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BDS4 > PAEDS PERMANENT TRAUMA > Flashcards

PAEDS PERMANENT TRAUMA Flashcards

1
Q

What feature of the occlusion doubles the incidence of dental trauma?

A

Overjet more than 9mm

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2
Q

What radiograph would you take to check for soft tissue laceration after a dental trauma?

A

Soft tissue radiograph

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3
Q

What might tooth mobility indicate post trauma?

A
  • Displacement of tooth
  • Root fracture
  • Bone fracture
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4
Q

What does a trauma sticker have for examining a permanent tooth trauma

A
  • Colour
  • Sinus
  • TTP
  • EPT
  • ECT
  • P.note
  • Mobility
  • Radiograph
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5
Q

When there is a trauma to one tooth , what other teeth would you examine ?

A

Adjacent and opposing ones

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6
Q

How long should you continue sensibility testing after a dental trauma in a permanent tooth?

A

2 years

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7
Q

What 5 factors determine the prognosis following a dental trauma?

A
  • Stage of root development
  • Type of injury
  • Presence of infection
  • Time between injury and treatment
  • Damage to PDL
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8
Q

3 aims of emergency treatment of trauma?

A
  • retain vitality
  • treat exposed pulp
  • reduction of immobilisation
  • tetanus prophylaxis
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9
Q

the aim of intermediate treatment of trauma?

A
  • Restoration
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10
Q

the aims of permanent treatment of trauma?

A
  • Apexigenesis
  • Apexification
  • root filling
  • gingival and alveolar collar modifications
  • coronal restoration
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11
Q

2 treatment options for enamel fractures?

A
  • Bond fragment to tooth
  • Smooth sharp edges
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12
Q

When would you follow up an enamel fracture?

A

6-8 weeks
6 months
1 year

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13
Q

Why would you take 2 PA radiographs for enamel fracture?

A

To rule out root fracture or luxation

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14
Q

Treatment options for enamel dentine fracture?

A
  • Bond fragment
  • Place composite bandage (line if close to pulp)
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15
Q

Prognosis of enamel fracture and enamel dentine fractures? and what would be the risk?

A
  • 0%
  • 5%
  • Risk of pulp necrosis
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16
Q

You follow up an enamel dentine fracture after treatment , you take radiographs and carry out a trauma sticker , what 4 things would you look for on the radiograph?

A
  • root development - width of canal and length
  • compare tooth with contralateral
  • check for internal or external inflammatory resorption
  • check for periapical pathology
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17
Q

A child presents with enamel-dentine-pulp fracture , how would you evaluate the exposure?

A
  • Size of pulp exposure
  • Time since injury
  • Associated PDL injuries
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18
Q

3 treatment options for managing enamel-dentine-pulp fractures?

A
  • Pulp Cap
  • Partial pulpotomy
  • Full coronal pulpotomy
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19
Q

What two materials you can use for Pulpotomy?

A
  • MTA
  • Calcium hydroxide
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20
Q

When would you render for full extirpation?

A

When the tooth is clearly non-vital

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21
Q

When would you choose a direct pulp cap for complicated crown fractures?

A
  • when there is a tiny exposure (1mm)
  • time between treatment and trauma is less than 24mm
  • Vital tooth - no TTP and positive to sensibility testing
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22
Q

Describe in 4 points how you would carry a direct pulp cap?

A
  • LA and rubber dam
  • Clean area with water then disinfect with NaOCl
  • Apply CaOH or MTA white to pulp exposure
  • Restore with composite
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23
Q

When would you carry out a partial pulpotomy for an enamel-dentine-pulp fracture?

A
  • Exposure more than 1mm
  • more than 24 hours since trauma
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24
Q

in 4 steps explain how you would carry out a partial pulpotomy?

A
  • La and dental dam
  • Clean area with saline then disinfect with NaOCl
  • Remove 2mm of pulp using high speed
  • Place saline soaked CW over exposure until heamostasis achieved
  • Apply CoOh and restore with composite
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25
Q

When would you proceed to a full pulpotomy when carrying out a partial pulpotomy?

A
  • If no bleeding or cannot arrest bleeding
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26
Q

What is the success rate of a partial pulpotomy and a full coronal pulpotomy?

A

Partial 97%
Full 75%

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27
Q

If the tooth is not vital , what is the treatment option?

A

Full pulpectomy

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28
Q

What problem would encounter during pulpectomy of immature incisors?

A
  • no apical stop to allow obturation with GP
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29
Q

3 treatment options to caary out a pulpectomy of immature incisors?

A
  • CoOH placed in canal to induce apexification
  • MTA or biodentine placed at apex of canal to create cement barrier
  • Regenerative endodontics to encourage hard tissue formation
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30
Q

Explain how you would carry out a pulpectomy?

