Brainscape's Knowledge GenomeTM

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


See full index

paeds 4th year > review of dental trauma and sequelae > Flashcards

review of dental trauma and sequelae Flashcards

1
Q

what is clinical and radiographic presentations of loss of vitality?

A

> Clinically
- History
- Sulcus-swelling, tenderness, sinus
- Discoloured – often progressively grey
- TTP
- Mobile
- Negative to sensibility tests
- Majority are –ve immed after trauma
- Most will respond within 3 months

> Radiograph
- Periapical radiolucency
- Resorption (Int/ Ext)
- Arrested root development

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

when a tooth has loss of vitality, and you’re thinking of Endodontic therapy, how many clinical signs do you need before carrying out RCT?

A

> 2

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

what does sensibility testing test for?

A

> nerve supply, not blood supply

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

what is periapical inflammation - transient apical breakdown ?

A

> Transient apical breakdown is a sequelae of certain dental traumatic injuries where the injured tissues undergo a spontaneous process of repair with no permanent damage to the pulp. Misdiagnosis of this condition may result in unnecessary endodontic treatment

> 4% of mature teeth following luxation injuries

> Mimics apical resorption

> Ambivalent clinical + radiographic signs - delay endodontic treatment

> Monitor closely

> May be present up to 2-3 months after trauma

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

how does arrested root development occur and what are the radiographic signs?

A

> If necrosis affects root sheath before root development complete then no further growth

> Radiographically - majority- failure of pulp canal to mature and reduce in size will indicate loss of vitality

> If sequential radiographs not available compare to root development of contra lateral tooth

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

what are the categories of root resorption?

A
  1. Surface resorption
  2. Inflammatory
    a. External
    b. Internal
    c . Cervical
  3. Replacement resorption (ankylosis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is the aetiology of external inflammation?

A

> Aetiology - non vital pulp
- Mainly seen with avulsion and intrusion injuries (possible with lateral luxation, extrusion and subluxation)
- Initiated by PDL damage and propagated by necrotic pulp/ pdl

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

what is the radiographic appearance of external inflammation?

A

> Radiographically
- Punched out areas of resorption
- Loss of root surface, loss of adjacent bone, radiolucent area
- Pdl expansion
- May be evident from 3 weeks

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

what is the treatment for external inflammation?

A

> Extirpation

> debridement

> non-setting Calcium hydroxide

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

what is the aetiology of internal inflammation?

A

> chronic pulpal inflammation

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

what is the radiographic presentation of internal inflammation ?

A

> ballooning of walls of root canal

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

what is the progression of internal inflammation like?

A

> rapid, may cause perforation of root surface

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

what is the treatment of root resorption?

A

> extirpation

> debridement

> Non-setting Calcium Hydroxide dressing

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

what is cervial resorption?

A

> Damage to root surface in cervical region

> Propagated by necrotic pulp or perio disease

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

what is the treatment for cervical resorption?

A

> Curette defect and

> restore +/-RCT

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

what is the aetiology behind replacement resorption (ankylosis) ?

A

> extensive damage to PDL and cementum (Intrusion/avulsion)

> Results in bony union between alveolar socket and root surface

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

what is the radiographic appearance of replacement resorption (ankylosis) ?

A

> Loss of periodontal space, bone in direct contact with root

> Usually evident within 2 mths -1 yr

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

what is the clinical test which allows you to confirm ankylosis?

A

> detected by distinctive high “metallic” note on percussion

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

what is the treatment for ankylosis?

A

> no effective treatment

> Extraction/root burial

> Cannot be moved orthodontically

20
Q

what is pulp can obliteration and when’s it more common?

A

> Progressive hard tissue formation within pulp cavity – narrowing of root canal
- Thin thread of pulp tissue remains

> More common in immature teeth and following luxation injuries

21
Q

what is the clinical appearance of a tooth with pulp canal obliteration?

A

> Opaque/ yellow crown

> Reduced response to vitality testing

22
Q

what is the treatment for pulp canal obliteration?

A

> conservative approach

23
Q

what is the follow up for trauma injuries?

A

> Varies by injury in guidelines

> See IADT guidelines (essential reading)

> May increase if equivocal findings

24
Q

when carrying out a trauma review what are key signs to look out for with regards to colour and soft tissues?

A

colour =
- Grey/brown- pulp necrosis
- Yellow- pulp canal obliteration
- Pink- internal resorption, bleed into dentine

soft tissues =
- Swelling
- Tenderness
- Erythema
- Sinus

25
Q

when carrying out a trauma review what are you assessing regards to mobility and TTP/ tone?

A

mobility =
- Assess between 2 ends of metal instrument
- One labial, one palatal
- Vertical

TTP/ tone =
a. Check TTP with metal instrument
> Vertical
b. Tone
> Hi = Replacement resorption or intrusion
> Cracked cup = root fracture

26
Q

when carrying out a trauma review how do you carry out an ethyl chloride and electrical pulp test? |(sensibility testing)

A
  1. ethyl chloride =
    - Cotton wool held in tweezers applied to centre of labial surface of tooth (Avoid gingivae)
    - Newly erupted teeth may not respond
    - May need repetitions for reliability in children
    - After injury up to 3/12 for response
  2. electric pulp testing =
    - Isolate teeth with cotton wool
    - Lip electrode applied
    - Tip dipped in toothpaste
    - Raise hand on first sensation
    - Avoid any restorations
27
Q

when carrying out a trauma review what are key things to record in regards to the radiograph report and RCT?

