L.11 TRAUMA Flashcards
Where do ORAL injuries rank on the most common injuries of the body ages 0-6?
2nd! behind facial injury
Where do ORAL injuries rank on the most common injuries of the body ages 0-6?
2nd! behind facial injury
When do most oral injuries occur?
at night and on the weekends
What fraction of oral injuries are considered serious threats to quality of life?
1/3
Who gets oral injury more? Girls or Boys?
Boys 3:2, but its catching up to 1:1..YAY EQUALITY!
What is the best predictor of future trauma?
previous drama lol.
What years of life are the most common for dental injury?
2-3 years of age
Permanent vs Primary dentition- what is the most common type of injury in each?
perm: fractures…primary: luxation (short crown,less calcified bone,thin cortical plates)
50% of child abuse victims are less than __ years old and 30-___% of their injuries are head and neck..
Medical Hx aspects of trauma: Cardiac disease, Bleeding disorders, Seizure disorders, Allergies, Medications, Illnesses,WHAT ARE THE LAST TWO odd balls??
When was their Last Meal? and… Immunizations: tetanus**
Assessing the Cranial Nerves: II
Optic-check their visual acuity
Assessing the Cranial Nerves: III
Oculomotor- Pupil Constriciton (BIGGEST ONE!!-concussion often has very different and noticeable pupils)…Ptosis (drooping eyelid)
Assessing the Cranial Nerves: IV
Trochlear..Diplopia (double vision)
Assessing the Cranial Nerves: VI
Abducens…follow finger side to side
Assessing the Cranial Nerves: VII
Facial-close eyes, smile, frown
What is the acronym used to check: Pupils Equal, Round, Responsive to Light and Accommodation
PERRLA
What two Cranial Nerves does PERRLA check for?
CN II and III
What Glasgow Coma Scale score should be evaluated medically? What is a severe score?
below 15 = med eval…less than 8 is severe
How many radiographs do we need for trauma?
3..1) PA at 90 degrees 2.PA from M or D 3.Occlusal view
How long can you defer x-rays?
2-3 days
What % of normal exposure time do you use for soft tissue?
25%
About how long does it normally take normal blood flow to return to a traumatized tooth?
9 months (so pulp testing is useless in trauma)
About how long does it normally take normal blood flow to return to a traumatized tooth?
9 months (so pulp testing is useless in trauma)
When do most oral injuries occur?
at night and on the weekends
What fraction of oral injuries are considered serious threats to quality of life?
1/3
Who gets oral injury more? Girls or Boys?
Boys 3:2, but its catching up to 1:1..YAY EQUALITY!
What is the best predictor of future trauma?
previous drama lol.
What years of life are the most common for dental injury?
2-3 years of age
Permanent vs Primary dentition- what is the most common type of injury in each?
perm: fractures…primary: luxation (short crown,less calcified bone,thin cortical plates)
What is a radiographic sign of subluxation?
PDL thickened
Medical Hx aspects of trauma: Cardiac disease, Bleeding disorders, Seizure disorders, Allergies, Medications, Illnesses,WHAT ARE THE LAST TWO odd balls??
When was their Last Meal? and… Immunizations: tetanus**
Assessing the Cranial Nerves: II
Optic-check their visual acuity
Assessing the Cranial Nerves: III
Oculomotor- Pupil Constriciton (BIGGEST ONE!!-concussion often has very different and noticeable pupils)…Ptosis (drooping eyelid)
Assessing the Cranial Nerves: IV
Trochlear..Diplopia (double vision)
Assessing the Cranial Nerves: VI
Abducens…follow finger side to side
Assessing the Cranial Nerves: VII
Facial-close eyes, smile, frown
What is the acronym used to check: Pupils Equal, Round, Responsive to Light and Accommodation
PERRLA
What two Cranial Nerves does PERRLA check for?
CN II and III
What Glasgow Coma Scale score should be evaluated medically? What is a severe score?
below 15 = med eval…less than 8 is severe
How many radiographs do we need for trauma?
3..1) PA at 90 degrees 2.PA from M or D 3.Occlusal view
How long can you defer x-rays?
2-3 days
What % of normal exposure time do you use for soft tissue?
