Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Fourth year > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

what is the most common injury in the primary dentition

A

luxation injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is the most common injury in the permanent dentition

A

uncomplicated crown fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

When a child presents to you with a traumatic injury, what are the 7 steps you should take in treatment

A
  1. Reassurance
  2. Take detailed history
  3. Examination
  4. Diagnosis
  5. Emergency treatment
  6. Important information for parents
  7. Further treatment and review
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

why is it important to reassure patients

A

trauma may be the reason for the child’s first visit to dentist and can be upsetting for both child and parent. It was not a planned visit.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what questions would you ask when taking a trauma history

A
  1. When did the injury occur - time interval between injury and treatment can significantly influence prognosis of some injuries
  2. Where did the injury occur - this may indicate need for tetanus
  3. How did the injury occur - the nature can yield information on type of injury suspected and discrepancy may raise suspicion of abuse
  4. Are there any other symptoms or injuries - concussion, headache, vomiting, amnesia may require investigation at hospital for brain damage
  5. Are there any lost Fragment/teeth - if cannot be accounted for, a chest radiograph should be obtained
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

when taking a medical history following trauma, what should you pay particular attention to

A
  1. Congenital heart disease - may influence treatment which would be offered if an infection risk must be minimised, liaise with cardiologists
  2. History of rheumatic fever or immunosuppression
  3. Bleeding disorders - haematology team can be contacted
  4. allergies - may need to give antibiotics
  5. Tetanus immunisation status
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

when taking a dental history following trauma, what should you ask

A
  1. Previous trauma - explain baseline clinical and radiographic findings and repeated episodes can raise concerns regarding abuse
  2. Treatment experience - how does child usually cope at dentist
  3. Legal guardian/child attitude to treatment - are they keen/is attending easy for them
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

When carrying out an extra-oral exam following trauma, what should you look for

A
  • lacerations (bruising and swelling as well)
  • haematoma
  • haemorrhage/ CSF
  • subconjunctival haemorrhage
  • bony step deformities
  • mouth opening
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

when carrying out an intra-oral exam following trauma, what should you look for

A
  1. soft tissues - lacerations, haematomas and swelling should be recorded and lacerations examined for tooth fragments/foreign materials
  2. Alveolar bone - assess for evidence of fracture
  3. Occlusion - does patient feel bite is normal
  4. Teeth - charted and any dental injury recorded
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what can tooth mobility indicate

A
  • tooth displacement
  • root fracture
  • alveolar bone fracture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what six things are recorded on a trauma stamp

A
  1. mobility
  2. colour
  3. TTP
  4. Sinus
  5. Percussion note
  6. Radiograph
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what radiographs are used to diagnose a root fracture

A
  • two periapical radiographs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

After a traumatic injury in the initial emergency treatment, what homecare should you recommend to parents

A
  1. analgesia - ibuprofen and/or paracetamol
  2. soft diet for 10-14 days - cut things into small pieces and chew with molars
  3. brush teeth with a soft toothbrush after every meal
  4. topical chlorhexidine gluconate 0.12% mouthrinse twice a day for 1 week
  5. warn regarding signs of infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is a concussion injury

A

Concussion injury to the tooth supporting structures without increased mobility, displacement of tooth or gingival bleeding. There is pain on percussion and sensibility tests may initially be negative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is a subluxation injury

A

subluxation is when a traumatic injury has occurred to the periodontal tissues leading to increased mobility, gingival bleeding but no displacement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is a lateral luxation injury

A

a lateral luxation injury is displacement of a tooth other than axially (palatal, lingual or labial). Displacement is accompanied by communication or fracture of either the labial or palatal/lingual bone. The PDL has suffered both tearing and crushing injuries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what is an intrusion injury

A

an intrusion injury is when the tooth has been driven into the alveolar process due to an axially directed impact. The tooth is usually displaced through the labial bone plate but can impinge on the permanent tooth bud. Crushing injury to PDL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is an extrusion injury

A

an extrusion injury is when the tooth is either partially or completely separation from the PDL resulting in displacement of the tooth out of the socket. This is a tearing injury to the PDL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what is an avulsion injury