A
  • Rubber dam and access using high speed
  • haemorrhage control using LA or water
  • Take diagnostic radiograph for WL
  • Prepare canal 2mm short of estimated working length
  • Dry canal and apply non setting calcium hydroxide and place CW in pulp chamber
  • GI cement and evaluate CaOh using radiograph
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31
Q

How long would place CoOH in the canal?

A

4-6 weeks after identified non vital

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32
Q

After apexification induced by CoOH , how woud you obturate?

A

Using MTA plug and heated GP obturation

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33
Q

Permanent crown root fracture treatment options?

A
  • XLA
  • Remove fragement and restore
  • Remove fragment and gingivectomy
  • Orthodontic extrusion of apical portion
  • Decoronisation
  • Surgical extrusion
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34
Q

When would be the 3 steps in orthodontic extrusion of apical portion by endodontics for the management of crown root fractures?

A
  • Endo
  • Extrusion
  • Post-Crown
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35
Q

When would fragment removal and gingivectomy be indicated for crown-root fractures?

A
  • When there is a palatal subgingival extension
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36
Q

Why would you decoronate a tooth with crown root fracture?

A

To preserve bone for a future implant

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37
Q

Two types of trauma related to its nature that you should take into consideration?

A

Separation injury
Crushing injury

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38
Q

TTP for concussion?

A

no pain on percussion may still be TTP, no treatment required

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39
Q

when would you follow up a percussion?

A

4 weeks then 1 year

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40
Q

3 clinical findings for a subluxation injury?

A
  • TTP
  • Increased mobility
  • Bleeding from gingival cervice
41
Q

Treatment of subluxation?

A

No treatment , splint if excessive mobility

42
Q

When would you review subluxation?

A

2 to remove splint
3 months
6 months
1 year

43
Q

What is this?

A

Extrusion

44
Q

4 clinical findings of extrusion injuries?

A
  • Tooth appears elongated
  • Increased mobility
  • Bleeding
  • Usually displaced palatally
45
Q

Tx for extrusion?

A
  • Reposition under LA and splint
46
Q

When would you follow up extrusion?

A
  • 2 weeks
  • 4 weeks
  • 8 weeks
  • 3 months
  • 6 months
  • 1 year
  • then annually 5 years
47
Q

What is lateral luxation injury?

A

Displacement of the tooth in a socket in a direction other than axially , accompanied by comminution or fracture of the alveolar bone plate

48
Q

Give 5 clinical findings of lateral luxation?

A
  • Tooth appears displaced in socket
  • No mobility
  • High ankylotic percussion note
  • Gingival bleeding
  • Root apex may be palpable in sulcus
49
Q

What is the treatment of lateral luxation?

A
  • Reposition under LA
  • Splint
  • Monitor in 2 weeks for endo evaluation
50
Q

When would you commence endo treatment for lateral luxation?

A
  • when pulp becomes necrotic
51
Q

Explain how incomplete root formation and complete root formation differ in managing lateral luxation?

A
  • If incomplete may have a chance of revascularisation meaning pulp necrosis may not happen
  • If complete , pulp necrosis will happen and will need endodontic treatment
52
Q

When would you follow up lateral luxation ?

A
  • 2 weeks - endo evaluation
  • 4 weeks - splint removal
  • 8 weeks
  • 3 months
  • 6 months
  • 1 year
    every year for 5 years
53
Q

Define intrusion?

A

Tooth forced into socket and locked into bone

54
Q

3 clinical findings of intrusion?

A
  • Crown appears shortened
  • Bleeding from gingivae
  • high metallic note (ankylotic)
55
Q

How to manage intrusion in immature root formation?

A
  • Allow to spontaneous repositioning
  • if no eruption within 4 weeks ; ortho repositioning
  • If pulp becomes necrotic - endo treatment
56
Q

How would you manage less than 3mm intrusion for mature root formation?

A
  • allow for spontaneous repositioning
  • if no re-eruption within 8 weeks surgical repositioning and splint for 4 weeks
  • Or reposition orthodontically before ankylosis
57
Q

How would you manage 3-7mm intrusion for mature root formation?

A

Reposition surgically or orthodontically

58
Q

How would you manage more than 7mm intrusion for mature root formation?

A

reposition surgically

59
Q

What is the aim of endo treatment in intrusion injuries in mature root formation?

A

prevent external root resorption as pulp always becomes necrotic

60
Q

When would you follow up an intrusion injury?

A
  • 2 w - endo
  • 4 w - splint removal
  • 8 w
  • 3 months
  • 6 months
  • 1 year
61
Q

What three factors are important for prognosis of avulsed tooth?

A
  • Extra-alveolar dry time
  • Extra-alveolar time
  • Storage medium
62
Q

Child avulsed tooth , mom calls , what immediate advice would you give mom to do?

A
  • Ensure it is a permanent tooth
  • Hold by crown
  • tell mom to replant immediately, if tooth is dirty rinse in milk, saline or saliva
  • tell to bite on gauze to secure
  • Seek immediate dental advice
63
Q

If immediate replant not possible , in what storage medium will you tell the mom to place the tooth into? in order give 5

A

Milk
HBSS
Saliva
Saline
Water

64
Q

2 management factors of avulsion?

