Paeds Trauma Flashcards
What is recorded on a trauma stamp?
TTP
Colour
Sinus
Mobility
Percussion
Sensibility
Radiograph
What does TTP test?
PDL inflammation
What is a favourable radiograph in outcome post trauma
Continued root development
No pathology
What colours might a traumatised tooth be?
Pink
Yellow
Grey/brown
What causes a pink appearance of a tooth?
Transient, happens immediately after
Fresh bleeding
What causes a yellow appearance of tooth?
This happens months post trauma
Caused by the laying down of tertiary dentine - sclerosis of the canal (pulp canal obliteration)
What causes grey/ brown discolouration?
Happens within weeks of tooth becoming non vital
Due to a build up of blood products (the tooth is non-vital so no cells to clear it out)
What can cause increased mobility?
Damage to PDL, root resorption (creating an unfavourable crown root ratio)
What is a favourable crown root ratio?
1:2
1:1 is minimum for adequate tooth support
What causes decreased mobility/ no mobility
Ankylosis - replacement resorption.
Severe damage to PDL, PDL is replaced by bone which also replaces adjacent dentine and cementum.
What might a dull percussion note suggest?
Root fracture
Ankylosis
What does sensibility testing test?
Tests the nerve supply of the tooth
Note- tooth may not have a vital nerve (negative to sensibility tests) but may still have a vital blood supply.
What are the 4 Ypres of root resorption?
External (inflammatory)
Internal (inflammatory)
Replacement resorption
Surface (external)
What is external inflammatory root resorption?
This is progressive and is initiated by PDL damage (trauma). The pulp becomes non vital and toxins reach the external root surface, resulting in a moth like appearance (on radiograph) on root surface.
Straight, tram line walls of the pulp are still visible.
What is internal inflammatory root resorption?
This is progressive and initiated by pulp necrosis
Causes ballooning of the pulp walls (on radiograph) as infected material from necrotic pulp propagates resorption.
External root surface remains in tact
What is replacement resorption?
Ankylosis
No PDL
Causes infraoccluded teeth (tooth stays in the same position as teeth around erupt).
What is a treatment option for an ankyloses tooth?
Decoronate and bury the root
This maintains position of gingival margin for future bridge/ implant
What is surface external resorption?
This resorption stops when the excessive force is removed eg. Fixed ortho/ canine erupting on top of lateral.
Causes blunting appearance of root tips.
What is the treatment for external and internal inflammatory resorption?
Remove the pulp tissue and fill with CaOH for 4-6 weeks
What is the max length of time CaOH can be placed in canal for and why?
Max 6 weeks
PH 10 causes the tooth to become brittle and can snap.
What is an ‘eyebrow sign’ on a radiograph?
A dark shadow on X-ray in the orbit which suggest the presence of gas, suggesting a fracture.
What are the 2 radiographic views required for midface trauma?
OPG and PA mandible
2 angulations of PA
CT ?
What should you look for when looking at radiograph?
Can you see what you need?
Well penetrated
Rotated
Blood or fluid where it shouldn’t be?
Gas
What does ipsilateral numbness of mandible suggest?
Nerve damage (not fracture)
What is sublingual haematoma?
Bruise under tongue - suggestive of mandible fracture
What causes external inflammatory resorption in an extruded tooth?
Damage to the PDL surface resulting in necrotic inflamed pulp.
this releases bacterial toxins which move up the dentinal tubules and stimulate osteoclasts to resort root
What does EADT time indicate?
If PDL cells are viable (<60 mins)
What are the clinical signs external inflammatory resorption
Negative sensibility
Maybe TTP
Moth eaten appearance on radiograph
