Brainscape's Knowledge GenomeTM

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


See full index

BDS3 Paeds > Paeds Trauma- Supporting Tissue Injuries > Flashcards

Paeds Trauma- Supporting Tissue Injuries Flashcards

1
Q

Give examples of supporting tissue trauma

A

Concussion, subluxation, lateral luxación, infusion, extrusion, avilesino, alveolar fracture

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

Define dental concussion

A

Injury to the tooth supporting structures without abnormal loosening or displacement of the tooth

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

Describe the clinical findings, treatment and follow up of dental concussion trauma

A

There is no pain on percussion
No treatment
Follow up clinically and radiographically 4 weeks later and 1 year later

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

Define subluxation

A

An injury to the tooth-supporting structures with abnormal loosening but without tooth displacement

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

Describe the clinical findings of subluxation trauma

A

Increased mobility, tender to percussion, bleeding from gingival crevice may be present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Describe the treatment and follow up of subluxation trauma

A

Treatment is not normally required, splint if excessive mobility or tenderness when biting
Follow up clinical and radiographic - 2 weeks later for splint removal, 12 weeks, 6 months and 1 year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How are subluxation and concussion injuries monitored at follow up?

A

Trauma stamp
Sensibility testes (false negative response is possible relating to future pulp necrosis)
Radiographs (looking at root development and resorption, compare with contra lateral tooth)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is assessed in a trauma stamp

A

Sinus
Colour
Mobility
TTP
Percussion
Ethyl chloride
EPT
Radiograph

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

5 years later, what is the pulp survival in subluxation/ concussion injuries with open v closed apices?

A

100% survive with open apex
85 and 95% relatively with closed apices

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

5 years later, what is the resorption in subluxation/ concussion injuries with open v closed apices?

A

1% resorption in open apex
3% resorption in closed apex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Define extrusion?

A

An injury in which the tooth suffers axial displacement partially out of the socket

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the clinical findings for an extrusion injury

A

Tooth appears elongated, usually displaced palatally, mobility present, bleeding from the gingival sulcus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Describe the treatment and follow up for extrusion trauma

A

Treatment- repositioning the tooth by gently pushing it back into the tooth socket under LA, splint placement
Follow up- 2 weeks later for splint removal, 4 weeks, 8 weeks, 12 weeks, 6 months and 1year.
Then annually for 5 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

5 years later, what is the pulp survival in extrusion injuries with open v closed apices?

A

95% in open apex
45% in closed apex

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

5 years later, what is the % resorption in extrusion injuries with open v closed apices?

A

5% in open apex
7% in closed apex

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

Define lateral luxación

A

Displacement of a tooth socket in a direction other than axial, accompanied by communication or fracture of alveolar bone plate

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

What are the clinical findings of a lateral luxation

A

Tooth appears displaced in socket, immobile, high ankylosis percussion tone
May be bleeding from gingival sulcus
Root apex may be palpable in sulcus

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

What is the treatment for lateral luxation

A

Reposition under LA, splint placement
Monitor- endodontic evaluation (2 weeks later)

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

What is the follow up plan for lateral luxation?

A

2 weeks (endo evaluation), 4 weeks (splint removal), 8 weeks, 12 weeks, 6 months, 1 year
Then annually for 5 years

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

At the 2 week endo evaluation for lateral luxation what are the 2 possible outcomes?

A

Incomplete root formation
- spontaneous revascularisation may occur
If the pulp becomes necrotic and signs of inflammatory external resorption, begin endo treatment

Complete root formation
- the pulp will likely become necrotic, begin endo treatment
- corticosteroid antibiotic/ CaOH as Intra-canal medicamento to prevent development of inflammatory external resorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

5 years later, what is the pulp survival in lateral luxation injuries with open v closed apices?

A

95% open apex
255 closed apex

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

5 years later, what is the % restoration in lateral luxation injuries with open v closed apices?

A

3% open apex
38% closed apex

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

Define intrusion

A

Tooth is forced into socket in axial direction and locked into bone

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

What are the clinical findings of intrusion

A

Crown appears shorter, bleeding from gingival
ankylosis high, metallic percussion tone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the treatment options for intrusion

A

Immature root formation
- spontaneous repositioning independent of the degree of intrusion
- if no re-eruption within 4 weeks- ortho repositioning
- monitor the pulp, spontaneous pulp revascularisation may occur
- if pulp becomes necrotic and infected/ signs of inflammatory external resorption- begin endo treatment ASAP when position of tooth allows.

Mature root formation
- <3mm spontaneous repositioning (if none within 8 weeks- reposition surgically and splint for 4 weeks/ orthodontically before ankylosis develops)
- 3-7 mm - surgical (preferably) or ortho repositioning
- >7mm - surgical repositioning

  • pulp almost always becomes necrotic- start endo treatment 2 weeks/ as soon as positioning allows to prevent inflammatory (infection related) resorption
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the follow up plan for intrusion

A

2 weeks, 4 weeks (splint removal), 8 weeks, 12 weeks, 6 months, 1 year
Then annually for 5 years

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

5 years later, what is the pulp survival in intrusion injuries with open v closed apices?

