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BDS3 CDS > Paediatrics: Trauma > Flashcards

Paediatrics: Trauma Flashcards

1
Q

What is the epidemiology of primary tooth trauma?

A

prevalence: 16-40%
peak incidence: 2-4 years
Maxillary primary incisor teeth
Male>Female

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2
Q

What is the aetiology of primary tooth trauma?

A
  • falling
  • bumping into objects
  • non-accidental
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3
Q

Name the 5 classifications of injury’s to the Dental hard tissues and pulp?

A
  1. Enamel fracture (uncomplicated)
  2. enamel dentine fracture (uncomplicated)
  3. Enamel dentine and pulp fracture (complicated)
  4. Crown root fracture
  5. root fracture
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4
Q

Name the 5 classifications of injury’s to the supporting tooth tissues?

A
  • concussion
  • subluxation
  • lateral luxation
  • intrusion
  • extrusion
  • Avulsion
  • alveolar bone fracture
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5
Q

What parts of the tooth are involved in a crown-root fracture?

A
  • enamel, dentine and root
  • pulp may or may not be involved (complicated or uncomplicated)
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6
Q

Describe a concussion injury?

A
  • PDL injury, tooth tender to touch but has not been displaced
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7
Q

Describe a subluxation injury?

A
  • tooth tender to touch and has increased mobility but has not been displaced (bleeding from the gingival crevice may be noted)
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8
Q

Describe a lateral luxation injury?

A
  • tooth has been displaced usually in a palatal or labial directions
  • commission or fracture of the alveolar bone
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9
Q

Describe a intrusion injury?

A
  • tooth usually displace through the labial bone plate or it can impinge on the permanent tooth bud
  • commission or fracture of the alveolar socket
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10
Q

Describe an extrusion injury?

A

partial displacement of a tooth out its socket

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11
Q

Describe an avulsion injury?

A

tooth is completely out its socket

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12
Q

Describe an alveolar bone fracture injury?

A
  • fracture involves the alveolar bone ( labial and palatal/lingual) and may extend to the adjacent bone
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13
Q

What is the most common injury in the primary dentition?

A

luxation (62-69%)

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14
Q

What are the 7 steps in the management of Dental trauma?

A
  1. Reassurance
  2. History
  3. Examination
  4. Diagnosis
  5. Emergency Treatment
  6. Important information
  7. Further Treatment and Review
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15
Q

When Obtaining a history for a trauma patient what information do you want to know?

A
  1. Injury history
    - where, when, how, lost teeth fragments, other symptoms or injuries
  2. Medical History
    - allergies, tetanus immunisation, bleeding disorders, medications, underlying health conditions
  3. Dental History
    - previous trauma, treatment experience, legal guardian/child relationship
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16
Q

What sort of things would you be looking for in a extra oral examination for a dental trauma patient?

A

Lacerations
Haematoma
Haemorrhage / CSF
Subconjunctival haemorrhage
Bony step deformities
Mouth opening

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17
Q

What would you be looking for in a intra-oral examination in a dental trauma patient?

A
  1. soft tissue damage: penetrating wounds/ foreign bodies
  2. Tooth mobility: may indicate tooth displacement or bone fracture
  3. transillumination: may show fracture lines in teeth, pulpal degeneration or caries
  4. Tactile test with probe: may help detect horizontal/vertical fractures and pulpal involvement
  5. Percussion: duller not may indicate root fracture
  6. Occlusion: traumatic occlusion needs urgent treatment
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18
Q

What investigation does a trauma stamp include?

A

-Mobility
- colour
- TTP
- sinus
- percussion note
- radiograph

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19
Q

During dental trauma of a primary tooth what is usually the most suitable emergency treatment?

A

observation

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20
Q

What important information do you need to provide the parent or care giver of the child after a dental trauma?

A
  • care for the injured tooth to optimise heeling and prevent further damage
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21
Q

What homecare instructions would you give the parent or care giver for looking after a child’s injured tooth?