25%
Immediately following trauma, WHAT FRACTION of all luxated teeth will not respond to sensibility testing
1/2
About how long does it normally take normal blood flow to return to a traumatized tooth?
9 months (so pulp testing is useless in trauma)
IF you were to do pulp testing following trauma, which teeth might it actually help with? What type of material would you use?
elderly teeth..use endo ice
Do you have mobility or bleeding with a concussed tooth?
Nope
Which radiograph do you use with a concussed tooth?
occlusial
What % of concussed PEDO teeth have the chance of dying with pulp necrosis?
25%
Which permanent tooth has a better prognosis with concussion?…open or closed apex?
closed actually…5% of necrosis
If ankylosis starts to occur with a primary tooth and intrusion luxation, then what is the Tx?
EXTRACT THAT BEEZY
What is the cardinal sign of subluxation?
bleeding from the sulcus
What is a radiographic sign of subluxation?
PDL thickened
If there is a subluxed permanent tooth, how long do you splint (if at all)?
2 weeks
What is the risk of necrosis for a subluxed perm tooth with a closed root?
15%
What are the two options of splinting wire used for trauma?
small ortho wire or monofilament fishing line
What is the most complicated luxation injury? What is the most common complication with the healing of this injury and how long does it take to manifest?
Intrusional Luxation…ankylosed…5-10 years
BOOM: How long do you splint for SUBLUX, Extrusion, Intrusion, Avulsion?
2 weeks
BOOM: How long do you splint for LATERAL luxation, and delayed avulsion?
4 weeks
Which type of displacement injury is this? Tooth will appear elongated ++Mobility, tender to percussion
Pulp test will be negative
Radiograph will display increased PD
Extrusion Luxation
What is the limit distance of extrusion in a primary luxated tooth before extraction is to take place?
more than 3mm
the need to splint an _________ luxated primary tooth is likely an indication for extraction
extrusively
How many radiographs do we want for a permanent extrusion luxaiton?
the 3
Which has the best survival chance in a permanent extrusion lunation-a mature apex or open apex?
open
Say a PRIMARY tooth is labially (root to the lingual) luxated….what is the best Tx choice?
Extraction (don’t want to damage incoming incisors)
For a lateral luxation of a primary central or lateral incisor at what age might it be ok to reposition BECAUSE the permanents are DONE calcifying?
5 years old (so they can keep their central for another 2 years…)
How long do you splint a permanent lateral luxation?
4 weeks (get it set ASAP!)
An open apex has the best chance of survival on a permanent tooth lateral luxation, BUT overall what is the % chance the tooth will need RCT?
75%
What two diagnostic tests are not likely to succeed in an intrusion luxation?
percussion or mobility (the tooth is shoved into the bone!)
Primary tooth, Intrusion Luxation: if it is toward the labial what is the possible outcome?
SPONTANROUS RE-ERUPTION
Primary tooth, Intrusion Luxation: if it is toward the lingual what is the possible outcome?
Extraction (don’t want it messing up the permanent tooth-until 5 y/o)
Primary tooth, Intrusion Luxation: WHAT PERCENT? of intruded teeth will re-erupt spontaneously (either partially or completely) in HOW LONG OF TIME? HOW LONG IS THEIR SURVIVAL TIME?
90%….2 to 6 months…survive for 3 years!!
If ankylosis starts to occur with a primary tooth and intrusion luxation, then what is the Tx?
EXTRACT THAT BEEZY
What is the critical factor in intrusion luxation of a permanent tooth? What is the tx?
ROOT MATURITY…spontaneous re-eruption OR ortho..worst case-immediate reposition and splint/ortho
Intrusion luxation: What is the threshold for when an OPEN apex tooth is intruded to rely on spontaneous re-eruption?
Less than 7mm of intrusion!!
Intrusion luxation: What is the threshold for when a CLOSED apex tooth is intruded to rely on spontaneous re-eruption?
Less than 3mm of intrusion
What is the ONLY treatment option for a closed apex tooth that has been luxated intrusionally more than 7mm?
surgery
Say you are trying to get spontaneous re-eruption of a tooth…how long do you wait to see if other treatment is needed?
“a few weeks”
What is the most complicated luxation injury? What is the most common complication with the healing of this injury and how long does it take to manifest?
Intrusional Luxation…ankylosed…5-10 years
