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BDS3 CDS > paediatric trauma > Flashcards

paediatric trauma Flashcards

1
Q

most common teeth to be traumatised

A

maxillary incisors

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2
Q

tooth is tender to touch but not displaced or mobile - what injury has been sustained?

A

concussion

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3
Q

pt presents to you with a traumatised tooth. it is immobile as locked into bone. on percussion it displays a high ankylotic tone and radiographs show widening of PDL - state the type of injury sustained

A

lateral luxation

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4
Q

splinting time for lateral luxation injury

A

4 weeks - passive and flexible

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5
Q

percussion note associated with lateral luxation

A

high ankylotic

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6
Q

how does a subluxation injury present

A

tender to touch
increased mobility
no displacement
bleeding from gingival crevice

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7
Q

treatment of lateral luxation injury

A

reposition under LA
4 week splint - passive
endo evaluation in 2 weeks

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8
Q

how does a lateral luxation injury present

A

displacement of tooth out of socket in direction other than axially - usually palatally/lingually or labially

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9
Q

a pt presents with a trauma in which the tooth is displaces through the labial bone plate. you are worried this injury impinges on the permanent tooth bud, what type of injury is this?

A

intrusion

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10
Q

describe an extrusion injury

A

partial axial displacement of tooth out of socket
tooth appears elongated

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11
Q

describe an avulsion injury

A

tooth completely out socket

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12
Q

how do you manage a pt who has sustained a trauma injury

A

reassure
history
examine and diagnose

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13
Q

when testing percussion of teeth - what does a dull note indicate

A

root fracture

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14
Q

what information is recorded on a trauma stamp - 6

A

mobility
colour
TTP
sinus
percussion note
sensibility
radiograph

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15
Q

what is a complicated crown fracture

A

a fracture involving pulp, dentine and enamel

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16
Q

3 types of luxation injury

A

lateral
intrusion
extrusion

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17
Q

5 classification of supporting tissue injury

A

alveolar fracture
concussion
subluxation
luxation - lateral, intrusion, extrusion
avulsion

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18
Q

home care of an injured tooth to optimise healing

A

analgesia

soft diet

brush soft brush after every meal

be aware of infection signs

chlorhexadine mouth rinse 0.12% child at times other than brushing

avoid contact sports

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19
Q

treatment of enamel fracture child

A

smooth sharp edges

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20
Q

treatment of enamel dentine fracture child

A

cover exposed dentine with GI
restore composite later or immediately

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21
Q

treatment for complicated crown fracture in child

A

partial pulpotomy or extract

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22
Q

management of crown/rooth fracture on child

A

cover with GI if no pulp exposure

pulp exposure - pulpotomy ot extract

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23
Q

treatment of concussion injury

A

no treatment - observe

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24
Q

treatment of subluxation injury

A

no treatment - observe

if excessively mobile - place passive flexible splint up to 2 weeks

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25
Q

treatment of lunation injury

A

if no occlusal interference, spontaneous reposition

if severe displacement extract or reposition and splint

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26
Q

treatment of intrusion injury of 3+mm

A

reposition surgically and splint for 4 weeks

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27
Q

treatment of intrusion injury less than 3mm

A

allow spontaneous repositioning but if no eruption in 8 weeks surgically reposition and splint for 4 weeks

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28
Q

treatment ofd extrusion injury that is excessively mobile or >3mm

A

extract

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29
Q

treatment of extrusion injury

A

gently reposition under LA
passive flexible splint for 2 weeks

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30
Q

treatment of primary avulsion injury

A

do not replant
radiograph to confirm avulsion

31
Q

how long do you splint an alveolar fracture for after repositioning the segment

A

4 weeks

32
Q

4 long term complications of child trauma injury

A

delayed exfoliation
discolouration
trauma to permanent successor
infection

33
Q

meaning of mild grey tooth colour

A

may maintain vitality

34
Q

meaning of opaque/yellow tooth colour

A

pulp obliteration

35
Q

true or false - the younger trauma occurs, the more chance of injury to permanent successor

A

true

36
Q

trauma can affect permanent successor in multiple ways - give 5

A

enamel defects

arrested development

abnormal crown or root morphology e.g. dilaceration

ectopic tooth position

delayed eruption

37
Q

what is enamel hypo mineralisation

A

qualitative defect
normal thickness of enamel put poorly mineralised
white/yellow

38
Q

what is enamel hypoplasia

A

quantitive defect
reduced thickness but normal mineralisation
yellow/brown defects

