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1. SBA > permanent tooth trauma > Flashcards

permanent tooth trauma Flashcards

1
Q

What is an enamel infarction?

A

Incomplete fracture of enamel surface - no loss of structure.

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2
Q

Which 2 methods would you use to diagnose an enamel infarction?

A
  1. transillumination
  2. PA radiographs
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3
Q

What are the treatment options for an enamel infarction?

A
  1. no treatment
  2. use flowable to seal
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4
Q

When should you follow up an enamel infarction?

A

No follow up is required.

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5
Q

How much mobility and sensibility should you expect to see in an enamel fracture?

A

No mobility with normal sensibility (+).

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6
Q

What would be used to diagnose an enamel fracture?

A

PA radiograph +/- soft tissue radiograph.

(think missing fragment)

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7
Q

What are the 3 treatment options for an enamel fracture?

A
  1. no treatment and review
  2. smooth the edges with a soflex disc
  3. restore with composite
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8
Q

When should an enamel fracture be followed up?

A

6-8 weeks and then 1 year.

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9
Q

Which type of fracture is an enamel-dentine crown fracture?

A

uncomplicated -
fracture involving enamel and dentine with NO pulpal exposure.

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10
Q

What should be used to diagnose an enamel-dentine fracture?

A

PA radiograph +/- soft tissue.

(missing fragment)

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11
Q

If the tooth fragment is available for an enamel-dentine fracture, how would this be treated?

A

re-hydrate with saline / water for 20 mins and re-attach

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12
Q

If the tooth fragment is NOT available in an enamel-dentine fracture, how would this be treated?

A

emergency protection with a composite bandage.

(dentine coverage but not restored to full height)

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13
Q

What is the definitive treatment for an enamel-dentine fracture?

A

composite build up

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14
Q

What is the recommended follow up time for an enamel-dentine fracture?

A

6-8 weeks and then 1 year

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15
Q

Which type of fracture is an enamel-dentine-pulp fracture?

A

complicated - exposed pulp

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16
Q

What degree of mobility and sensibility should be expected in a complicated fracture?

A

+++ sensibility but no mobility

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17
Q

What should be used to investigate a complicated crown fracture?

A

PA radiograph +/- soft tissue

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18
Q

Depending on the time and extent of injury, what are the 2 treatment options for a complicated crown fracture?

A

1 - direct pulp cap (IF LESS THAN 24 HRS OR <1MM)
2 - pulpotomy

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19
Q

What is the recommended follow up time for a complicated crown fracture?

A
  • 6-8 weeks
  • 3 months
  • 6 months
  • 1 year
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20
Q

When should a direct pulp cap be used for a complicated crown fracture?

A

If the injury was less than 24 hours ago OR the fracture is less than 1mm.

(also use for pulpal blush in uncomplicated fractures)

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21
Q

Which materials would be used for a direct pulp cap in the instance of a complicated fracture?

A

setting CaOH (dycal) and a composite bandage / reattachment of fragment.

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22
Q

When would a partial pulpotomy be indicated in a complicated fracture?

A

If the injury was over 24 hours ago or the fracture is over 1mm.

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23
Q

What is the success rate of a pulpotomy?

(also known as vital pulp therapy or partial pulpotomy)

A

97%

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24
Q

Outline the steps for a pulpotomy.

A
  1. LA & rubber dam
  2. remove coronal pulp (round diamond bur)
  3. reach healthy pulp tissue (controlled bleeding under pressure)
  4. achieve haemostasis with cotton wool and saline
  5. calcium hydroxide / MTA dressing placed in contact with tissue (not clot)
  6. GIC
  7. composite restoration
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25
Q

Which tooth structures are involved in a crown-root fracture?

A
  1. enamel
  2. dentine
  3. cementum
    +/- pulp
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26
Q

What should be used to investigate a crown-root fracture?

A

PA radiographs and and occlusal.

(done to assess where the fracture is)

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27
Q

What are the 2 phases of treatment for a crown-root fracture?

A
  1. acute treatment - initial management
  2. referral to paeds specialist
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28
Q

For acute treatment of a crown-root fracture, how is this done by a GDP?

A

stabilise the mobile fragment with GIC or if it is very loose, remove the fragment and place GIC / composite bandage +/- direct pulp cap.