A

an avulsion injury is when the tooth is removed completely from the socket. Location of missing tooth should be determined during history and exam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

how would you treat an enamel fracture to the primary dentition

A
  • smooth sharp edges with a soft flex disc
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

how would you treat an enamel-dentine fracture to the primary dentition

A
  • cover exposed dentine with either GI or composite
  • restore lost tooth structure with composite
  • follow up 3-4 weeks

Radiographic findings will detect no abnormalities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

how would you treat a complicated crown fracture to the primary dentition

A
  1. partial pulpotomy - inflamed part of coronal pulp removed and non setting CaOH placed over pulp with a thin layer of GI on top restored with composite
  2. Extract

Follow up
- 1 week clinical
- 6-8 weeks clinical and radiographic
- 1 year clinical and radiographic

Looking for - continuing root development in immature teeth and a hard tissue barrier

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

how would you manage a crown root fracture in the primary dentition

A
  1. remove loose fragment and determine if crown can be restored
  2. if restorable - pulpotomy/ cover exposed dentine with GI
  3. if unrestorable - extract loose fragments

Follow up
- 1 week clinically
- 6-8 weeks clinical and radiographically
- 1 year clinically

Check for signs of apical periodontitis, no continuing root development (these are poor outcomes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

how would you manage a root fracture in primary dentition

A
  1. coronal fragment not displaced - no treatment
  2. coronal fragment displaced but not excessively mobile - leave to spontaneously reposition even if some occlusal interference
  3. coronal fragment displaced and mobile - either extract loose fragment or reposition loose fragment and splint
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

how would you manage a concussion injury in primary dentition

A

no treatment, tooth should be reviewed 1 week and 6-8 weeks clinically

Favourable outcome - continuing root development in immature teeth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

how would you manage a subluxation injury in the primary dentition

A

no treatment - observe and review

Follow up
- 1 week clinical
- 6-8 weeks clinical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

how would you manage a lateral luxation in the primary dentition

A
  • allow to reposition spontaneously
  • if displacement causes occlusal interference, tooth can be gently repositioned by combined labial and palatal pressure under local anaesthetic
  • if displacement is severe, extract (favourable) or reposition and splint for 4 weeks

follow up
- 1 week clinical
- 2-3 weeks clinical
- 6-8 weeks clinical and radiographically
- 1 year clinical and radiographically

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

how would you manage an intrusion injury to the primary dentition

A
  • allow tooth to spontaneously reposition itself if the apex is displaced through labial plate
  • extract if apex displaced into developing tooth germ

follow up
- 1 week clinical
- 2-3 weeks clinical and radiographically
- 6-8 weeks clinical
- 6 months clinical and radiographically
- 1 year clinical and radiographically

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

the apical tip of an intruded tooth can be seen and the tooth appears short compared to contralateral tooth radiographically, what does this mean

A

the apex has displaced towards/through the labial bone plate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

the apex of intruded tooth cannot be visualised and tooth appears elongated compared to contralateral radiographically, what does this mean

A

apex has displaced towards permanent tooth germ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

how would you manage an extrusion injury to the primary dentition

A
  • not interfering with occlusion - spontaneous repositioning
  • excessive mobility or extruded more than 3mm - extract
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

how would you manage avulsion in primary dentition

A
  • radiograph to confirm avulsion
  • do not replant
  • follow up
    1 week clinically
    6 months clinical and radiographically
    1 year and every year until eruption of permanent clinical and radiographically
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

how would you manage an alveolar fracture to the primary dentition

A
  1. reposition segment
  2. stabilize with a flexible splint to adjacent uninjured teeth for 4 weeks
  3. Teeth may need to be extracted after alveolar stability has been achieved
34
Q

what are the sequelae of trauma to the primary tooth

A
  1. discolouration
  2. discolouration and infection
  3. Delayed exfoliation
35
Q

what does a mild grey discolouration indicate

A

intrapulpal bleeding with a pulp which is still vital

36
Q

what does an opaque/yellow colour indicate

A
  • pulp obliteration
  • this is the response of a vital pulp to traumatic injury
  • pulp laying down an increased thickness of dentine for protection
37
Q

