 4 weeks [splint removal]
  • 6/8 weeks
  • 4 months
  • 6 months
  • 1 year
  • yearly for 5 years
42
Q

What would be considered unfavourable outcomes after an alveolar fracture?

A
  • symptomatic
  • pulp necrosis and infection
  • apical periodontitis
  • inadequate soft tissue healing
  • non-healing of bone fracture
  • external inflammatory resorption
43
Q

What are the clinical findings after a concussion injury?

A
  • normal mobility
  • tooth is TTP
  • tooth responds to pulp sensibility testing
44
Q

What investigations should you do on a tooth that has experienced concussion?

A

PA radiograph [no abnormalities should be seen]

45
Q

What treatment is required for a tooth that has experienced concussion?

A

No Tx
- monitor pulp condition for 1 year at least

46
Q

What is the follow up schedule for a tooth that experienced concussion?

A

Clinical and Radiographic Evaluation:
- 4 wks
- 1 year

47
Q

What would be considered unfavourable outcomes after a concussion injury?

A
  • symptomatic
  • necrosis and infection
  • apical periodontitis
  • no further root development in immature teeth
48
Q

What is a subluxation injury?

A

Injury to the tooth supporting structures with abnormal loosening, but without displacement of tooth

49
Q

What are the clinical findings of a subluxation injury?

A
  • TTP
  • increased mobility but NOT displaced
  • bleeding from gingival crevice may be seen
  • tooth may/may not respond to pulp sensibility testing
50
Q

What investigations are done on teeth that have experienced subluxation?

A

PA/occlusal radiograph + another view for parallax (radiograph should appear normal)

51
Q

What is the treatment required after a subluxation injury?

A

No Tx needed

If excessive mobility = passive + flexible splint for 2 weeks

52
Q

What is the follow up regime for a tooth that has experienced subluxation?

A

Clinical and radiographic evaluations:
- 2 weeks [only if splint placed, this is for removal]
- 12 weeks
- 6 months
- 1 year

53
Q

What would be considered unfavourable outcomes after subluxation of a tooth?

A
  • symptomatic
  • pulp necrosis and infection
  • apical periodontitis
  • no further root development in immature teeth
  • external inflammatory resorption
54
Q

What should be done if external inflammatory (infection-related) root resorption occurs after a subluxation injury ?

A

RCT initiated immediately
- use CaOH as intracanal medicament
- or Ledermix followed by CaOH

55
Q

What is extrusion of a tooth?

A

Displacement of the tooth out of its socket in an incisal/axial direction

56
Q

What are the clinical findings of an extrusion injury?

A
  • tooth appears elongated
  • tooth has increased mobility
  • likely no response to pulp sensibility testing
57
Q

What investigations should be done to a tooth that has experienced extrusion? What will be seen radiographically?

A

PA/Occlusal radiograph + another view for parallax
- increased PDL space
- tooth not seated in socket

58
Q

What is the treatment for extrusion of a tooth?

A
  • reposition tooth by gently pushing it back into the socket
  • stabilise tooth using a passive + flexible splint [2 weeks]
  • monitor pulp condition
  • if pulp becomes necrotic then perform RCT based on appropriate stage of root development
59
Q

What is the follow-up schedule for a tooth that has experienced extrusion?

A

Clinical and Radiographic evaluations:
- 2 weeks [splint removal]
- 4 weeks
- 8 weeks
- 12 weeks
- 6 months
- 1 year
- annually for 5 years

60
Q

What would be considered favourable outcomes after extrusion of a tooth?

A
  • asymptomatic
  • signs of normal/healed PDL
  • no marginal bone loss
  • continued root development in immature teeth
61
Q

What would be considered unfavourable outcomes after extrusion of a tooth?

A
  • symptomatic
  • pulp necrosis and infection
  • apical periodontitis
  • breakdown of marginal bone
  • external inflammatory (infection-related) root resorption
62
Q

What is lateral luxation?

A

Displacement of the tooth in any lateral direction

63
Q

What are the clinical findings of a lateral luxation injury?

A
  • tooth displaced in a lateral direction [lingual/palatal/labial]
  • usually associated fracture of alveolar bone
  • tooth frequently immobile
  • percussion high metallic sound
  • likely no response to pulp sensibility testing
64
Q

What investigations should be done for a tooth that has experienced lateral luxation? What is seen radiographically?

A

PA/occlusal radiograph + another view for parallax

[widened PDL space]

65
Q

How should a lateral luxation injury be treated?

A
  • Reposition tooth under LA
  • Stabilise tooth for 4 weeks using passive + flexible splint
  • monitor pulp condition & make endodontic evaluation at around 2 weeks

INCOMPLETE ROOT FORMATION:
- spontaneous revascularisation may occur
- if root becomes necrotic RCT

COMPLETE ROOT FORMATION
- pulp will likely become necrotic
- RCT should be started using CaOH or Ledermix as an intracanal medicament

66
Q

What is the follow up schedule for a tooth that has experienced lateral luxation?

A

Clinical and Radiographic Evaluation:
- 2 weeks
- 4 weeks [splint removal]
- 8 weeks
- 12 weeks
- 6 months
- 1 year
- annually for 5 years

67
Q

What would be considered favourable outcomes after lateral luxation?

A
  • asymptomatic
  • healed PDL
  • positive response to pulp sensibility testing
  • marginal bone height corresponds repositioned tooth
  • continued root development in immature teeth
68
Q

What would be considered unfavourable outcomes of lateral luxation?

A
  • symptomatic
  • breakdown of marginal bone
  • pulp necrosis & infection
  • apical periodontitis
  • ankylosis
  • external replacement resorption
  • external inflammatory resorption
69
Q

What is intrusive luxation?