A
  • Analgesia (paracetamol/ibuprofen)
  • Soft diet for 10-14days( can be normal diet but food cut very small)
  • brush teeth with soft toothbrush after every meal
  • apply topical chlorohexidine gluconate ) 0.12% mouth rinse twice a day for 1 week
  • warn about signs of infection
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22
Q

What would be the reconstructive treatment for an uncomplicated enamel fracture?

A

Smooth sharp edges with a soft flex disk

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23
Q

What would be the treatment for an uncomplicated enamel dentine fracture?

A
  • cover all exposed dentine with glass ionomer or composite
  • can be restored immediately with composite or at a later visit
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24
Q

How would you treat a complicated crown fracture (enamel dentine and pulp)?

A

Either:
1. partial pulpotomy
2. Extract
Depends of co-operation of the child and discussion with parent

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25
Q

How would you do a partial pulpotomy?

A
  • LA
  • remove pulp tissue
  • arrest bleeding with ferric sulphate
  • non-setting calcium hydroxide paste placed over pulp
  • thin layer of GI cement on top
  • tooth restored with composite
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26
Q

What are the treatment options for a crown-root fracture?

A
  • Remove the loose fragment and determine if crown can be restored

If restorable:
No pulp exposed: cover exposed dentine with glass ionomer
Pulp exposed: pulpotomy or endodontic treatment

If unrestorable:
Extract loose fragments
! Don’t dig!

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27
Q

How would you treat a root fracture?

A

Coronal fragment not displaced
- No treatment
Coronal fragment displaced but not excessively mobile
- Leave coronal fragment to spontaneously reposition even if some occlusal interference
Coronal fragment displaced, excessively mobile and interfering with occlusion:
Option A: Extract only the loose coronal fragment
Option B: Reposition the loose coronal fragment +/- splint

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28
Q

How would you treat a concussion injury?

A
  • No Treatment
  • observation
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29
Q

How would you treat a subluxation injury?

A
  • No treatment
  • observation
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30
Q

How would you treat a lateral luxation injury?

A

if minimal with no occlusal interference
- allow to spontaneously reposition
Severe displacement:
1. Extraction
2. Reposition +/- a splint

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31
Q

How would you treat an intrusion injury?

A
  • allow tooth to spontaneously reposition
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32
Q

How long can it take for a tooth that’s suffered an intrusion injury to reposition?

A

6months-1year

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33
Q

What radiographs are best for determining direction of movement in an intruded tooth?

A

periapical or lateral premaxilla (extra oral film)

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34
Q

Why is it important to determine the direction the intruded tooth has moved?

A

helps to assess danger to the permanent tooth germ and allows better counselling regarding prognosis

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35
Q

How would you treat and extruded tooth?

A

Not interfering with occlusion
- Spontaneous repositioning

Excessive mobility or extruded >3mm
- Extract

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36
Q

How would you treat an avulsed tooth?

A

radiograph to confirm avulsion
- do not re-implant

37
Q

How would you treat an alveolar bone fracture?

A

Reposition segment

Stabilize with a flexible splint to the adjacent uninjured teeth for 4 weeks

Teeth may need to be extracted after alveolar stability has been achieved

38
Q

What can occur to the primary tooth after dental trauma?

A
  1. Discolouration
  2. Discolouration and infection
  3. Delayed exfoliation
39
Q

Why can a primary tooth start to appear more yellow and opaque after a dental trauma?

A

pulpal obliteration: pulp lays down more layers of dentine to try protect itself and this causes the discolouration

40
Q

If a primary tooth starts to discolour (grey or yellow) after a dental trauma but is asymptomatic how would you treat it?

A
  • if there is no signs of pulpal necrosis or infection no treatment is required
  • review
41
Q

If a primary tooth starts to show signs of discolouration and infection after under going a dental trauma how would you treat this?

A

Extract or endodontic treatment

42
Q

A primary tooth that has under gone a trauma may have delayed exfoliation. What are the consequences of this?

A
  • ectopic eruption of permanent successor
  • delayed eruption…
  • prevent eruption…
    This can have effects on occlusion and aesthetics of the permanent dentition
43
Q

What type of supporting tissue trauma injury is most likely to damage the permanent successor?