A

40% open apex
0% closed apex

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

5 years later, what is the % resorption in intrusion injuries with open v closed apices?

A

67% in open apex
100% in closed apex

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

Define avulsion and its clinical findings

A

Tooth completely displaced from socket
Socket is empty or filled with coagulum

30
Q

What are the 3 critical factors in avulsion

A

Extra-alveolar dry time (EADT)
Extra alveolar time (EAT)
Storage medium

31
Q

Provide emergency advice for a patient with an avulsed tooth

A
  1. Ensure permanent tooth
  2. Hold by crown
  3. Encourage attempt to place tooth immediately into socket (if tooth is dry, rinse gently in milk/ saline/ saliva and replant)
  4. Bite on gauze/ tissue etc to hold in place once replanted
  5. Seek immediate dental advice
32
Q

What are the 5 storage mediums for an avulsed tooth

A

Milk
HBSS
Saliva
Saline
Water

33
Q

Which 2 factors influence management of avulsion

A

Maturity of root
PDL cell condition

34
Q

In a tooth with a closed apex, describe the overall treatment plan for avulsion

A

Clean injured area
Verify replanted tooth position and apical status (clinical and radiographic)
Place splint
Suture gingival lacerations if present
Consider antibiotics and check tatenus status of patient
Provide post op instructions
Follow up

35
Q

In a closed apex avulsed tooth when the EADT < 60 mins, describe the management

A

PDL cells may be viable but compromised

Remove debris
History and exam with tooth in storage
Replant under LA
Splint
Suture gingival lacerations
Antibiotics? Tetanus status?
Post op instructions
Follow up

36
Q

In an avulsed tooth with closed apex with EADT > 60 mins, describe the management

A

PDL cells are likely to be non-viable

Remove debris
Replant under LA
Splint
Suture gingival lacerations
Antibiotics? Tetanus status?
Post op instructions
Follow up

37
Q

In an avulsed tooth with closed apex, when should endo treatment be started and which Intra canal medicament used?

A

Commence endo treatment within 2 weeks
Use CaOH up to 1 month or corticosteroid/ antibiotic paste for 6 weeks

38
Q

What is the result of delayed replant action of an avulsed tooth with closed apex

A

Poor long term prognosis (ankylosis related root resorption)
Decision to replant almost always correct
Referral to paeds specialist/ inter disciplinary management

39
Q

What is the follow up for avulsion with closed apex

A

2 weeks (splint removal)
4 weeks, 3 months, 6 months, 1 year
Then annually for 5 years

40
Q

What is the management for an avulsed tooth with an open apex which has already been replanted

A

Clean injured area
Verify replanted tooth position and apical status (clinical and radiographic)
Place splint
Suture gingival lacerations
Antibiotics? Tetanus status?
Post op instructions
Follow up

41
Q

What is the management for an avulsed tooth with open apex and EAT < 60 mins

A

Potential for spontaneous healing

Remove debris
History and exam with tooth in storage medium
Replant under LA
Splint
Suture gingival lacerations
Consider antibiotics, check tetanus status
Post op instructions
Follow up

42
Q

What is the management of an avulsed tooth with open apex and EAT > 60 mins

A

PDL cells likely to be non-viable
Likely outcome is ankylosis-related (replacement) root resorption

Remove debris
Replant under LA
Splint placement
Suture gingival lacerations
Consider antibiotics, check tetanus status
Post op instructions
Follow up

43
Q

What is the goal of treatment of avulsed teeth with open apices?

A

Revascularisation
This requires close monitoring, endo treatment if definitive signs of pulp necrosis and infection of root canal

44
Q

What are the effects of delayed replant action of an open apex avulsed tooth?

A

Poor long term prognosis (ankylosis related (replacement) root resorption)
Decision to replant almost always correct
Refer to paeds specialist/ inter disciplinary management

45
Q

What is the follow up of avulsion with open apex?

A

2 weeks (splint removal)
1 month, 2 months, 3 months, 6 months, 1 year
Then annually for 5 years

46
Q

When should you not replant an avulsed tooth?

A

Medical contraindications (immunocompromised, other serious injuries requiring preferential emergency treatment)

Dental contraindications (very immature apex and extended EAT> 90 mins, very immature lower incisors in young children- may find difficult to cope)

47
Q

5 years later, what is the pulp survival in avulsion injuries with open v closed apices?

A

30% in open apex
0% in closed apex

48
Q

5 years later, what is the % resorption in avulsion injuries with open v closed apices?

A

Frequent.