what are the consequences of delayed exfoliation following trauma

A
  • cause ectopic eruption of permanent successor
  • delay eruption
  • prevent eruption
38
Q

what does the prognosis of a traumatic injury depend on

A
  1. stage of root development
  2. type of injury
  3. presence of infection
  4. time between injury and treatment
  5. damage to PDL involvement
39
Q

what does the emergency treatment of a traumatised permanent tooth involve

A
  1. retain vitality of fractured or displaced tooth
  2. treat exposed pulp tissue
  3. reduction and immobilisation of displaced teeth
  4. antiseptic mouthwash +/- antibiotics and tetanus prophylaxis
40
Q

what does the intermediate treatment of a traumatised permanent tooth involve

A
  • pulp treatment if required
  • restoration (minimally invasive approach)
41
Q

what does the permanent treatment of a traumatised permanent tooth involve

A
  • apexogenesis/apexification/revascularisation for teeth that have lost vitality
  • root filling + root extrusion
  • gingival and alveolar collar modification
  • coronal restoration
42
Q

how do you manage an enamel fracture to the permanent dentition

A
  1. bond fragment to tooth OR grind sharp edges
  2. Take 2 periapical radiographs to rule out root fracture or luxation
  3. follow up at 6-8 weeks, 6 months and 1 year
43
Q

how do you manage an enamel-dentine fracture to the permanent dentition

A
  1. place composite bandage or bond tooth fragment back on - line if close to pulp
  2. take two periapical radiographs to rule out fracture or luxation
  3. radiograph any lacerations
  4. sensibility test and evaluate tooth maturity
  5. place definitive restoration
  6. follow up at: 6-8 weeks, 6 months and 1 year
44
Q

at follow up appointments what should you check clinically and radiographically

A
  1. clinically - compare trauma stamp to previous trauma stamps
  2. radiographically - check for root development (width and length of canal), comparison with contralateral tooth, internal and external inflammatory resorption and periapical pathology
45
Q

What options for treatment are there following a complicated crown fracture and when would you use

A
  1. pulp cap - exposure <1mm in size and <24 hours old
  2. Partial pulotomy (Cvek) - exposure >24 hours old or >1mm
  3. Full coronal pulpotomy - exposure >48 hours
  4. non vital tooth - pulpectomy
46
Q

what is the aim in managing a complicated root fracture and why

A

aim to keep pulp vitality because immature teeth have short roots with wide apices and thin dentine walls. Loss of pulp vitality before a tooth has reached maturity will leave it vulnerable to fracture with unfavourable crown to root ratio

47
Q

what are the steps to carrying out a direct pulp cap

A
  1. Trauma sticker and radiograph assessment - non TTP and +ve sensibility
  2. Use LA and rubber dam
  3. Clean area with saline and disinfect with sodium hypochlorite
  4. apply calcium hydroxide or MTA to pulp exposure
  5. restore tooth with composite
  6. review 6-8 weeks, 6 months and 1 year
48
Q

what are the steps to carrying out a partial pulpotomy (Cvek pulpotomy)

A
  1. Trauma sticker and radiographic assessment
  2. Use LA and rubber dam
  3. Clean area with saline and disinfect area with sodium hypochlorite
  4. Remove 2-3mm of pulp with hi-speed, round diamond bur
  5. Place saline soaked cotton wool over exposure until haemostasis is achieved - if no bleeding or cannot arrest bleeding proceed to full coronal pulpotomy
  6. Apply CaOH then GI and restore with composite restoration
49
Q

what are the steps to carry out a full coronal pulpotomy

A
  1. begin with partial pulpotomy
  2. assess for haemostasis after application of saline soaked cotton wool
  3. if hyperaemic or necrotic - remove all coronal pulp
  4. place calcium hydroxide in pulp chamber
  5. seal with GIC lining and coronal restoration
50
Q

what is the aim of a pulpotomy

A

to keep vital pulp tissue within the canal to allow normal root growth (apexogenesis) both in length of root and thickness of dentine

51
Q

If a tooth is non vital a full pulpectomy is required. There is no apical stop to allow obturation with gutta percha in immature teeth. What are the options