A

intrusion injuries

44
Q

At what age is there the greatest risk of trauma to a primary tooth causing damage to the permanent successor?

A

0-2years (63%)

45
Q

What is the most frequent injury/anomaly to occur to the permanent successor following trauma to the primary tooth?

A

enamel defect (44%)

46
Q

Name two enamel defects?

A

enamel hypoplasia
enamel hypo mineralisation

47
Q

What is enamel hypo mineralisation?

A
  • qualitive defect of enamel where the enamel is normal thickness but poorly mineralised
  • tooth is more white/yellow in colour
48
Q

How can you treat hypomineralised teeth?

A
  • no treatment
  • composite masking
  • tooth whitening
49
Q

What is enamel hypoplasia?

A
  • quantitative defect
  • reduced thickness of enamel but normal mineralisation
  • yellow/ brown colour
50
Q

What is the treatment for enamel hypoplasia?

A
  • no treatment
  • composite masking
51
Q

Name two abnormal crown/root morphology defects that can be caused due to trauma to the primary tooth?

A
  • Dilaceration
  • crown-root dilaceration
52
Q

What is dilaceration?

A

Abrupt deviation of the long axis of the crown or root portion of the tooth

53
Q

What is the treatment for a crown dilaceration?

A
  • surgical exposure and orthodontic alignment
  • improve aesthetics restoratively
54
Q

What is the treatment for a root dilaceration/ angulation/duplication?

A
  • combined surgical and orthodontic approach
55
Q

Why can premature loss of a primary tooth cause delayed eruption of the permanent successor?

A

thickened mucosa

56
Q

What would you do if there was >6month delay in the eruption of the contralateral tooth?

A
  • radiograph
  • surgical exposure and orthodontic alignment
57
Q

How would you treat an ectopic unerupted tooth position?

A

surgical exposure and orthodontic alignment

58
Q

How would you treat a tooth that had arrested development?

A
  • endodontic treatment if sufficient root development
  • extraction if severe under development
59
Q

How would you treat a tooth germ that has failed to develop into a tooth?

A
  • it may sequestrate spontaneously
  • or require removal
60
Q

How would you treat an odontome?

A
  • removal
61
Q

What is the most common injury in the permanent dentition?

A

Crown fractures (enamel/dentine)

62
Q

What age is the peak period for dental trauma to the permanent teeth?

A

7-10 years

63
Q

What can greatly increase the chance of trauma to the permanent dentition?

A

large OJ >9mm

64
Q

What medical health conditions do you want to take special care for when treating a dental trauma patient?

A
  • congenital heart defects
  • immunosuppression
  • rheumatic fever
65
Q

What tests are on a trauma stamp for trauma to permanent teeth that you would carry out when doing an intra-oral exam?

A
  • mobility
  • colour
  • TTP
  • EPT
  • ECT
  • percussion note
  • occlusion
  • Radiographs
66
Q

What 3 things is mobility to a traumatised tooth an indication of?

A
  • displacement of tooth
  • root fracture
  • bone fracture
67
Q

How would you carry out a sensibility test?

A
  • compare injured tooth with adjacent non -injured tooth
  • test with ethyl chloride/gutta percha and EPT and note response
  • continue to do sensibility tests for 2 years after the injury
68
Q

What are the aims and principles of emergency treatment to a traumatised tooth?

A
  • maintain tooth vitality by protecting exposed dentine
  • treat exposed pulp tissue
  • reduction and immobilisation of displaced teeth
  • tetanus prophylaxis
69
Q

What are the aims and principles of immediate treatment to a permanent traumatised tooth?

A
  • +/- pulp treatment
  • restoration
70
Q

What are the aims and principles of permanent treatment to the traumatised tooth?

A

Apexigenesis
Apexification
Root filling +/- root extrusion
Gingival and alveolar collar modification if required
Coronal restoration

71
Q

How would you manage an enamel fracture in a permanent tooth?

A
  • either bond fragment to tooth or smooth sharp edges
  • take 2 periapical radiographs to rule out root fracture or luxation
  • follow up appointment at 6-8weeks, 6months and 1 year
72
Q

What is the prognosis of an enamel fracture?

