Oral Trauma I Flashcards
Peak age of injuries to the primary teeth.
2-4 years
50% of abused children suffer injuries to this region.
Head and neck
Triangle of safety
Ear, neck, and top of the shoulders.
What should the kid have if there’s a dirty wound?
Tetanus protection.
How many vaccinations is the Tetanus shot?
5
What ages do you get the Tetanus booster?
2 mo 4 mo 6 mo 15-18 mo 4-6 yrs
At what age do you get a booster?
11-12
How often after 11-2 yrs old do you get the booster?
Every ten years
Incomplete fracture of the enamel.
Infraction
Tx for infraction
None
Fracture restricted to the enamel, with no damage to the neurovascular supply or the tooth germ.
Enamel fracture.
Tx for enamel fracture.
Smooth out the sharp edges to avoid irritation to the tongue and lips.
Fracture involving the enamel, dentin, and cementum.
Crown split into two fragments- one of which is mobile.
Crown-root fracture without pulp involvement.
Tx for a crown to root fracture without pulp involvement.
1) Remove the fragment that ‘s mobile and restore if it’s not too far subgingivally.
2) Extract in all other cases.
Fracture of the enamel, dentin, cementum, and pulp.
Crown split into two or more fragments, one of which is mobile.
Crown-Root fracture with pulp involvement.
Tx for crown-root fracture with pulp involvement.
1) Remove mobile part if not too subgingival, do pulp therapy, and restore.
2) Extract
Tx for enamel-dentin fracture.
Cover with GI
Keep this in mind when taking soft tissue x-rays.
Exposure time is 25% of usual time when taking intraoral soft tissue image.
Exposure time is 50% of usual time when taking an extraoral soft tissue image.
When do you extract a tooth ASAP?
1) External root resorption
2) Inflammation is affecting the follicle of the permanent tooth bud.
Why is a Cvek good to do on a baby tooth that’s not completely formed?
Allows for root formation.
You CANNOT put down formocresol when doing a Cvek. So
what intracanal medicament can you use?
Sodium Hypochlorite or Chlorhexidine.
If I do a pulpectomy on a baby tooth, can I use gutta percha?
No bc it’s not resorbable.
3 reasons NOT to do a pulpOTOMY:
1) Internal root resorption
2) External root resorption
3) Inflammation affecting the follicle of the permanent tooth.
Tenderness to percussion.
Concussion
The PDL absorbs the injury and is inflammed.
Concussion.
Tx for concussion.
None
Increased mobility but not displaced from the socket.
Subluxation
The tooth is not mobile or displaced.
Concussion
Tx for subluxation
None.
Recommend a soft diet and good oral hygiene to prevent contamination of the damaged PDL.
Can do chlorhexidine that’s alcohol free on the affected area with cotton swabs twice a day for a week.
This happens if you have concussion or subluxation after a while.
Tooth discoloration
What do you do if you see a gray baby tooth?
70% of the time, you do nothing.
Does color change in a tooth indicate the need for pulp therapy or extraction?
No, there has to be periapical pathology, signs of infection, etc.
What does pink discoloration indicate?
1) Recent injury where the capillaries in the pulp are hemorrhaging and releasing blood into the crown space.
2) Internal root resorption
What does yellow discoloration indicate?
Pulp calcification.
Good prognosis
Tx for yellow discoloration.
Monitor
This causes dark discoloration of the tooth.
RBC’s containing hemogolobin stain the tooth dark.
What percent of untreated dark discolored primary incisors remain without radiographic or clinical pathology?
70%
The tooth is completely out of the socket.
Avulsion
This percent of avulsions involving a primary have a damaged developing successor.
75%.
Should you reimplant an avulsed BABY TOOTH?
No! Can do damage to the permanent successor.
Someone with a congenital heart defect who has a heart valve that’s been completely repaired needs to pre-medicate for low long after the procedure was done?
6 months
Do artificial heart valves need premedication?
Yes
a history of this bacterial heart disease needs premedication.
Infective endocarditis
Does a cardiac transplant that develops a heart problem need premedication?
Yes
Dislocation of the tooth in an axial direction into the alveolar bone.
Intrusion
If my baby tooth is intruded, want to figure out the position of it in relation to the permanent incisor.
True
When would you extract an intruded tooth.
If it’s impinging on the permanent successor.
What does buccal inclination of the crown indicate in intrusion?
The root is hitting the permanent tooth germ, and the baby tooth needs to be extracted ASAP.
What does lingual inclination of the baby crown indicate in intrusion?
The baby root is towards the buccal plate, away from the tooth germ, so just let it re-erupt.
Foreshortened and opaque tooth. What does this say about the type of intrusion?
Okay to keep in.
The root is buccal, away from the follicle.
Elongated root on x-ray indicate what about the intrusion type?
EXTRACT= elongated
The root is going towards the lingual, into the follicle.
Intruded primary teeth, unlike adult teeth, maintain what?
Pulp vitality.
Describe the PDL space on a radiograph for an extruded tooth.
Widened around the apex.
If the extrusion is less than 3 mm, what do you do?
Reposition or allow it to spontaneously realign.
What to do if the extrusion is greater than 3 mm?
Extract with LOCAL ANESTHESIA!
What do you do in a horizontal root fracture where the coronal fragment is only moderately or slightly displaced?
Reposition and splint
What to do in a horizontal root fracture if the coronal segment is really displaced?
Extract, but leave the root tips in so you don’t damage the permanent successor.
The tooth is usually not mobile in this type of injury bc the root is forced into the bone.
Lateral luxation.
Alveolar bone fracture is often caused by this type of injury.
Lateral luxation.
This type of injury is often associated with a swollen upper lip due to fracture of the buccal bone plate by the tooth apex.
Lateral luxation
Lateral luxation treatment if there’s no occlusal interference, like in an anterior open bite.
Allow to spontaneously reposition.
Lateral luxation treatment if there’s occlusal interference.
Give local and manually reposition.
Lateral luxation treatment for teeth with severe displacement in a labial direction.
Extraction.
Teeth have mobility of the alveolar process in this type of oral trauma.
Alveolar fracture (buccal and lingual plates are fractured).
Splint these two types of oral trauma.
Root fracture and Alveolar fracture.
General anesthesia is indicated for this type of oral trauma.
Alveolar fracture.
