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Paediatric Dentistry > Permanent tooth trauma > Flashcards

Permanent tooth trauma Flashcards

1
Q

Which teeth are susceptible to trauma?

A

Upper anteriors

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2
Q

What type of malocclusion is susceptible to trauma?

A

Proclined upper incisors - class 2 div 1

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3
Q

First aid advice for PERMANENT tooth trauma

A
  • Handle the tooth by the crown only
  • Wash in water if visible debris
  • Try to reimplant the tooth or store in milk, saliva or in mouth
  • Visit emergency dentist
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4
Q

Post-op instructions for the reimplanted permanent tooth

A
  • No contact sports for 2 weeks
  • OTC analgesics for pain relief
  • Soft diet 2 weeks
  • CHX mouthwash for 1 week
  • Careful OHI
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5
Q

When to recall a patient after reimplanted permanent tooth

A
  • in 24 hours to assess stability

- in 7-10 days to assess pulp vitality, radiograph and rct (mature tooth)

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6
Q

Emergency management of avulsed permanent tooth that is not replanted

A
  • Rinse blood clot and any if any bony socket modifications are required
  • Replant slowly with slight digital pressure
  • Suture any lacerations
  • Take radiograph to confirm correct position
  • Splint
  • Systemic antibiotics if required
  • Tetanus protection
  • Post op instructions and recall
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7
Q

What determines the prognosis of reimplanted tooth?

A
  • Open apices have a better prognosis
  • Short extra-oral time
  • Transported in socket
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8
Q

What is a splint?

A

Rigid or flexible device or compound used to support, protect or immobilise a tooth that has been loosened, reimplanted, fractured or subject to endo surgical procedures.

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9
Q

What are the aims of splinting?

A

Stabilise the tooth to allow optimum healing of the PDL or repair of a root fracture

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10
Q

What are the two categories of splints?

A

Flexible / functional-physiologic

Rigid

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11
Q

Describe the function of flexible splints

A

Allows physiological mobility of the teeth to promote healing of the PDL and discourage replacement resorption

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12
Q

How many abutments do flexible splints require?

A

One tooth either side of the injured tooth

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13
Q

When are rigid splints indicated?

A

Cervical third root fracture and dentoalveolar injuries

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14
Q

How many abutments do rigid splints require?

A

Two teeth either side of the injured tooth

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15
Q

Ideal properties of a splint

A
  • Stabilises tooth and maintains stabilisation throughout
  • Simple to place and remove
  • no additional trauma to tooth or tissues
  • Allows physiologic mobility
  • No occlusal interference
  • Easy to clean
  • Aesthetically acceptable
  • Able to carry out endo/sensibility testing
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16
Q

List examples of flexible splints

A
  • composite wire splint
  • Ortho brackets and wire
  • Fibre splint
  • Titanium trauma splint
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17
Q

What injuries require a 4-week splinting period

A
  • Lateral luxation
  • Intrusions
  • Avulsion without EOT >60 mins
  • Apical or mid 1/3 root fractures
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18
Q

What injuries require a 2-week splinting period?

A

Extrusion

Avulsion with EOT <60 mins

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19
Q

How long does a cervical root fracture need to be splinted

A

4 months

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20
Q

Management of enamel-dentine fracture

A
  • GIC bandage (temp) as emergency tx

- Restore

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21
Q

What is a GIC bandage

A

Temporary GIC restoration placed to prevent the ingress of bacteria through dentine tubules to the pulp

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22
Q

What is a complicated fracture

A

Fracture involving the enamel, dentine and pulp

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23
Q

Aims of treating a complicated fracture of a immature permanent incisor

A

Maintain pulp vitality so the immature tooth continues root development and maturation

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24
Q

Define apexogenesis

A

Treatment of a vital pulp via pulp capping or pulpotomy to allow continued root growth and closure of the open apex

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25
Q

What does the prognosis of pulp therapy depend on?

A
  • Associated PDL injury
  • Extent of exposed dentine
  • Age of pt (open or closed apex)
  • Time since injury
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26
Q

Indications fo Cvek pulpotomy

A

Traumatic pulp exposure of immature permanent teeth

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27
Q

Method of Cvek pulpotomy

A
  • access through exposed surface
  • Remove 2-3mm of pulp tissue with high speed
  • Arrest haemorrhage
  • Irrigate
  • Dress pulp (NS CAOH or MTA)
  • Restore
28
Q

Define apexification

A

Inducing a calcified barrier in a non-vital immature tooth (open apices)