A

0% risk of pulpal necrosis

73
Q

How would you manage an enamel dentine fracture?

A
  • either bond fragment to tooth or place a composite bandage (use liner if close to pulp)
  • take 2 periapical radiographs to rule out root fracture
  • radiograph any laceration to rule out embedded fragment
  • sensibility test and evaluate tooth maturity
  • definitive restoration
  • follow up at 6-8weeks, 6months and a year
74
Q

What is the prognosis of a enamel dentine fracture?

A

5% risk of pulpal necrosis in 10years

75
Q

What would you do at a review appointment for a post dental trauma patient?

A
  • use trauma sticker for clinical review

Radiographs to check for:
- root development (canal width and length)
- comparison with other side
- internal and external inflammatory resorption
- periapical pathology

76
Q

What are the 3 treatment options for a enamel-dentine-pulp fracture?

A
  • pulp cap
  • pulpotomy
  • pulpectomy
77
Q

What factors help decide how to treat an exposed pulp in a traumatised tooth?

A
  • size of pulp exposure
  • time since injury
  • Associated PDL injuries
78
Q

When would a direct pulp cap be a suitable option in a traumatic pulp exposure?

A
  • tiny pulp exposure (1mm)
  • less than 24hrs since exposure
  • should be non TTP and positive to sensibility testing
79
Q

How would you do a direct pulp cap?

A
  • LA and rubber dam
  • clean area with water and disinfect with sodium hypochlorite
  • apply calcium hydroxide (dycal) or MTA to pulp exposure
    -restore tooth with composite restoration
  • review 6-8 weeks, 6 months and a year
80
Q

What are the dental indications that a partial pulpotomy (Cvek) would be the most suitable treatment for a traumatic pulp exposure?

A
  • larger exposure (>1mm)
  • > 24hrs since injury
  • positive to sensibility tests and non TtP
81
Q

How would you carry out a partial pulpotomy?

A
  • LA and dental dam
  • Clean with saline and disinfect with sodium hypochlorite
  • remove 2mm of pulp with high speed diamond bur
  • place saline soaked cotton pellet over exposure until haemostasis achieved
  • apply CaOH then GI then restore with composite
  • if homeostasis not achieved continue with full pulpotomy
82
Q

When would you carry out a full pulpotomy after a pulp exposure?

A
  • if pulp is hyperaemic or necrotic
83
Q

What is the success rate of a partial pulpotomy (cvek)?

A

97% success

84
Q

what is the success rate of a full pulpotomy?

A

75%

85
Q

What is the aim of a partial pulpotomy?

A
  • to keep tooth vital to allow normal root growth (apexogenesis) both in the length of the root and the thickness of dentine
86
Q

what is the clinical problem in performing a pulpotomy if a tooth is non-vital but has open apices?

A
  • no apical stop to allow obturation with GP
87
Q

what are the options when carrying out a pulpotomy in a tooth with open apices?

A
  • CaOH placed in the canal aiming to induce a hard tissue barrier to form (apexification)
    -or MTA/BioDentine placed at apex of canal to create cement barrier
  • Or Regenerative Endodontic Technique to encourage hard tissue formation at apex
88
Q

Describe how you would carry out a pulpotomy in a tooth with open apices?

A

CaOH apexification
- Rubber dam
- drill Access
- Haemorrhage control - LA / sterile water
- Diagnostic radiograph for WL
- File 2mm short of estimated WL
- Dry canal, Non-setting Ca(OH)2 , CW in pulp - chamber
- Glass-ionomer temporary cement in access cavity and evaluate calcium hydroxide fill level with radiograph
- Extipate pulp and place CaOH for no longer than 4-6 weeks after identified as non-vital
- use MTA plug and hot gutta percha for obturation if apexogenesis fails

89
Q

What are the 6 treatment options for a crown-root fracture with no pulp exposure?

A
  • extraction
  • fragment removal only
  • fragment removal and gingivectomy
  • decornation
  • orthodontic extrusion of apical portion
  • surgical extrusion

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