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ICP > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

Risks for paediatric trauma [6]

A 
Increased overjet
No lip closure
Epilepsy
Poor motor control
Does contact/dangerous sports
History of dental trauma
Obesity
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2
Q

Primary/emergency management of paediatric trauma

A 
Try and reimplant the tooth, or store in saline/milk
Full history
- What happened
- MH
- Other injuries
- Where is the tooth/fragment
E/O and I/O
- Soft tissue injuries
- Occlusion
- TTP, EC, EPT, mobility
- Xrays
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3
Q

Which radiographs are best for paediatric trauma [3]

A

PAs
Upper/lower standard occlusals
OPT

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4
Q

Types of tooth injury (paediatric trauma)

A 
Concussion
Subluxation
Luxation
- Intrusion
- Extrusion
- Lateral luxation
- Avulsion
Enamel infraction
Uncomplicated enamel/dentine fracture
Complicated fracture (involves pulp)
Crown+root fracture
Root fracture
- Coronal third
- Mid third
- Apical third
Alveolar fracture
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5
Q

What is a tooth concussion

A

Injury to tooth-supporting structures but the tooth hasn’t moved

  • Pain and bleeding, sensitivity
  • Monitor in 4 weeks and 1 year
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6
Q

What is a tooth subluxation injury and management

A

Injury/damage to tooth-supporting structures and some tooth mobility but no displacement of the tooth

  • Pain, bleeding, sensitivity
  • Splint for 2-4 weeks
  • Review regularly for 1 year
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7
Q

What is a tooth luxation injury and types

A

The tooth has been displaced

Intrusion

  • Tooth displaced in
  • Severe injury, causing damage to PDL cells and neurovascular bundle

Extrusion

  • Tooth displaced out of the socket a bit
  • Might be mobile
  • Damage to PDL cells

Lateral luxation

  • Tooth displaced buccally or palatally so might not be mobile and have dull percussion
  • Damage to PDL cells and neurovascular bundle
  • Can get locked in bone

Avulsion

  • Tooth falls out
  • Death of PDL cells and neurovascular bundle
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8
Q

Intrusion injury permanent tooth management

A

Tooth displaced in. Need radiographs to see where it is (parallax, SLOB)

If immature apex

  • Allow it to re-erupt for 2 weeks
  • If no movement can use ortho or surgical extrusion
  • Splint for 4-8 weeks (if marginal bone breakdown)
  • Monitor to check pulp vitality. RCT + apical plug if pulp dies.

If mature apex

  • <3mm intrusion, allow to re-erupt
  • Ortho if this doesn’t work after 4 weeks
  • > 7mm, surgically/ortho extrusion and RCT
  • Splint for 4-8 weeks

Monitor and review regularly for 5 years

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9
Q

Extrusion injury permanent tooth management

A

Reposition and splint for 2-6 weeks (if marginal bone breakdown)
Monitor for 5 years and check pulp vitality

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10
Q

Lateral luxation injury and Permanent tooth management

A

Reposition and disengage from the bony lock
Splint for 4-8 weeks (if marginal bone breakdown)
Regular monitoring for 5 years to check pulp status
- If mature apex, it will likely lose vitality so do RCT

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11
Q

Avulsion injury - prognosis and patient instructions

A

Reimplant as soon as possible

  • If <15 mins, good prognosis
  • If exposed for <60 mins, guarded prognosis
  • If exposed for >60 mins, poor prognosis
  • PDL cells will have died

Hold the tooth by the crown, wash and store in milk/saline/reimplant and bite down.

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12
Q

Prognosis of dental trauma depends on ? [4]

A

Age of patient
Stage of tooth development
Type of injury
Any other injuries to the tooth

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13
Q

Types of pulp healing/responses after trauma [3]

A
  1. Complete healing - vital pulp
  2. Secondary dentine and pulp sclerosis/obliteration and loss of vitality
  3. Pulp necrosis, infection +/- inflammatory resorption
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14
Q

Types of tooth resorption

A

Internal resorption

  • Will continue until the tooth is non-vital
  • Starts from the pulp canal

External cervical resorption

  • PDL cells are dead so inflammatory cells come to remove them and continue removing the tooth.
  • Necrotic pulp so will continue until all the pulp/bacteria has been removed.

External replacement resorption

  • Oc get activated by trauma and are in contact with the root surface bc dead PDL cells so remodelling the root into bone
  • Will continue until all root is replaced, then the crown falls off
  • Happens quicker in chidlren
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15
Q

General treatment after paediatric trauma

A 
Xrays and images
Reposition tooth
Splint
Regular monitoring
\+/- RCT
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16
Q

Advantages of replanting avulsed teeth

A

Aesthetics
Avoid restorative work for a while
Psychological benefit
Preserve bone levels and gingival levels

17
Q

Disadvantages of replanting avulsed teeth

A

Lots of monitoring and appointments
The tooth will need extraction eventually
Infraoccluded/external resorption = loss of verticle height and gingival contour
Risk of tooth necrosis, pain, infection
Discolouration

18
Q

Contraindications of replanting avulsed teeth

A

Immunocompromised or severe heart condition
If have supernumerary teeth or severe anterior crowding
Can’t commit to multiple appointments e.g. learning disability

19
Q

How to replant avulsed teeth (steps)

