Module 7 Flashcards
what is a patient examination
A rational examination procedure is essential in order to establish a complete and correct diagnosis of all soft and hard tissue injuries.
what needs to be done with regards to a patient’s history if they present with trauma
- Take a short medical and dental history
- The medical history should include the patient’s general health, allergies and other conditions that may influence treatment
- Be alert to other injuries and symptoms which can indicate more serious injury.
- It is also of value to ask what has been done before the patient reached the clinic, such as any treatment carried out elsewhere and how avulsed teeth have been stored.
- The dental history should indicate previous dental traumas, information which may explain radiographic findings such as pulp canal obliteration or apical pathology.
what are important questions to ask relating to the injury
• Where did the injury occur?
○ This information may have legal implication for the patient and may on occasion indicate the possibility of contamination.
• How did the injury occur?
○ This may lead to identification of the impact zones
○ i.e. a chin injury is often combined with crown or crown-root fractures in premolar and molar regions.
• When did the injury occur?
○ This information may be essential in relation to many injury types.
○ In relation to a tooth avulsion the extent of time and the extraoral storage condition becomes very decisive for later treatment.
• Was there a period of unconsciousness?
○ If so, for how long?
○ Amnesia, nausea and vomiting are all signs of brain damage and require medical attention.
• Is there any disturbance in the bite?
○ An affirmative answer may indicate a luxation injury with displacement, an alveolar or jaw fracture or a fracture of the condylar region.
• Is there any reaction in the teeth to cold and/or heat exposure?
○ A positive finding indicates exposed dentin and/or pulp.
what is recommended with regards to the clinical examination
A systematic approach is recommended.
what is the general principle with oral injuries
The general principle with oral injuries to “examine from outside to inside and treat from inside to outside” is helpful for a systematic approach.
Hence suturing of lip lacerations should be carried out after intraoral injuries of urgent character have been treated.
Otherwise it may be difficult to enter the oral cavity once oedema has started to develop.
give an over view of what a systemic approach to a clinical examination would include
• Clean the face and the oral cavity with water or saline
○ If there are soft tissue wounds, a mild detergent should be used.
○ This cleaning will make the patient feel more comfortable and facilitate extraoral and oral examination.
- Examine the face, lips and oral muscles for soft tissue lesions.
- Palpate the facial skeleton for signs of fractures.
• Inspect the dental trauma region for fractures, abnormal tooth position, tooth mobility and abnormal response to percussion.
○ Furthermore, registration of direction of displacement in case of luxation injuries.
○ In case of fractures their extent and involvement of dentin, pulp and the relation to the gingival sulcus area is noted.
- Pulp testing (usually electrometric) completes the clinical examination.
- Percussion testing of teeth may reveal a high pitch bony sound indicating intrusion of the tooth.
• The possibility of inhaled or swallowed teeth, parts of teeth or prosthetic appliances at the time of injury should always be considered.
○ Foreign body in the airways usually give symproms such as coughing but may go undetected, which is especially important when treating unconscious patients
why are multiple radiographic procedures needed
Several clinical studies have shown that multiple radiographic procedures are needed to detect displacement of the tooth in its socket as well as presence of root fractures
what does the clinical examination identify
The completed clinical examination has now identified the trauma region and this site should now be examined with relevant radiographic techniques.
What needs to be considered for the radiographic examination
It is essential to consider the radiographic film format used in order to achieve a high quality image of the traumatized tooth.
what gives an excellent view of most lateral luxations, apical and mid-root fractures and alveolar fractures
A steep occlusal exposure (using a size 2 film (DF 58, EP 21)) of the traumatized anterior region gives an excellent view of most lateral luxations, apical and mid-root fractures and alveolar fractures
what is a minimum series of radiographs for a typical dental trauma to the anterior region of the maxilla
3 films with parallel technique supplemented with one film with steep occlusal exposure.
what happens if there is a lip laceration
In case of lip laceration a radiograph with the film placed inside the lip and reduced exposure time should be added
when would CBCT be considered
Cone beam CT may be a valuable tool and can be considered if the obtained information will influence the choice of treatment.
An example could be a tooth with a crown-root fracture where the extend of the fracture will determine whether it will be possible to preserve the tooth or not.
when is a soft tissue radiograph used
In the presence of a penetrating lip lesion, a soft tissue radiograph is indicated in order to locate any foreign bodies.
what do the oral orbicular muscles do with a foreign body
It should be noted that the oral orbicular muscles close tightly around foreign bodies in the lip, making them impossible to palpate; they can only be identified radiographically.
This is accomplished by placing a dental film between the lips and the dental arch and using the lowest exposure time.
