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Paeds > Sequela trauma > Flashcards

Sequela trauma Flashcards

1
Q

Discuss the complications which may arise from trauma to the permanent teeth

A

Loss of vitality
Periapical inflammation
Arrest of root development
Root resorption
Inflammatory (external/internal)
Replacement
Pulp canal obliteration

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2
Q

Loss of vitality clinically

A

History
(symptoms of irreversible pulpitis)
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

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3
Q

Loss of vitality radiographically

A

Periapical radiolucency
Resorption (Int/ Ext)
Arrested root development

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4
Q

Loss of vitality treatment

A

Endodontic therapy
(At least 2 clinical signs before commencing RCT)

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5
Q

Periapical inflammation

A

Transient apical breakdown

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6
Q

Transient apical breakdown

A

> 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

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7
Q

Arrest of root development happens when

A

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

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8
Q

Arrest of root development- radiographically

A

majority- failure of pulp canal to mature and reduce in size

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

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9
Q

Root resorption
Types

A

Inflammatory (surface/external/internal/cervical)
Replacement resorption (ankylosis)

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10
Q

Root resorption- external inflammatory -aetiology

A

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

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11
Q

Root resorption- external inflammatory- radiographically

A

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

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12
Q

Root resorption- external inflammatory- treatment-

A

Extirpation, debridement, non-setting Calcium hydroxide

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13
Q

Root resorption- internal inflammatory-Aetiology

A

– chronic pulpal inflammation

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14
Q

Internal root resorption radiographically

A

Ballooning of walls of root canal

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15
Q

Root resorption- internal inflammatory- progression –

A

rapid, may cause perforation of root surface

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16
Q

Root resorption- internal inflammatory- treatment-

A

extirpation, debridement,
Non-setting Calcium Hydroxide dressing

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17
Q

Cervical resorption

A

Damage to root surface in cervical region
Propagated by necrotic pulp or perio disease
Pink spot

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18
Q

Cervical resorption- treatment

A

Curette defect and
restore +/-RCT

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19
Q

Root resorption -Replacement (Ankylosis)- Aetiology –

A

– extensive damage to PDL and cementum (Intrusion/avulsion)
Results in bony union between alveolar socket and root surface

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20
Q

Root resorption -Replacement (Ankylosis)- radiographically

A

Loss of periodontal space, bone in direct contact with root
Usually evident within 2 mths -1 yr

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21
Q

Root resorption -Replacement (Ankylosis)- clinically

A

detected by distinctive high “metallic” note

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22
Q

Root resorption -Replacement (Ankylosis)-treatment

A

– No effective treatment
Extraction/root burial
Cannot be moved orthodontically

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23
Q

Replacement resorption- See px when?

A

6 weeks post injury, 18 months, 32 months,

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24
Q

Replacement resorption- radiographically

A

difference in incisal levels

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25
Q

Pulp canal obliteration is the…

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

26
Q

Pulp canal obliteration clinically-

A

Opaque/ yellow crown
Reduced response to vitality testing

27
Q

Pulp canal obliteration- treatment-

A

Conservative approach

28
Q

Trauma follow up

A

Varies by injury in guidelines
See IADT guidelines (essential reading)
May increase if equivocal findings

29
Q

Dental trauma review

A

Date and time

30
Q

Trauma Colour

A

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

31
Q

Trauma soft tissues clinically is shown by

A

Swelling
Tenderness
Erythema
Sinus

32
Q

Trauma review mobility

A

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

33
Q

TTP/tone

A

Check TTP with metal instrument
Vertical
Tone
Hi
Replacement resorption
intrusion
Cracked cup
root fracture

34
Q

Trauma review Ethyl chloride

A

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

35
Q

Trauma review electric pulp tester

A

Isolate teeth with cotton wool
Lip electrode applied
Tip dipped in toothpaste
Raise hand on first sensation
Avoid any restorations

36
Q

Trauma review tests

A

ethyl chloride and electric pulp tester

37
Q

Uncomplicated crown fracture

A

Fractures confined to enamel and dentine

38
Q

Uncomplicated crown fracture prognosis

A

Pulp necrosis 54% if no dentinal coverage
8% if dentine protected

39
Q

Complicated crown fracture
Tx

A

Apexogenesis procedure - Vital/Cvek pulpotomy

40
Q

Complicated crown fracture prognosis

A

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

41
Q

5 year pulp survival and outcomes after intrusion

A

see tables

42
Q

Root fractures-
Healing influenced by-

A

Position of fracture line
Degree of displacement of coronal fragment
Necrosis of pulp usually only coronal fragment and coronal to #line

Coronal fracture

43
Q

Healing outcomes root fractures

A

Hard tissue formation
Fibrous
Bone and connective tissue

Non-union-inflammatory/granulation
Necrosis of coronal portion

44
Q

Survival of a tooth with a fracture

A

Prognosis improves as distance from gingival margin increases

45
Q

Avulsion Outcomes what is important and what is not

A

Extra – oral time is critical
Storage medium important

PDL survival is critical- resorption at 1year best predictor of survival
Pulp death is less important

46
Q

Avulsion Outcomes- what affects prognosis

A

Dry storage - decreases prognosis
Contamination – decreases prognosis
Prolonged splint time increases replacement resorption

47
Q

Informed consent -Severe injuries – intrusions/avulsions

A

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

48
Q

Complications of
primary teeth

A

Pulpal necrosis – commonest complication

Root resorption

Pulpal canal obliteration

Replacement resorption

49
Q

Pulpal necrosis in the primary dentition- clinically

A

Grey colour/ sulcus/ history/ mobile/ TTP
Transient - intrapulpal bleed,
vital tooth, colour resolves
persists, implies non vital (but may be uninfected)

50
Q

Pulpal necrosis in the primary dentition- radiographically

A

Failure of pulp cavity to reduce
Periapical area

51
Q

Pulpal necrosis in the primary dentition-
treatment

A

Extraction recommended
Endodontic treatment occasionally- specialist
Options discussed with parent
Informed consent

52
Q

Pulp Canal Obliteration in primary dentition- Clinically

A

yellow / opaque crown

53
Q

Pulp Canal Obliteration in primary dentition-Radiography

A

Pulp canal narrowing

54
Q

Pulp Canal Obliteration in primary dentition
Treatment

A

Usually exfoliates
If periapical inflammation - recommend extraction
Discuss with parents – informed consent

55
Q

Replacement resorption- ankylosis - Clinically

A

Below occlusal level
Ensure no non-nutritive sucking

56
Q

Replacement resorption- ankylosis -Radiographs are taken to…

A

Confirm presence of replacement resorption
Assess position of permanent tooth

57
Q

Replacement resorption- ankylosis
Treatment

A

Monitor - may resorb
Extraction
If pathology, delayed eruption, displacement

58
Q

Injuries to developing dentition following trauma to primary teeth
studies…

A

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

59
Q

Injuries to developing dentition following trauma to primary teeth
see all the photos of the labelled 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

60
Q

Injuries to developing dentition following trauma to primary teeth

A

Avulsion
Subluxation
Lateral luxation
Intrusion
Alveolar/jaw fracture
Periapical pathology

61
Q

Follow up-
Injuries to developing dentition following trauma to primary teeth-
Avulsion
Subluxation
Lateral luxation
Intrusion
Alveolar/jaw fracture
Periapical pathology

A

Monitor eruption pattern - delayed, ectopic
Advice to parents

Paeds (11 decks)

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