29
Q

Indications for apexification

A

Non-vital tooth with open apices

30
Q

How long can the calcific barrier take to form in apexification

A

up to 9 months

31
Q

Management of pulp exposure of a mature permanent incisor

A

Direct pulp cap
Pulpotomy
Pulpectomy
Conventional RCT

32
Q

Management of an avulsed mature permanent tooth

A

ALWAYS REQUIRES RCT as the apex is closed

33
Q

Why are splints placed labially

A
  • Prevents occlusal interference

- Allows access palatally for endo

34
Q

How is an avulsed mature permanent incisor retained

A

Due to ankylosis

35
Q

Emergency management of avulsed tooth that was replanted

A
  • Leave in place
  • Clean with water, saline or chx
  • Suture gingival lacerations
  • RG to confirm position
  • Splint for 2 weeks
  • AB + tetanus
  • Post op instructions
  • Recall
36
Q

Management for delayed replantation

A

Remove attached non-viable soft tissue with gauze
RCT prior to replantation
Fluoride application on the root

37
Q

Why apply fluoride to the root in delayed replantation

A

Can slow down osseous replacement of the tooth

38
Q

What is the aim of delayed replantation

A

Maintain alveolar bone height

39
Q

Why has delayed replantation have a poor prognosis

A

All PDL cells are non-viable after >60 mins dry time

40
Q

Difference between replanting immature and mature permanent teeth

A

All mature teeth will require rct whereas immature have the ability to revascularise

41
Q

What is the aim of replanting an immature permanent tooth?

A

Maintain pulp vitality and allow continued root development

42
Q

Contraindications for replantation

A
  • Extensive caries
  • Perio disease
  • Non-cooperative pt
  • Severe cardiac conditions
43
Q

Tx of enamel fracture

A

Smooth sharp corners

If extensive, composite restoration for aesthetics

44
Q

Tx of ED fracture

A

GIC bandage
Consider indirect pulp cap
Restore definitively
Monitor pulp vitality

45
Q

Signs of ED fracture

A

Loss of tooth structure but no pulp exposure
Pulp testing positive
Not TTP or mobile

46
Q

Signs of EDP fracture

A

Loss of tooth structure with exposed pulp
Sensitivity to stimuli
Not TTP or mobile

47
Q

Tx of EDP fracture of an immature tooth

A

Immature - pulp cap or pulpotomy to preserve vitality

48
Q

Tx of EDP fracture of mature tooth

A

RCT preferred

Can do pulp cap or pulpotomy

49
Q

Signs of crown-root fracture

A

Fracture of enamel, dentine and cementum and extends below gingival margin

  • TTP
  • coronal fragment mobile
  • Gingival bleeding
  • Vitality testing positive for apical fragment
50
Q

Emergency tx of crown root fracture

A

Stabilise with a splint

If pulp exposure - then pulpotomy for immature and rct for mature

51
Q

Signs of root fracture

A

Coronal segment mobile and displaced
Sucular bleeding
Vitality negative initially
Transient discolouration of the crown

52
Q

Tx of root fracture

A

Reposition coronal fragment if displaced

Stabilise with splint (4 w or 4m depending on location)

53
Q

Signs of alveolar fracture

A

Segment mobile and dislocated
Several teeth move together
Misaligned teeth in alveolar segment

54
Q

Tx of alveolar fracture

A

GA, reposition segment and stabilise with splint

Monitor teeth in fragment line

55
Q

Signs of subluxation

A

TTP
Inc mobility BUT NO DISPLACEMENT
Sucular bleeding
Vitality initially negative

56
Q

Tx of subluxation

A

Monitor pulp vitality

Can splint to reduce discomfort

57
Q

Signs of lateral luxation

A 
Tooth displaced palatally or labially 
Fracture of alveolar process 
Immobile 
Metallic sound on percussion 
Vitality negative
58
Q

Tx of lateral luxation

A

No occlusal interference = monitor for spontaneous repositioning
Occlusal interference - reposition and splint 4 weeks

RCT if necrosis occurs

Severe - extract

59
Q

Signs of intrusion

A

Immobile
Metallic sound on percussion
Vitality negative
Shorter than other teeth

60
Q

Radiographic signs of intrusion

A

CEJ located apically to other teeth

PDL space absent from all/part of the root

61
Q

Radiographic signs of lateral luxation

A

PDL space enlarged apically

62
Q

Tx of intrusion of immature teeth

A

Minor - monitor, if no spontaneous repositioning then carry out ortho repositioning
- >7mm intrusion - reposition surgically or w ortho with 4 week splint

63
Q

Signs of extrusion

A

Elongated tooth
Very mobile
Bleeding
Vitality negative

64
Q

Radiographic signs of extrusion

A

PDL widened apically

65
Q

Tx of extrusion

A

If minor and mobile - intrude gently and splint

RCT indicated if pulpal necrosis occurs

66
Q

Tx intrusion of mature teeth

A

Minor - allow spontaneous eruption, if nothing then reposition surgically or orthodontically

If 3-7+mm - reposition surgically or ortho and splint

RCT usually required

67
Q

When is RCT carried out after repositioning of intruded teeth

A

2-3 weeks

Paediatric Dentistry (11 decks)

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