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29
Q

What is the recommended follow up for a crown-root fracture?

(6 steps)

A
  • 1 week
  • 6-8 weeks
  • 3 months
  • 6 months
  • 1 year
  • yearly for 5 years
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30
Q

Specialist management of a crown-root fracture:

A
  1. remove fractured coronal portion and inspect for restorability and pulp exposure.
  2. pulpotomy and restore (fracture margin must be supragingival before definitive restoration)
  3. if subgingival, the margin can be exposed either by orthodontic extrusion or gingivoplasty.
  4. extraction and partial denture for space maintenance.
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31
Q

Describe a root fracture.

A

A fracture confined to the root of the tooth.

(involves cementum, dentine and the pulp)

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32
Q

Which 2 things do you note when diagnosing a root fracture?

A
  1. location on the root (apical, middle, coronal)
  2. direction of fracture line (horizontal, oblique, vertical)
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33
Q

What kind of sensibility response is to be expected in a root fracture?

A

TTP but -ve to sensibility.

34
Q

Which type of colour changes are common in root fractures?

A

red or grey (due to bleeding in the pulp chamber)

35
Q

Which types of radiographs should be taken for a root fracture?

A

PA and occlusal (to see the position of the fracture)

36
Q

What is the recommended GDP treatment for a root fracture?

A

splinting if mobile and refer to a specialist

37
Q

If the root fracture is in the apical / middle third, how long should it be splinted for?

A

4 weeks

38
Q

If the root fracture is in the coronal 1/3 of the root, how long should it be splinted for?

A

4 MONTHS

39
Q

What is the recommended follow up for a root fracture?

(6 steps)

A
  1. 4 weeks
  2. 6-8 weeks
  3. 4 months
  4. 6 months
  5. 1 year
  6. yearly for 5 years

(take radiographs at each review)

40
Q

As a GDP, how would you treat a root fracture?

A
  1. reposition the displaced portion
  2. check radiographically
  3. splint for 4 weeks - 4 months (depending on the position of the fracture)
41
Q

As a GDP, what should your next steps be if you are unable to reposition a root fracture?

A

splint as best you can and URGENTLY REFER

42
Q

Specialist root fracture treatment if tooth becomes non-vital:

A

RCT up to fracture line -
treat as though it is a short root (requires apical barrier to be placed)

43
Q

Specialist treatment for root fracture if fragment lost or requires removal:

A
  1. extract coronal fragment
  2. extirpate and dress remaining root canal
  3. definitive options - extrude remaining root, RCT and post-crown / root burial / extraction.
44
Q

Describe a concussion injury:

A

Injury to the tooth supporting structures, no mobility or displacement.

(often just TTP)

45
Q

What is the difference between a subluxation and concussion injury?

A

Concussion injury is an injury to the supporting structures with no mobility or displacement.
WHEREAS
Subluxation is injury to the tooth supporting structures WITH mobility but no displacement.

46
Q

How would you treat a subluxation with marked mobility?

A

Place a flexible splint for up to 2 weeks.

47
Q

What is the recommended follow up for a concussion injury?

(2 steps)

A

4 weeks and then 1 year

48
Q

What is the recommended follow up for a subluxation injury?

(4 steps)

A

2 weeks
12 weeks
6 months
1 yearly

49
Q

Why is there no long term follow up for a concussion / subluxation injury?

A

As this is a minor injury.

50
Q

Describe an extrusion injury.

A

Partial displacement of a tooth out of its socket.

51
Q

What is the typical presentation of an extrusion injury?

A
  • Tooth appears elongated and mobile.
  • TTP
  • negative to sensibility testing
  • interference with occlusion
52
Q

Which radiographs should be requested for an extrusion?

A

PA and occlusal - check positioning from different angles.

53
Q

As a GDP, how would you treat an extrusion injury?

A
  1. reposition (gauze and axial finger pressure)
  2. radiograph to check positioning
  3. place a flexible splint for 2 weeks
54
Q

What are the recommended follow up times for an extrusion?

A

2 weeks
4 weeks
8 weeks
3 months
6 months
1 year AND then yearly for 5 years

55
Q

If unable to reposition fully, what should your next steps be as a GDP?

A

Reposition and splint as best as you can and urgently refer to a paeds specialist.

