Trauma 1 Flashcards
Accidental damage to permanent teeth are more common in individuals with a large ________.
overject
OJ >9mm doubles incidence
What is the most common injury to permanent teeth?
enamel dentine fractures (uncomplicated- no pulpal involvment)
List some causes of accidental damage to permanent teeth
- falls (most common)
- bike, skateboard, RTA
- sport
- fights
Road Traffic accidents
What history should you take for the injury?
- when
- where
- how
- any other symptoms
- lost teeth or fragments
Why is the “when” an vital part of the history?
- success of the intervention is time sensitive
- assessment of PDL cell survival
What must you look out for if laceration injuries are also present?
- look for missing fragments
- other objects may be found in lacerations, look carefully
What are the key pieces of MH that should be taken in a trauma appointment?
- congenital and acquired heart abnormalities
- immunosuppression
- vaccination status - tetanus
What are the components of a DH in a trauma case?
- previous dental trauma
- treatment experience
- parent or child attitude
What may warrant the prescription of antibiotics in trauma injuries?
- soft tissue injuries
- medical history
(limited evidence for Abs in emergency luxation injuries)
What must you identify in an E/O examination for a trauma case?
- lacerations
- haematoma (bleeding outside BV)
- haemorrhage/CSF
- subjunctival haemorrhage- bleeding under eyes
- bony step deformities
- mouth opening
It is unusual for children to get bony step injuries unless it is a high impact injury. True or false. Why is this?
True
bone is more elastic
What should constitute your I/O examination for a trauma case?
- soft tissue- penetrating wounds
- alveolar bone
- occlusion- traumatic occlusion demands urgent treatment!
- teeth- mobility, displacement, root fracture, bone fracture
When completing an I/O examination, what is the benefit of using transillumination?
- caries
- pulpal involvement
- fracture lines on teeth
What information can you gather from a tactile test on teeth using a probe?
- horizontal fractures
- vertical fractures
What special investigations should you carry out in a trauma case?
- sensibility test (endofrost, ethylchloride, warm GP), EPT
- percussion
- radiographs (I/O, occlusal, OPT, soft tissue radiograph, additional angulations, CBCT)
- photographs
- compare with contralateral uninjured tooth- perform sensibility tests on contralateral tooth to see if you are getting the same response
What is the advantage of using endofrost over ethyl chloride?
- reaches lower temperatures and therefore more accurate
A duller note on a percussion test may be an indication of…
a root fracture
What is included in the trauma stamp/chart?
- mobility
- displacement
- TTP
- colour
- sinus/tender in sulcus
- thermal (ethyl chloride)
- EPT
- radiograph
Why may sensibility tests be unreliable?
this is because there may be transient loss of neuronal response
undifferentiated A-delta fibres in young teeth
What is the difference between A delta and A beta fibres?
A delta fibres- temperature and pain
A beta fibres- information related to touch
Temporary loss of sensibility is a frequent finding during post traumatic healing, especially post luxations. True or false
True
A lack of pulpal response for several months is definitively conclusive of pulpal necrosis. True or false
False
How long should you continue sensibility tests ? What is the basis of this
should continue to review for 5 years after injury
this is because a lack of response is not indicative of pulpal necrosis
What is a good predictor of long term prognosis of a tooth ?
baseline sensibility testing