A
  1. Radiograph report =
    - Findings especially
    - Periapical pathology
    - Root development
    - Periodontal ligament space
    - Marginal bone levels
    - Root canal outline
  2. RCT
    - ongoing
    - obturated
28
Q

what is uncomplicated crown fractures and what is the prognosis?

A

> Fractures confined to enamel/dentine

> Prognosis =
- Pulp necrosis 54% if no dentinal coverage, 8% if dentine protected

29
Q

what is the treatment for complicated crown fracture and what is the success rate?

A

> Apexogenesis procedure - Vital/Cvek pulpotomy

> Success rates 80 – 96%
- Better prognosis than direct pulp cap for immature permanent teeth exposed>24 hrs

30
Q

what are the 5 year survival rates for each type of trauma?

A
  1. Concussion
    - open apex = 100%
    - closed apex = 96%
  2. Subluxation
    - open apex = 100%
    - closed apex =85%
  3. Extrusion
    - open apex = 95%
    - closed apex =45%
  4. Lateral lux
    - open apex = 95%
    - closed apex =25%
  5. Intrusion
    - open apex = 40%
    - closed apex =0
  6. Avulsion
    - open apex = 18-34% (time and storage dependent)
    - closed apex =0
31
Q

what are the outcomes after intrusion?

A
  1. Normal healing
    - open apex = 33
    - closed apex = 0
  2. Inflammatory resorption
    - open apex =41
    - closed apex =35
  3. Replacement resorption
    - open apex =10
    - closed apex =31
32
Q

what is healing influenced by in root fractures?

A

> Position of fracture line

> Degree of displacement of coronal fragment
- Necrosis of pulp usually only coronal fragment and coronal to #line

> Coronal fracture

33
Q

what are the healing outcomes of a root fracture?

A

> Hard tissue formation

> Fibrous

> Bone and connective tissue

> Non-union-inflammatory/granulation
- Necrosis of coronal portion

34
Q

what is the survival rate of a root fractured tooth across ten year?

A

> apical 1/3 = 100%

> middle 1/3 = 75%

> gingival 1/3 = >50%

(prognosis increases as distance from gingival margin decreases)

35
Q

what are avulsion outcomes?

A

> Extra – oral time is critical

> Storage medium important
- Dry storage - decreases prognosis
- Contamination – decreases prognosis

> Prolonged splint time increases replacement resorption

> PDL survival is critical- resorption at 1year best predictor of survival

> Pulp death is less important

36
Q

why is informed consent important during a trauma case?

A

> Severe injuries – intrusions/avulsions
- At least 8 – 12 visits
- Time off school / parents work
- Cost to NHS

> Unpredictable outcome

> consider treatment options carefully

> Parents must be fully informed regarding nature of injuries, treatment, sequelae and long term prognosis

37
Q

what are the most common complications to primary teeth as a result of trauma?

A
  1. Pulpal necrosis – commonest complication
  2. Root resorption
  3. Pulpal canal obliteration
  4. Replacement resorption
38
Q

what is the clinical presentation of pulp necrosis in the primary dentition?

A

> Grey colour/ sulcus/ history/ mobile/ TTP

> Transient - intrapulpal bleed
- vital tooth, colour resolves
- persists, implies non vital (but may be uninfected)

39
Q

what are the radiographic features of plural necrosis in the primary dentition?

A

> Failure of pulp cavity to reduce

> Periapical area

40
Q

what is the treatment for plural necrosis in primary dentition?

A

> Extraction recommended

> Endodontic treatment occasionally- specialist

> Options discussed with parent
- Informed consent

41
Q

how does a pulp canal obliteration present in the primary dentition?

A

> clinically = yellow/ opaque crown

> radiographically = pulp canal narrowing

42
Q

what is the treatment of pulp canal obliteration in the primary dentition?

A

> Usually exfoliates

> If periapical inflammation - recommend extraction

> Discuss with parents – informed consent

43
Q

how does replacement resorption/ ankylosis present in primary teeth?

A

> Clinically
- Below occlusal level
- Ensure no non-nutritive sucking

> Radiograph
- Confirm presence of replacement resorption
- Assess position of permanent tooth

44
Q

what is the treatment of replacement resorption/ ankylosis?

A

> Monitor - may resorb

> Extraction
- If pathology, delayed eruption, displacement

45
Q

what injuries can occur to developing dentition following trauma to primary teeth?

A

> Hypomin/ hypoplasia of enamel

> Crown / root dilaceration

> Odontoma – like formation

> Root duplication

> Arrest of root development

> Disturbance in eruption

> Sequestration of tooth germ

( - Studies suggest 12 – 69% of primary trauma affect successor
- Depends on type and severity of injury, high with intrusions
- Most damage occurs before 3 yrs of age during its developmental stage )

paeds 4th year (12 decks)

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