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Stage 4 CDH > Permanent Dentition Trauma 1 (HT) > Flashcards

Permanent Dentition Trauma 1 (HT) Flashcards

1
Q

define

Infraction

A

An incomplete fracture (crack) of the
enamel without loss of tooth
structure.

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2
Q 
Visual= Visible crack
Mobility= None
Percussion= None
SensibilityTesting's=Unusualy positive
Radiographic Finding=No abnormalities
A

infraction

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3
Q

treatment of infraction:

b) what follow up is there?

A
  1. No treatment
  2. Etch and Bond
    b) none
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4
Q 
Visual= Loss of tooth tissue
Mobility= None
Percussion= None
SensibilityTesting's=Unusualy positive (if negative may be transient)
Radiographic Finding=No abnormalities
A

Enamel/dentine fracture

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5
Q

Enamel/dentine fracture- treatment:

b) follow up?

A

1.Composite bandage or definitive
composite restoration
2. Bonding fractured portion (use flowable composite)
b) 6-8w (rad), 1 yr (rad)

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6
Q

Define enamel fracture

A

Fracture with the LOSS of tooth substance confined to the enamel

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7
Q

Visual= Enamel/dentineloss and exposure of the pulp
MobilityNone
PercussionNone
Sensibility Testing’sUsually positive (ifnot delayed)
Radiographic
Findings Visible = piece of enamel/dentine and into pulp visible

A

enamel/dentine /pulp fracture

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8
Q

tx for enamel/dentine /pulp fracture=
scenario 1: less than 24 hours and tiny exposure less than 2 mm
Scenario 2: MOre than 2 mm or more than 24 hours sicne
b) follow up

A
  1. Maintain vitality
    scenario1 : Pulp capping with Ca(OG)2, and hermetic seal (composite)
    Scenario1L Partial pulpotomy or full coronal : both with Ca(OH)2 and hermetic seal (composite)
    3.. Extipation
    B) 6-8 week (rad), 3 m (rad), 6 m (rad), 1 year (rad)
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9
Q

What does an uncomplicated Cr-root fracture involve?

A

enamel, dentine and cementum

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10
Q

Visual: Crown fracture extending below gingival margin.
Mobility: Coronalfragment often mobile
Percussion: Tender
Sensibility Test: Usually positive for apical portion
Radiographic Findings: Apical extension of fracture usually not visible. CBCT may be helpful

A

uncomplicated Cr-Root fracture

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11
Q

Treatment of CR-root fracture (uncomplicated):

B) Follow-up

A 
Removal of fractured  portion  then:
1.Restore with composite
2.Gingivectomy/ostectomy
3.Orthodontic  extrusion
4.Surgical extrusion
5.Decoronation
6.Extraction
B)6-8w (RAD);3m (RAD), 6m RAD, 1yr (RAD), Annually  till up to at least 5 years (RAD)
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12
Q

What do you needs to asses in a root fracture

A

Classified by position of # lines radiographicallyAssess displacement of coronal fragmentAssess stage of root development: Mature or immature

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13
Q

What is involved in a complicated Cr-Root fracture

A

cementum, dentine, enamel and pulpal exposure

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14
Q

What is the follow up for complicated Cr-root fracture

A

6-8w;6m, 1yr

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15
Q

What is the emergency tx for cr-root fracture (complicated_

A

Use flowable composite to sandwich together. Removal of fractured portion and pulpotomy or extirpation (as per EDP#)

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16
Q

What is the longer term tx for Cr-root fracture (complicated_
(6)

A

manadge pulp then tx as you would if uncomplicated. remove # portion (and yes in an emergency you just sandwitch the 2 together), then tx pulp: pulpotomy or extirpation (as you would in complicated enamel–dentine-pulp #)Restore with composite2.Gingivectomy/ostectomy3.Orthodontic extrusion4.Surgical extrusion5.Decoronation6.Extraction

17
Q

define root fracture

A

a fracture confined to the root of the tooth involving cementum, dentin and the pulp

18
Q

Visual: The coronal segment may be mobile and in some cases displaced. Transient crown discoloration (red or grey) may occur. Bleeding from the gingival sulcus may be noted.
Mobility: Coronalfragment often mobile
Percussion: Tender
Sensibility Test: Initially negative (transient)
Radiographic Findings: The root fracture line is usually visible