49
Q

Define dento-alveolar fracture

A

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

50
Q

Describe the clinical findings of a dento-alveolar fracture

A

Complete alveolar fracture extending from the buccal to palatal bone in the maxilla and from the buccal a=to lingual bony surface in the mandible
Segment mobility and displacement with several teeth moving together
Occlusal disturbance
Gingival laceration

51
Q

Outline the treatment of a dento-alveolar fracture

A

Reposition any displaced segment
Stabilise by splinting
Suture gingival lacerations if present
Monitor the pulp condition por all teeth involved

52
Q

Outline the follow up appointments, after dento-alveolar fracture

A

Monitor the patient (clinical and radiograph) - looking at root development (canal width and length compared with neighbouring unaffected tooth) and resorption

4 weeks (splint removal)
6-8 weeks, 4 months, 6 months, 1 year
Annually for 5 years

53
Q

In a dento-alveolar injury, what is the risk of pulpal necrosis of a tooth with closed apex?

A

50% risk of pulpal necrosis

54
Q

provide advice for a patient with a dento-alveolar fracture

A

Soft diet for 7 days
Avoid contact sport whilst splint is in place
Careful oral hygiene with use of chlorohexidine mouthwash (0.12%)

55
Q

How long is splint placement for a dento-alveolar fracture

A

4 weeks

56
Q

What are the key properties of a splint?

A

Flexible and passive
Easy to place/ remove
Facilitate sensibility testing/ clinical monitoring
Allows oral hygiene
Aesthetic

57
Q

What are the different types of splints?

A

Chair side
- composite and wire
- titanium trauma splint
- ortho brackets and wire
- acrylic

Lab made
- vacuum formed splint
- acrylic

58
Q

What type of wire is used for composite and wire splint
And how is it placed

A

Stainless steel wire (up to 0.4mm in diameter)
Must be passive (ensures not placing unwanted forces on traumatised tooth) and include one tooth either side (bonded with composite, away from gingiva and proximal areas- avoids plaque retention and secondary infection, better healing)

59
Q

Describe placement of titanium trauma splint

A

Passive splint
Rhomboid mesh structure, 0.2mm thick
Can be easily adapted to the contour of dental arch (flexible in all directions)
Secured with composite resin

60
Q

When is an acrylic splint used?

A

When there are few abutment teeth (palatal coverage and acrylic extended over incisal edges on labial surface of anterior teeth)

61
Q

What are the main complications of dental trauma

A

Pulp necrosis and infection
Pulp canal obliteration
Root resorption
Breakdown of marginal gingiva and bone

62
Q

What is pulp canal obliteration

A

This is the response of a vital pulp. Common in luxation with displacement.
Progressive hard tissue formation within the pulp cavity, resulting in narrowing of pulp chamber and canal (total/ partial obliteration).
Affected tooth becomes opaque/ yellow

63
Q

What is the treatment for pulp canal obliteration

A

Conservative management is advised
Only 1% may give rise to PAP

64
Q

What are the types of root restoration

A

External
- surface
- external infection related (IRR)
- cervical
- ankylosis related (RRR)

Internal
- internal infection related IRR

65
Q

What is external surface root resorption

A

Vital teeth
Superficial resorption lacunae are repaired with new cementum.
Response to localised injury
Not progressive

66
Q

What is external infection related IRR

A

Non-vital tooth with infected pulp canals
Initiated by PDL damage (propagated by root canal toxins reaching external root surface through patent dentinas tubules)
Can be aggressive
Often a chance diagnosis from trauma review (change in the contour of the root and surrounded by bony lucency)

67
Q

What is external infection related IRR

A

A rapid process (however, if infected canal contents are removed, the propagated stimulus is lost, lesion will arrest, endo treatment started)
Tooth dressed with CaOH for 4-6 weeks before obturación with GP.
Cervical resorption is an unusual form of external infection related IRR- initiated by damage to root surface of cervical region and propagated by infected root canal contents/ perio micro flora)

68
Q

What is ankylosis related RRR

A

Follows severe luxation/ avulsion injuries
Initiated by severe damage to PDL and cementum

If >20% PDL is damaged/ lost bone cells can grow into contact with the root surface more quickly than remaining periodontal fibroblasts can recolonise the root surface- root now becomes involved in bony remodelling process and is replaced with bone in the folllowing years

Root will appear ragged in outline with no obvious PDL space.

69
Q

What is the treatment for ankylosis related RRR

A

No effective treatment

Speed of progression is variable - infraoccclusion due to alveolar bone development
When discrepancy in the gingival margins of ankylosed tooth, compared with contractural tooth is more than 3mm- consider decroronation of ankylosed tooth

Plan for loss (although may be years later)

70
Q

What is internal infection related IRR

A

This is due to progressive pulp necrosis
Infected material via non-vital coronal part of canal propagates resorption, rapid tissue destruction

Large resorptive defects affecting coronal 1/3 canal may result in pink appearance of tooth

Round, symmetrical expansion of root canal walls (ballooning of canal)
Tramlines of root canal are indistinct, root surface in tact

71
Q

What is the treatment of infection related IRR

A

Remove stimulus
Endo treatment
- non setting CaOH for 4-6 weeks
- obturate with GP
- if progressive, plan for loss.

BDS3 Paeds (5 decks)

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