56
Q

Specialist management of extrusion:

A
  • orthodontic forces used to reposition the tooth gradually.
  • RCT required if tooth becomes non-vital.
57
Q

Prognosis would be more favourable in which type of apex?

A

Immature (open) -
however pulp canal obliteration is possible.

58
Q

Describe lateral luxation.

A

Displacement of the tooth in a labial or palatal direction.

59
Q

Which type of injury is a lateral luxation commonly associated with?

A

Alveolar fracture.

60
Q

On examination, how does a lateral luxation commonly present?

A

Displaced and firm, TTP with occlusal interference.

61
Q

How would a lateral luxation be expected to respond to sensibility testing and why?

A

Negatively -
due to the nerve supply being severed.

62
Q

GDP treatment for lateral luxation:

A
  1. repost on under LA (disengage from bony lock)
  2. radiograph to check positioning
  3. flexible splint for 4 weeks
63
Q

At 2 weeks, how does the approach to lateral luxation differ between teeth with open and closed apices.

A

OPEN: monitor for loss of vitality
CLOSED: extirpate and dress with CaOH

64
Q

What is the recommended follow up time for a lateral luxation?

(6 steps)

A

2 weeks
4 weeks
8 weeks
3 months
6 months
1 year and then annually for 5 years

65
Q

Describe intrusion.

A

Displacement of the tooth into the alveolar bone.

66
Q

What is the characteristic sound made by an intruded tooth upon TTP?

A

metallic sound

67
Q

How would intrusion be managed by a GDP?

A
  1. monitor for re-eruption OR surgically reposition.
  2. REFER to paeds specialist
  3. extirpate pulp of closed apex teeth at 2 weeks
68
Q

What does an intrusion injury leave the patient susceptible to?

(think pulp side effects)

A

replacement and inflammatory root resorption

69
Q

How far intruded must a tooth be to warrant spontaneous eruption?

A

up to 3mm - works best with open apices as they’re still developing.

70
Q

At what stage of presentation would orthodontic repositioning be considered?

A

delayed presentation / treatment

71
Q

How does orthodontic repositioning work in terms of treating intrusion?

A

Enables the repair of marginal bone in the socket along with the slow repositioning of the tooth.

72
Q

What is the splint time for intrusion?

A

4 weeks

73
Q

Describe avulsion.

A

Complete displacement of the tooth out of the socket.

74
Q

What are the 2 other differential diagnoses when a pt presents with an avulsed tooth?

A
  1. intrusion
  2. root fracture
75
Q

Which 4 factors impact the prognosis of an avulsed tooth?

A
  1. extra-oral time (time it’s been outside the mouth)
  2. extra-oral dry time
  3. storage medium (what it’s been kept in)
  4. maturity of apex
76
Q

Immediate management for avulsion.

A

ONLY REPLANT PERMANENT TEETH
1. handle the crown only
2. replant if possible and as soon as.
3. record the time it came out
4. store in saliva/sulcus/milk/saline if can’t
5. avoid water (causes lysis)

77
Q

6 contraindications to replantation:

A
  1. if there’s another medical priority
  2. immunocompromised / cardiac condition (infective endocarditis)
  3. avulsed tooth is extensively damaged
  4. damage to the socket preventing replantation
  5. lack of cooperation
  6. lost tooth - MAKE SPACE MAINTAINER
78
Q

GDP management of an avulsed tooth:

A
  1. handle the crown and rinse gently in milk/saline
  2. replant tooth with finger pressure
  3. get child to bite on gauze
  4. check positioning and prepare splint
  5. splint for 2 weeks and radiograph (baseline)
  6. antibiotics
  7. check tetanus status
  8. open apex: monitor
    - closed apex: extirpate and dress with CaOH at 2 weeks
  9. URGENT REF TO PAEDS
79
Q

What is the characteristic appearance of an alveolar fracture?

A

several teeth moving as a unit with occlusal interference

80
Q

How long should an alveolar fracture be splinted?

A

4 weeks - prevent ankylosis

81
Q

Follow up for alveolar fracture: 5 steps, not starting at 2 weeks.

A

4 weeks - take off splint
6-8 weeks
4 months
6 months
1 year and yearly for 5 years

1. SBA (35 decks)

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