A

Displacement of tooth in an apical direction into the alveolar bone

70
Q

What are the clinical findings of an instrusion injury?

A
  • tooth displaced axially into alveolar bone
  • immobile
  • high metallic percussion sound
  • likely no response to pulp sensibility tests
71
Q

What investigations should be done for a tooth that has experienced luxation? What would be seen radiographically?

A

PA/occlusal radiograph + another view to use parallax technique

[PDL space may not be visible and CEJ is located more apically]

72
Q

What is the treatment for an immature tooth that has experienced intrusion?

A
  • allow re-eruption without intervention [spontaneous repositioning]
  • if no eruption within 4 weeks initiate orthodontic repositioning
  • monitor pulp condition
  • if required perform RCT
73
Q

What is the treatment for a mature tooth that has experienced intrusion?

A
  • if less than 3mm intrusion, allow spontaneous repositioning
  • if no re-eruption within 8 weeks resposition surgically & splint for 4 weeks with passive + flexible splint
  • if tooth intruded 3-7mm, reposition surgically or orthodontically
  • RCT started at 2 weeks
74
Q

What is the follow up regime after a lateral luxation injury?

A

Clinical and Radiograph Evaluation:
- 2 weeks
- 4 weeks [splint removal]
- 8 weeks
- 12 weeks
- 6 months
- 1 year
- annually for 5 years

75
Q

What would be considered favourable outcomes after a lateral luxation injury?

A
  • asymptomatic
  • tooth in place or is re-erupting
  • intact lamina dura
  • positive response to pulp sensibility testing
  • no root resorption
  • continued root development in immature teeth
76
Q

What would be considered unfavourable outcomes after a lateral luxation injury?

A
  • symptomatic
  • tooth locked in place/ankylotic tone to percussion
  • pulp necrosis and infection
  • apical periodontitis
  • ankylosis
  • external replacement resorption
  • external inflammatory resorption
77
Q

A pt phones and states that their child has knocked their tooth out playing sports, what advice do you give over the phone?

A
  1. keep pt calm and reassure
  2. find tooth and pick up by crown/white part (NOT ROOT)
  3. if tooth is dirty rinse gently in milk, saline or pts saliva
  4. replant tooth as soon as possible if possible
  5. once replanted pt should bite on gauze/tissue to hold in place
  6. if replantation not possible place tooth in storage medium (milk>HBSS>saliva)
  7. see dentine ASAP
78
Q

Why is EADT important to know in avulsed teeth?

A

If <15 mins the PDL cells are most likely viable

If <60 mins the PDL cells may be viable but compromised

If >60 mins the PDL cells are likely non-vital

79
Q

What is the treatment for an avulsed permanent tooth (with a CLOSED apex) that has been replanted at site of injury?

A
  1. Clean injured area (water/saline/chlorhexidine)
  2. Verify correct position of replanted tooth (clinically and radiographically) move tooth if necessary
  3. Stabilise the tooth for 2 weeks with a passive flexible splint (diameter 0.4mm)
  4. suture gingival lacerations if present
  5. initial RCT within 2 weeks
  6. administer systemic antibiotics & assess tetanus status
80
Q

What is the treatment for an avulsed permanent tooth (with a CLOSED apex) that has an extra oral dry time of <60 mins?

A
  1. Remove visible contamination (saline)
  2. Take history & examine pt clinically/radiographically
  3. Irrigate socket & examine, reposition any socket fractures
  4. Replant tooth slowly (avoid excessive pressure)
  5. Verify correct position clinically/radiographically
  6. Stabilise with 0.4mm passive flexible splint for 2 weeks (associated alveolar fracture requires 4 weeks)
  7. Suture gingival lacerations if present
  8. Initiate RCT within 2 weeks
  9. Administer systemic antibiotics & check tetanus status
81
Q

What is the treatment for an avulsed permanent tooth (with a CLOSED apex) that has an extra oral dry time of >60 mins?

A
  1. Remove visible contamination (saline)
  2. Take history & examine pt clinically/radiographically
  3. Irrigate socket & examine, reposition any socket fractures
  4. Replant tooth slowly (avoid excessive pressure)
  5. Verify correct position clinically/radiographically
  6. Stabilise with 0.4mm passive flexible splint for 2 weeks (associated alveolar fracture requires 4 weeks)
  7. Suture gingival lacerations if present
  8. Initiate RCT within 2 weeks
  9. Administer systemic antibiotics/check tetanus status
82
Q

What is the treatment for an avulsed permanent tooth (with an OPEN apex) that has been replanted at site of injury?

A
  1. Clean area (saline/chlorhexidine)
  2. Verify correct position of tooth (clinically/radiographically)
  3. Leave tooth in place (move to correct position if necessary)
  4. Stabilise for 2 weeks using passive flexible splint 0.4mm wire
  5. Suture gingival lacerations if necessary
  6. Monitor pulp, if signs of pulp necrosis within 2 weeks initiate endodontic tx
  7. administer systemic antibiotics & check tetanus status
83
Q

What is the treatment for an avulsed permanent tooth (with a CLOSED apex) that has an extra-alveolar dry time of <60mins?

A
  1. Remove visible contamination (saline)
  2. Take history & examine pt clinically/radiographically
  3. Irrigate socket & examine, reposition any socket fractures
  4. Replant tooth slowly (avoid excessive pressure)
  5. Verify correct position clinically/radiographically
  6. Stabilise with 0.4mm passive flexible splint for 2 weeks (associated alveolar fracture requires 4 weeks)
  7. Suture gingival lacerations if present
  8. Monitor pulp, begin endo treatment if pulp necrosis becomes apparent
  9. Administer systemic antibiotics/check tetanus status

BDS4 PAEDIATRICS (5 decks)

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