A

root fracture (may be coronal, aprical or mid third) coronal =worse prognosis (up to 4 month flexible splint)

19
Q

follow up for a root fracture

A

4w (SPLINT (take off), RAD), 6-8w (RAD), 4m (SPLINT (if coronal third), RAD), 6m (RAD), 1yr (RAD), Annually till up to at least 5 years (RAD)

20
Q

treatment objectives for root fracutre

A

Repositionfracture portionApical/Mid –4 weeks flexible splint; Coronal –4 months flexibleRemove splint

21
Q

What must you do

pt C/O hit head now tooth wobbly:

A
  1. Head injuries?
    - MH, SH, DH, EXamine, E/O, I/O (do we do it in the sam order)
  2. manage pain
  3. check tetanus status (have they had their boosters)
  4. clean injury
  5. maintain vitality of tooth
  6. refer for specialist manadgement?
    (get a dental trauma sheat) (
22
Q

What MH can contraindicate certain manadgments for dental trauma?

A 
allergies
cardiac
immunology (e.g. chemo and immuno suppressed)- don't go putting a detty tooth back in their
Haematology
Disability (will they cooperate with tx)
23
Q

What extra oral things are you looking for in dental trauma

A

examine face, lips, and orla muscles for E/O ST lesions
2) palapate facial skeleton (fracture, anaesthesia, parasthesia and dysaesthesia)
TMJ (mouth opening
CSF leakage (check ears and nose)
Sub-conjuctive haemorrhage (white of eye is red)

24
Q

What does gingival crevicular bleeding around damadge trauma tooth indicate?

A

subluxation injury
(+ TTP, but not mobility)
Tx- monitor , Soft toothbrush , CHX mouth wash, (+/- splint for 2 weeks)

25
Q

WWhat does gingival displacement around damadge trauma tooth indicate?

A

dento-alveolar fracture

26
Q

What radiographs will we be taking in dental trauma?

A

PA with 90 degree horizontal angle with central beam on tooth
Occlusal view
PA with lateral angulations from mesial and distal
Soft tissue imaging (check nothing in ST)
CMCT (if fracture subgingival)

27
Q

What dental history is relevant when seeing pt with dental trauma?

A

previous trauma (NAI? safe gaurding!)
cooperation
other pathology

28
Q

What can we do to help medico-legally for record in dental trauma?

A

photos
diagrams
radiographs
dental trauma sheat

29
Q

what are we diagnosing in dental trauma?

possible cause +possible result

A 
PDL damadge (cause displacement can result in resorption)
Pulp damadge (cause Cr fracture of significant displacement may cause pulp necrosis)
30
Q

Manadgement of root fracture if pulp becomes necrotic?
B) how frequently does this occur?
c) different outcomes of distal fragment of root

A

extirpate to #line
2) dress non-setting CaOH then MTA/biodentine just coronal to # line
obturate to # line
b) 20%
c) remain with PDL intact, resorption, may become infected monitor for this

31
Q

A pt had a root # that was non-vital. You treated is by dressing pulp with non-setting CaOH and MTA then obturated to # line then did a final restoration. THe pt is back with pain, swelling in area. What happened?
b) tx

A

apical fragment of root didn’t resorb , became infected

b) antibiotics and apicetomy

32
Q

what determines the prognosis of root fractures?

A 
age of child (mature/immature teeth)
degree of displacement
associated injuries e.g. cr #
time between injury adn tx
presence of infection
33
Q

what determines prognosis of enamel-dentine pulp #?

A

Depends on:
 Age of child; mature / immature tooth
 Type of injury
 Associated injuries; PDL injuries( e.g. subluxation injuries/)
 Time between injury and treatment -Delays in
accessing care
 Presence of infection

34
Q

what is the success following in enamel, dentine, pulp fracture:
A)partial pulpotomy
b) coronal pulpotomy

A

Success:
 Partial –97% success
 Coronal –75% success

35
Q

what is the basic management of dental trauma?

A

Other injuries
 Soft diet
 Use of a soft toothbrush /Chlorhexidine rinse or gel?
 Analgesics
 Refer to GMP if Tetanus status uncertain
 Explain long-term management plan, prognosis & potential
complications

Stage 4 CDH (2 decks)

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