A

Xrays and emergency management
Gently clean tooth (handle from the crown) and keep in saline
- Measure root for future RCT
Analgesia/numb socket
Irrigate socket and remove debris e.g. any bone, blood clot
Insert the tooth into the socket but don’t force it in bc will shred PDL cells
Splint
Review
POIG
Antibiotics if worried about infection
- Amoxicillin or doxycycline (if older than 12)

20
Q

Splinting after dental trauma (steps and types of splints)

A

Direct splints

  • More hygienic
  • Flexible so allow tooth and PDL to move like normal
  • NiTi, orthodontic wires,
  • Can composite bond or use ortho brackets

Indirect

  • Would need to take imp
  • Tooth can’t move, less hygienic, not fixed
21
Q

Enamel infraction and permanent tooth management

A

Seal
Fluoride varnish
- Can use transillumination to diagnose

22
Q

Uncomplicated enamel/dentine fracture and permanent tooth management

A

Xray
Restore bc exposed dentine will be sensitive and can get caries
- GIC, composite, crown
Review

23
Q

Complicated tooth fracture and permanent tooth management

A 
Xray
Pulp cap if small exposure (<0.5mm, <24h) - use MTA, Biodentine, non-setting CaOH
Or partial pulpotomy (remove the infected pulp, until no more bleeding/control the bleeding using pledgets)
Or complete pulpectomy (RCT)
- if bleeding doesn't stop
- mature apex
- symptoms
- prolonged exposure/large exposure 
Restore (Crown, composite, temporary)
Review
24
Q

Crown and root fracture and permanent tooth management

A

Complicated - Crown lengthening procedure or ortho extrusion and restore

25
Q

Root fractures and permanent tooth management

A

Xrays to see where the fracture is (Parallax/SLOB)
Need hard tissue healing between the 2 segments
- Bone and CT, CT, or granulation tissue (a sign of inflammation)

Apical third
- Apical fragment can be left usually
- RCT coronal third if it loses vitality
- Splint if mobile or displaced
Middle third
Coronal third
- Poorer prognosis
- Splint for 4 weeks

Verticle fractures vs horizontal fractures

26
Q

Alveolar fractures and management

A 
Plain film Xrays
Fractured section of alveolar bone 
- multiple teeth moving together
- Soft tissue/gingival lacerations
Reposition and splint for 4 weeks
27
Q

Sequelae of trauma to immature permanent teeth and management

A

Can get pulp necrosis - inflammation and PAP or inflammatory resorption or ankylosis
Open apex, a large pulp and thin dentine walls

RCT will need an apical plug

  • MTA/Biodentine = quicker, effective
  • apexification using non-setting CaOH plugs replaced every few weeks for months - takes ages, dehydrates the dentine and can cause #

Remove pulp and use irrigants only (no mechanical prep)

28
Q

Infraoccluded incisors and management

A

External replacement resorption
Oc remodel the root into bone after PDL cell death

Incisors can look submerged if it happens before complete tooth formation = aesthetic concerns, loss of verticle height and gingival contour

Tx = Extract, coronal build-up, crown, orthodontic or surgical extrusion, decoronation

29
Q

Indications for tooth auto transplantation

A

Ectopic teeth
Supernumerary teeth and gaps/hypodontia
Avulsed teeth
- Ideally multirooted teeth with open apices

30
Q

Complications with dental trauma to primary teeth

A

Larger pulp, open apex, not fully erupted, will affect permanent successor.
If mobile then causes risk of inhalation so XLA if worried

31
Q

Uncomplicated fractures or enamel infractions in primary teeth (management)

A

OHE, diet advice, analgesia

Smooth or cover

32
Q

Crown/root fractures in primary teeth

A

OHE, diet advice, analgesia
Uncommon bc root would have to be not resorbed so the patient would need to be young
XLA and maintain space
or leave coronal segment/splint if not causing problems

33
Q

Management of complicated tooth fractures in primary teeth (pulp)

A

OHE, diet advice, analgesia
XLA and maintain space
Or pulp management (pulp cap, pulpotomy, RCT)

34
Q

Management of concussion and subluxation injuries in primary teeth

A

OHE, diet advice, analgesia
Splint if mobile
Reassurance

35
Q

Management of intrusion injuries in primary teeth

A

Xray to see where it is
If not affecting permanent tooth germ - allow to re-erupt for 2-4 months
If affecting permanent tooth germ, XLA and maintain space
Mobile teeth = risk of inhalation

36
Q

Management of lateral luxation injuries to primary teeth

A

If buccally displaced, more likely to be affecting permanent tooth germ (root displaced palatally)
Reposition and splint
Or XLA and maintain space
Mobile teeth = risk of inhalation

37
Q

Sequalae of trauma primary teeth

- primary teeth and permanent teeth

A

Primary teeth

  • Discolouration
  • Pulp necrosis, infection, abscess, pain
  • Loss of tooth
  • Pain
  • Delayed exfoliation
  • Infraoccluded

Permanent teeth

  • Delayed or no eruption
  • Displaced (Impacted or ectopic)
  • Rotated
  • Discoloured - opacities or brown, irregularities
  • Hypomineralisation, hypoplastic
  • Altered or stopped tooth development

ICP (7 decks)

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