PEADS - Trauma Flashcards
If a tooth gives off a dull note when percussed, what would that indicate about the health of the tooth?
A dull note suggests root fracture
What is a dental sinus?
This is an abnormal channel that drains longstanding dental abscesses and is commonly associated with dead or necrotic teeth.
What are the 8 categories in a trauma sticker?
Colour sinus tract Radiograph TTP Precussion (sound) EPT Ethyl chloride Mobility
When is the trauma sticker used?
It is used on the initial visit and then every subsequent visit for comparison.
What are the 6 classifications of crown and root fractures?
Enamel Enamel and dentine Enamel, dentine, and pulp Uncomplicated crown and root fracture Complicated crown and root fracture Root fracture, coronal, middle, and apical 1/3
What are the 5 key factors which influence the prognosis of a tooth after an injury?
ROOT development Type of injury Time - how long between the injury and treatment PDL - damage Infection - the presence of infection
When treating a patient with a fracture injury what does the GDP do in the emergency stage?
Place an adhesive dentine bandage to cover up any exposed dentine. (if no time build-up tooth with composite)
Treat any exposed pulp
Reduce and immobilize the displaced tooth and return to the correct place
Give tetanus shot if indicated
Prescribe A.B
When treating a patient with a fracture injury what does the GDP do in the intermediate stage?
Carry out RCT if indicated
Provide minimal invasive restoration
When treating a patient with a fracture injury what does the GDP do in the permanent stage?
If apexogenis has occurred (take radiographs) and the root is continuing to grow or the dentine wall is thickening, then this is the ideal situation.
Apexification - the tooth is no longer vital and the root of the tooth has not continued to grow. A man-made apex must be made in order for RCT to be carried out. This can be done with MTA. These teeth however have a poor prognosis as dentine walls are thin.
Root filling
Final coronal restoration
For an enamel crown fracture, there are 3 treatment options.
Place the fractured crown back onto the tooth.
Place a small amount of composite
File down any sharp edges
Why do you take two peri apicals for enamel and enamel and dentine fractures?
To rule out luxation and root fracture
What is the recall interval for crown fractures?
6-8w and 1 year
If part of a tooth is fractured and unaccounted for, where might you check?
Take a radiograph of the soft tissues and check for any lacerations.
For an enamel and dentine fracture, what are your treatment options?
If you can account for the fractured part of the tooth, you can stick it back on (this can discolour over time)
Or you can build up with composite.
What other tests might you do on an E&D F
Sensibility tests
Assess the maturity of the tooth
At the follow-up appointments, what is carried out at both 6-8w and 1y?
Trauma sticker and then compared to the contralateral tooth if the tooth was mature to check root development.
Check for any periapical pathology
There are 3 main factors to consider in your assessment of an E, D, P fracture.
PDL damage
SIze of exposure
TIme since exposure
What are the 3 options of treatment for an E, D, and P fracture?
Pulp cap
Partial pulpotomy
Full pulpotomy
Describe the stages involved in a pulp cap and what the indications are for choosing this treatment.
If the exposure is <1mm and <24hrs has passed since exposure then pulp cap.
Also, a trauma sticker has been carried out and the tooth isn’t TTP and positive EPT.
LA and dam
Water and SH to clean and disinfect the area.
Then setting CaOH (dycal) placed with a nice composite restoration
Describe the stages involved in a partial pulpectomy and what the indications are for choosing this treatment.
Exposure is > 1mm and > 24hrs has passed.
LA and rubber dam
2mm of pulp removed with HS round diamond
Water and SH to clean and disinfect.
Saline-soaked cotton wool is then used. (if the bleeding doesn’t stop or pulp never bleeds then FULL pulpotomy indicated).
Apply setting CaOH (dycal) and GI (vitrebond) or MTA and restore with composite.
Follow up with full clinical and radiographic assessment at 6-8w and 1y
Do you ever start with a full pulpectomy?
No
Always partial and then if bleeding doesn’t stop or no bleeding. then proceed with full
Crown and root fracture treatment options?
Ex - rarely done
Decoration - preserves root from implants
Fragment removal and restore
Fragment removal and gingivectomy
Classification of root fractures?
Position; - apical, middle, and coronal 1/3 Displacement of fragments - displaced or undisplaced Root development - mature or immature
For root, F what does the prognosis depend on?
Age of child - Root development Degree of displacement Associated injuries Time Presence of infection
Of all the root F which has the best prognosis?
Apical