A
  1. CaOH placed in canal aiming to induce hard tissue barrier to form
  2. MTA (mineral trioxide aggregate) in apex of canal to create a cement barrier
  3. Regenerative endodontic technique to encourage hard tissue formation
52
Q

what are the steps in a pulpectomy

A
  1. LA and rubber dam
  2. Access and diagnostic radiograph for working length
  3. File 2mm short of EWL
  4. Dry canal, place non setting CaOH in pulp chamber
  5. GI temporary cement
  6. Extirpate pulp and place CaOH for no longer than 4-6 weeks after tooth identified as non-vital
  7. Fill apical area with MTA and rest of canal with GP
53
Q

how would you treat a crown-root fracture with no pulp exposure

A
  1. remove fragment only and restore
  2. remove fragment and gingivectomy
  3. orthodontic extrusion to gain access to supragingival margins
  4. surgical extrusion
  5. decoronation - preserve bone for future implant
  6. extraction
54
Q

what would be the clinical findings of a concussion injury to the permanent dentition

A
  • pain on percussion, no mobility, no displacement
55
Q

what is the treatment and followup for a concussion injury to permanent dentition

A
  • no treatment
  • follow up at 4 weeks and 1 year
56
Q

what is the clinical findings of a subluxation injury to the permanent dentition

A
  • increased mobility
  • no displacement
  • tender to percussion
  • bleeding from gingival crevice may be present
  • radiographic appearance is usually normal
57
Q

what is the treatment of a subluxation injury to the permanent dentition

A
  • normally no treatment
  • splint with a passive flexible splint for 2 weeks if excessive mobility
  • ## follow up 2 week, 3 month, 6 month, 1 year
58
Q

what follow up is recommended following a subluxation injury to the permanent dentition

A
  • clinical and radiographic at 2 weeks (splint removal), 12 weeks, 6 months and 1 year
59
Q

What are the clinical findings following an extrusion injury to the permanent dentition

A
  • tooth appears elongated
  • usually displaced palatally
  • tooth is mobile
  • bleeding from gingival sulcus
60
Q

what is the treatment for an extrusion injury to the permanent dentition

A
  • reposition the tooth by gently pushing it back into the socked under local anesthesia
  • stabilize using passive flexible splint for 2 weeks
61
Q

what follow up is recommended following a extrusive luxation injury to the permanent dentition

A
  • 2 weeks clinical and radiographic including splint removal
  • 4 weeks, 8 weeks, 12 weeks, 6 months, 1 year and then annually for 5 years
62
Q

When is pulp canal obliteration common and rare following extrusive injuries

A

common - open apex
rare - closed apex

63
Q

what would the clinical findings be in a lateral luxation injury to the permanent dentition

A
  • tooth appears displaced in socket
  • tooth is locked into surrounding bone
  • high ankylotic percussion tone
  • may be bleeding from gingival sulcus
  • root apex may be palpable in sulcus
  • radiographs show a widened PDL space
64
Q

what is the treatment for a lateral luxation in the permanent dentition

A
  1. Reposition digitally by dig-engaging tooth from locked position and reposition into its original location under LA
  2. splint for 4 weeks using a passive flexible splint
  3. endodontic evaluation at approx 2 weeks post injury
  4. monitor with sensibility tests
65
Q

what is the likely outcome following lateral luxation of a permanent tooth with incomplete root formation

A
  • spontaneous revascularisation may occur
  • if the pulp becomes necrotic and signs of inflammatory external resorption occur endodontic treatment should be commenced
66
Q

what is the likely outcome following lateral luxation of a permanent tooth with complete root formation

A
  • the pulp will likely become necrotic
  • commene endodontic treatment
  • corticosteroid antibiotic or calcium hydroxide as an intra-canal medicament will help prevent development of EIIRR
67
Q

what is the follow up recommended following a lateral luxation injury

A
  • 2 weeks for endodontic evaluation (instigation of endo for any tooth with complete root formation)
  • 4 weeks splint removal
  • 8 weeks, 12 weeks, 6 months, 1 year
  • annually for at least 5 years
68
Q

what are the clinical findings of an intrustion injury to the permanent dentition

