Paeds - trauma

Question 1

What are trauma stamps used for

Answer 1

We use this on clinic for long term trauma monitoring

Question 2

What do you put at the top of a trauma stamp

Answer 2

what teeth you are examining

Question 3

What does a trauma stamp cover

Answer 3

SCT MEEP R

Sinus 
Colour 
TTP 
Mobility 
EPT 
ECL 
Percussion note 
Radiograph

Question 4

What do you write down in the corresponding box for a trauma stamp

Answer 4

For each category you need to put a plus/minus or tick in the box
You may also need to write down some description e.g. colour yellow etc

Question 5

What is avulsion

Answer 5

tooth comes completely out of the socket

Question 6

When can successful healing occur following avulsion

Answer 6

if there is only minimal damage to the pulp and the PDL

Question 7

What are the critical factors for successful healing for avulsion

Answer 7

EADT
EAT
storage medium type

Question 8

What does EADT stand for

Answer 8

Extra- alveolar dry time

Question 9

What does EAT stand for

Answer 9

Extra-alveolar time

Question 10

What is EADT

Answer 10

time the tooth is out of the mouth just in air e.g. lying on the ground (it is not in any type of storage medium and it is not back in the socket)

Question 11

What is EAT

Answer 11

EAT is the amount of time the tooth is out of the mouth and dry including the time that it has been in any type of storage medium

Question 12

What should you do if patient attends with tooth already reimplanted

Answer 12

Do not remove. Leave as is and follow instructions regarding splinting etc dependent on circumstance
Radiograph is important to establish status of root development
If a tooth comes out you want to put it straight back in its socket as this will give it the best prognosis. However, if there is a lot of debris and dirt etc you might feel that you would like to take it out and have a look at it and get rid of any large dirt or debris

Question 13

Why is a radiograph important post avulsion

Answer 13

to establish root development - we want to know how much root is there, and is it a mature or immature tooth (open or closed apex

Question 14

What is the advice to someone with an avulsed tooth

Answer 14

Hold by the crown only
Wash in cold running water (if there is obvious debris on the tooth - this can be done for up to 10 seconds)
Replace in the socket and get child to bite on tissue
OR store in milk/saliva/normal saline (if there is a lot of trauma you could potentially store it in the patient’s blood)
Seek immediate dental advice (the quicker you can get to a dentist the better)

Question 15

How do you construct a splint

Answer 15

Cut and bend 0.3mm stainless steel wire
Apply composite resin to traumatised tooth and those adjacent
Sink the contoured, passive wire into the composite
Shape and cure the composite
Smooth rough composite and wire ends
Need to ensure that the wire remains passive as if the wire is active the teeth will be moved

Question 16

What are other forms of splint other than composite and wire

Answer 16

vacuum formed
ortho brackets and wire
acrylic URA type splint
foil temporary splint cemented with kalzinol

Question 17

Why are vacuum shield splints not as good

Answer 17

OH is often poor

Question 18

What must be ensured with ortho bracket splints

Answer 18

its passive

Question 19

What is good about an acrylic URA type splint

Answer 19

useful when there are few abutment teeth

Question 20

When do you use a 2 week splint

Answer 20

Subluxation
Extrusion
Avulsion - open and closed apex <60 mins EADT

Question 21

When do you use a flexible 4 week splint

Answer 21

Lateral luxation 
Apical/middle ⅓ root fracture 
Intrusion 
Dento-alveolar fractures 
Avulsion - closed apex >60 mins EADT

Question 22

When do you use a 4 month splint

Answer 22

coronal ⅓ root fracture

Question 23

Patient comes in with a tooth that shows increased mobility but no displacement
What type of injury is this, what type of splint will you use

Answer 23

subluxation

2 week flexible splint

Question 24

patient shows with tooth displaced like this

what is the name of this? what splint will you use

Answer 24

extrusive luxation

2 week flexible splint

Question 25

patient shows with this injury
what type of injury is it
what type of splint

Answer 25

lateral luxation

flexible 4 week splint

Question 26

patients front tooths fallen out, theyre calling you crying
it fell out two hours ago and shes stuck in traffic coming to you, she’s put the tooth in her purse

she is 16 YO

what is this injury called, what will you do?

Answer 26

avulsion
EADT time is more than 60 minutes 
closed apex
PDL healing is unlikely so looking for bony healing 
do extra oral endo 
put it back under LA
4 week flexible splint

Question 27

How do we classify crown fractures

Answer 27

enamel
enamel dentine
enamel dentine pulp

Question 28

How do we classify crown root fractures

Answer 28

with or without pulp exposure

Question 29

How do we classify root fractures

Answer 29

position - apical, middle or coronal third
displacement - are fragments displaced or undisplaced
what stage of root development - open or closed apex

Question 30

What are the different periodontal healing outcomes after reimplantation post avulsion

Answer 30

Regeneration
PDL healing
Bony healing
Uncontrolled infection

Question 31

When should a tooth not be reimplanted

Answer 31

if a child is immunocompromised

it is a decidious tooth

Question 32

What should you do if there is concussion/subluxation of a primary tooth

Answer 32

observe

Question 33

What should you do if there is lateral luxation for a primary tooth

Answer 33

if no occlusal interference then allow to position spontaneously
if there is occlusal interference then extract

Question 34

What should you do if there is intrusion in a primary tooth

Answer 34

monitor re-eruption

if no re-eruption after 6 months consider extraction to avoid problems with eruption of permanent tooth

Question 35

What should you do if there is extrusion with a primary tooth

Answer 35

extract

Question 36

What should be done for primary tooth avulsion

Answer 36

radiograph to confirm avulsion

do not replant