A
  • Maturity of root
  • PDL cell condition
65
Q

Management of replanted avulsed tooth with closed apex ?

A
  • Clean injured area
  • radiographic and clinical assessment of apex and tooth position
  • Splint
  • Suture gingival lacerations if present
  • Consider Abs
  • Provide post-op advice
66
Q

What does EADT less than 60 mins indicate?

A

PDL cells may be viable but compromised

67
Q

Management of EADT less than 60 mins avulsed tooth with closed apex ?

A
  • Replant under LA and splint
  • Suture laceration and consider ABs
68
Q

What does EADT > 60 mins?

A

PDL cells likely to be non-viable

69
Q

When would you commence endodontic treatment for an avulsed tooth with closed apex? and what intracanal medicament would you place?

A

at 2 weeks , CaOH for 1 month or antibiotic paste for 6 weeks

70
Q

What complications can occur in delayed replantation of closed apex tooth?

A

Ankylosis

71
Q

When would you followup a closed apex avulsed tooth?

A
  • 2 weeks
  • 4 weeks
  • 3 months
  • 6 months
  • 1 year
72
Q

How to manage avulsed tooth with open apex ?

A
  • same as closed apex but use EAT instead of EADT
  • Vascularisation may occur meaning endo treatment may not be required
73
Q

When would replantation not be indicated? (4)

A
  • child immunocompromised
  • other serious injuries
  • Very immature apex and extended EAT
  • very immature lower incisors and uncooperative
74
Q

What is the difference between EAT and EADT?

A

while EAT measures the total time a tooth is out of its socket, EADT specifically measures the time it has been out and not kept moist. Both are important for the prognosis of avulsed teeth, with shorter times being more favorable for successful reimplantation and healing.

75
Q

What are dentoalveolar fractures?

A

Fracture of the alveolar bone which may or may not involve the alveolar socket

76
Q

4 clinical findings of dento-alveolar fracture?

A
  • complete alveolar fracture from buccal to palatal bone in maxilla or buccal to lingual bony surface in mandible
  • Several teeth moving together
  • Occlusal derrangement
  • Gingival lacerations
77
Q

Management of dentoalveolar fractures?

A
  • Reposition any displaced segment
  • Stabilise by splinting
  • Suture gingival lacerations if present
  • Monitor the pulp condition of all teeth involved
78
Q

4 characteristics of a splint?

A
  • Flexible and passive
  • Ease of placement and removal
  • Facilitate clinical monitoring
  • Allow oral hygiene
  • Good aesthetics
79
Q

3 types of chairside splints?

A
  • Composite and wire
  • Titanium trauma splint
  • Composite
  • Orthodontic brackets and wire
  • Acrylic
80
Q

2 types of lab made splints?

A
  • Vacuum-formed splint
  • Acrylic splint
81
Q

SS diameter ?

A

0.4mm

82
Q

How many teeth would you include on the sides of the splints?

A

one tooth on either side of traumatised tooth/teeth

83
Q

What is this splint made off?

A

Titanium , 0.2mm
Rhomboid mesh structure

84
Q

When would you use this acrylic splint

A

When there is few abutment teeth

85
Q

5 main post trauma complications?

A
  • Pulp necrosis
  • Pulp canal obliteration
  • Root resorption
  • Breakdown of gingiva and bone
86
Q

What is pulp canal obliteration?

A
  • Progressive hard tissue formation within pulp cavity leading to narrowing of pulp chamber
  • does not require treatment
87
Q

What are the two types of root resorption?

A
  • External - surface, inflammatory, replacement (ankylosis)
  • Internal - inflammatory
88
Q

Explain external surface resorption?

A
  • Superficial resorption repaired with new cementum
  • Response to injury
  • not progressive
89
Q

in what kind of tooth with external infection related external root resorption occur?

A
  • non vital tooth
90
Q

How would you diagnose external infection related IRR?

A
  • indistinct root surface
  • root canal tramlines intact
91
Q

What initiates inflammatory external root resorption?

A

PDL damage

92
Q

How to manage external root resorption (inflammatory)?

A

Remove stimulus and endodontic treatment

93
Q

What initiates ankylosis RRR?

A

severe damage of PDL and cementum leading to failure of normal repair where bone cells are faster than PDL fibroblasts

94
Q

What type of injuries may cause ankylosis?

A

Severe luxation or avulsion

95
Q

How would ankylosis present radiographically?

A
  • Ragged root outline
  • no PDL space
96
Q

How does internal root resorption occur?

A

pulp necrosis

97
Q

What are the radiographic signs of internal infection related IRR?

A
  • expansion of root canal walls
  • indistinct root canal tramlines
98
Q

How to treat IRR?

A
  • Remove stimulus
  • Endodontic treatment

BDS4 (63 decks)

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