39
Q

when is a radiograph indicated for delayed eruption of a permanent tooth

A

if 6 month delay or more compared to the contralateral tooth

40
Q

most common injury in primary dentition

A

luxation

41
Q

what is the affect of a large over-jet >9mm on incidence of trauma

A

doubles the incidence

42
Q

patient presents to you with a dental trauma injury. when doing an extra oral examination, give 3 things you are checking for

A

lacerations
CSF
haemorrhage

43
Q

patient presents to you with a dental trauma injury. when doing an intra oral examination, give 3 things you are checking for

A

occlusion

penetrating wounds

soft tissues

44
Q

tests available to test sensibility of tooth

A

thermal - ethyl chloride or warm GP
EPT

45
Q

why should you sensibility test the teeth adjacent and opposing to obviously traumatised tooth

A

they will have received direct or indirect concussive injuries

46
Q

when managing an enamel dentine pulp fracture, what 3 features of the exposure will influence your treatment

A

size of exposure
time since injury
associated PDL injury

47
Q

suitable material for pulp capping or partial pulpotomy

A

MTA
CaOH dycal

48
Q

why is it important to preserve pulp vitality in open apices

A

to secure further root development

49
Q

when is a direct pulp cap a suitable treatment option

A

tiny exposures <1mm in less than 24 hrs

no TTP and sensibility +ve

50
Q

disinfectant used in pulp capping and pulpotomy

A

sodium hypochlorite

51
Q

when is a direct pulp cap a suitable treatment option

A

larger exposure >1mm or 24hr +

52
Q

how many mm of pulp is removed during a partial pulpotomy and using what instrument

A

2mm - high speed round diamond bur

53
Q

when would you need to proceed to a full coronal pulpotomy during a partial pulpotomy procedure

A

if hyperaemic or necrotic pulp after application of saline soaked cotton wool

54
Q

why is MTA placed at apex of canal in open apex pulpectomy

A

to create a barrier at apex/plug

55
Q

why does an extrusive luxation injury heal quicker than an intrusive luxation

A

extrusion - separation injury - limited damage to cells in area of trauma so wound healing can arise with minimal delay

intrusion - crushing injury - extensive damage to cells - damaged tissue must be removed by macrophages and/or osteoclasts before healing can occur

56
Q

true or false - there is greater chance of resorption in a closed apex after trauma

A

true

57
Q

pt presents with a traumatised tooth which appears shorter in crown length. on percussion there is a high ankylotic metallic note. what injury has been sustained

A

intrusion

58
Q

describe an intrusion injury

A

tooth forced into socket in an axial direction

59
Q

critical factors of an avulsion injury that influence prognosis

A

EADT - extra alveolar dry time

extra alveolar time - EAT

storage medium

60
Q

what emergency advice do you give to a pt with an avulsed tooth

A

insure permanent

hold by crown, rinse in milk, saline or saliva if dirty

replant immediately

bite on gauze to hold in place - seek dental help immediately

if can’t replant - store in milk, saliva saline or water

61
Q

tooth with closed apex, what effect does EADT less than 60 mins have on PDL cells

A

might be viable but compromised

62
Q

tooth with closed apex, what effect does EADT > 60 mins have on PDL cells

A

likely non viable

63
Q

how long is an avulsed tooth splinted for

A

2 weeks

64
Q

open apex - EAT less than 60 mins, what is the likely outcome

A

spontaneous healing

65
Q

open apex - EAT >60 min, what is likely outcome

A

PDL cells non viable and likely outcome is ankylosis related root resorption

66
Q

give 3 contraindications of replanting a tooth

A

immunocompromised

there is other injuries requiring emergency treatment

very immature apex and EAT >90 mins or immature lower incisors in young child

67
Q

how would you clinically diagnose a dentoalveolar fracture

A

several teeth move together

palpate for segment moving

68
Q

splint time for dento alveolar fracture

A

4 weeks

69
Q

splint times general rule

A

all 4 weeks except for subluxation, extrusion and avulsion are 2 weeks

70
Q

splint time for subluxation, extrusion and avulsion injuries

A

2 weeks

71
Q

3 properties of a trauma splint

A

passive and flexible
easy of placement and removal
allow OH

72
Q

main post trauma complications

A

pulp necrosis and infection
pulp canal obliteration
root resorption
breakdown of marginal gingiva and bone

73
Q

what is pulp canal obliteration

A

progressive hard tissue formation in canal - narrowing until total or partial obliteration

74
Q

tooth colour associated with pulp canal obliteration

A

opaque yellow

BDS3 CDS (11 decks)

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