A
  • crown appears shortened
  • bleeding from gingivae
  • tooth is immobile
  • ankylotic high, metallic percussion tone
  • radiographically PDL space may not be visible for all or part of root and cemento-enamel junction is located more apically
69
Q

what is the treatment of an intrusion injury to a tooth with immature root

A
  • spontaneous repositioning independent to degree of intrusion
  • if no re-eruption within 4 weeks, orthodontic repositioning is advised
  • monitor pulp condition
  • if pulp becomes necrotic of signs of infection related inflammatory external resorption begin endodontic treatment
70
Q

what is the treatment of an intrusion injury to a tooth with mature root

A

<3mm - allow spontaneous repositioning and if no re-eruption within 8 weeks, reposition surgically and splint for 4 weeks or reposition orthodontically
3-7mm - reposition surgically or orthodontically (LA using forceps)
>7mm - reposition surgically

71
Q

what is the recommended follow up for an intrusion injury

A
  • 2 weeks
  • 4 weeks (including splint removal)
  • 8 weeks, 12 weeks, 6 months and 1 year
  • annually for 5 years
72
Q

how can you monitor re-eruption of the tooth that suffered intrusion

A
  • measure distance between incisal edge of adjacent tooth and intruded tooth
  • study models to monitor eruption of teeth
  • clinical photographs are most useful
73
Q

what are the critical factors determining the outcome of an avulsed tooth

A
  • extra-alveolar dry time
  • extra alveolar time
  • storage medium
74
Q

what emergency advice should you give following an avulsion

A
  1. ensure permanent tooth - avulsed primary should not be replanted
  2. hold by crown
  3. encourage attempt to place tooth immediately into socket - if dirty gently rinse in milk or patients salilva and replant. Do not rub or scrub
  4. bite on gauze/handkerchief to hold in place once replanted
  5. seek immediate dental advice
75
Q

what are potential storage mediums for an avulsed tooth

A
  1. milk
  2. HBSS
  3. saliva
  4. saline
  5. water
76
Q

what is the choice of treatment following avulsion determined by

A
  • maturity of root
  • PDL cell condition - dependent on time out of mouth an storage medium tooth was kept in
77
Q

what is the treatment following avulsion of a tooth with a closed apex which has already been replanted

A
  1. clean injured area with water, saline or chlorhexidine
  2. verify replanted tooth position and apical status - clinical and radiographic. If tooth is malpositioned, correct using digital pressure. If tooth is rotated or wrong socket, replant correctly if under 48 hours
  3. Splint 2 weeks flexible passive
  4. suture gingival lacerations if present
  5. consider antibiotics and check tetanus status
  6. Provide post operative instructions
  7. Follow up
78
Q

what is the treatment following avulsion of a tooth with a closed apex with an EAT of less than 60 minutes

A

there is potential for spontaneous healing

1.remove debris from surface by gently cleaning it in storage medium
2. History and examination with tooth in storage medium
3. replant under LA. Irrigate socket with sterlie saline, examine alveolar socket and remove coagulum. If socket wall fractured, reposition it. Verify correct position both clinically and radiographically
4. Flexible passive splint for 2 weeks
5. suture gingival lacerations if present
6. consider antibiotics and check tetanus status
7. Provide post operative instructions
8. Follow up

79
Q

what is the treatment following avulsion of a tooth with a closed apex with an EAT of more than 60 minutes

A
  1. remove debris or visible contamination
  2. Leave tooth in storage medium whilst taking history and examination
  3. Replant tooth under LA. Examine socket, remove coagulum and reposition any fractures of socket wall. Re-implant slowly with slightly digital pressure. Verify position clinically and radiographically
  4. passive flexible splint for 2 weeks
  5. suture gingival lacerations if present
  6. consider antibiotics and check tetanus status
  7. provide post-operative instructions
  8. Follow up
80
Q

what is the long term prognosis of a permanent tooth with a closed apex that has been avulsed with delayed replantation

A

ankylosis-related replacement root resorption

81
Q

what is the follow up recommendations following avulsion of a permanent tooth with a closed apex

A
  • 2 weeks for splint removal
  • 4 weeks, 12 weeks, 6 months and 1 year
  • annually for at least five years
82
Q

what is the name of the trauma guidelines to follow

A

International association of Dental Traumatology

Fourth year (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions