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Clinical Knowledge 2 > Trauma 1 > Flashcards

Trauma 1 Flashcards

1
Q

Accidental damage to permanent teeth are more common in individuals with a large ________.

A

overject
OJ >9mm doubles incidence

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2
Q

What is the most common injury to permanent teeth?

A

enamel dentine fractures (uncomplicated- no pulpal involvment)

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3
Q

List some causes of accidental damage to permanent teeth

A
  • falls (most common)
  • bike, skateboard, RTA
  • sport
  • fights

Road Traffic accidents

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4
Q

What history should you take for the injury?

A
  • when
  • where
  • how
  • any other symptoms
  • lost teeth or fragments
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5
Q

Why is the “when” an vital part of the history?

A
  • success of the intervention is time sensitive
  • assessment of PDL cell survival
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6
Q

What must you look out for if laceration injuries are also present?

A
  • look for missing fragments
  • other objects may be found in lacerations, look carefully
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7
Q

What are the key pieces of MH that should be taken in a trauma appointment?

A
  • congenital and acquired heart abnormalities
  • immunosuppression
  • vaccination status - tetanus
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8
Q

What are the components of a DH in a trauma case?

A
  • previous dental trauma
  • treatment experience
  • parent or child attitude
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9
Q

What may warrant the prescription of antibiotics in trauma injuries?

A
  • soft tissue injuries
  • medical history

(limited evidence for Abs in emergency luxation injuries)

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10
Q

What must you identify in an E/O examination for a trauma case?

A
  • lacerations
  • haematoma (bleeding outside BV)
  • haemorrhage/CSF
  • subjunctival haemorrhage- bleeding under eyes
  • bony step deformities
  • mouth opening
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11
Q

It is unusual for children to get bony step injuries unless it is a high impact injury. True or false. Why is this?

A

True
bone is more elastic

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12
Q

What should constitute your I/O examination for a trauma case?

A
  • soft tissue- penetrating wounds
  • alveolar bone
  • occlusion- traumatic occlusion demands urgent treatment!
  • teeth- mobility, displacement, root fracture, bone fracture
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13
Q

When completing an I/O examination, what is the benefit of using transillumination?

A
  • caries
  • pulpal involvement
  • fracture lines on teeth
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14
Q

What information can you gather from a tactile test on teeth using a probe?

A
  • horizontal fractures
  • vertical fractures
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15
Q

What special investigations should you carry out in a trauma case?

A
  • 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
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16
Q

What is the advantage of using endofrost over ethyl chloride?

A
  • reaches lower temperatures and therefore more accurate
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17
Q

A duller note on a percussion test may be an indication of…

A

a root fracture

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18
Q

What is included in the trauma stamp/chart?

A
  • mobility
  • displacement
  • TTP
  • colour
  • sinus/tender in sulcus
  • thermal (ethyl chloride)
  • EPT
  • radiograph
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19
Q

Why may sensibility tests be unreliable?

A

this is because there may be transient loss of neuronal response

undifferentiated A-delta fibres in young teeth

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20
Q

What is the difference between A delta and A beta fibres?

A

A delta fibres- temperature and pain

A beta fibres- information related to touch

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21
Q

Temporary loss of sensibility is a frequent finding during post traumatic healing, especially post luxations. True or false

A

True

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22
Q

A lack of pulpal response for several months is definitively conclusive of pulpal necrosis. True or false

A

False

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23
Q

How long should you continue sensibility tests ? What is the basis of this

A

should continue to review for 5 years after injury
this is because a lack of response is not indicative of pulpal necrosis

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24
Q

What is a good predictor of long term prognosis of a tooth ?

A

baseline sensibility testing

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25
Q

In the first month/so of an injury, what can be observed in the periapical area? Is this a cause for concern?

A

transient apical breakdown

this is a normal sign

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26
Q

Arrested root development always indicated a loss of vitality. True or false

A

false
arrested root development does not necessarily mean loss of vitality

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27
Q

What is a sign of continued vitality of a traumatised tooth?

A

root canal obliteration

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28
Q

What is root canal obliteration?

A
  • pulpal response to trauma
  • characterised by rapid deposition of mineralised tissue in the root canal space
  • this is an indication of vitality and blood continues to carry minerals to the pulpal space
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29
Q

What are some indications of a loss of vitality to a tooth?

A
  • PDL widening
  • arrested root development (not always)
  • TTP
  • slight tenderness in buccal sulcus
  • poor response to sensibility testing- nerves dying off due to damaged blood supply?
  • discolouration- yellow, pink, dark/grey
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30
Q

What signs show an OBVIOUS loss of vitality?

A
  • periapical radiolucency
  • infection
  • pain
  • inflammatory resorption
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31
Q

What are the classifications of crown and root fractures

A
  • enamel fracture
  • uncomplicated enamel-dentine fracture
  • complicated enamel-dentine fracture
  • uncomplicated crown-root fracture
  • complicated crown-root fracture
  • root fracture (apical 1/3, mid 1/3, coronal/gingival 1/3)
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32
Q

What does the prognosis of crown and root fractures depend on?

A
  • age of child, mature/immature tooth (open or closed apex)
  • type of injur
  • combination of two types of injury on same tooth- negative synergistic effect
  • time between treatment and injury
  • presence of infection
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33
Q

What are the aims and principles of treatment in emergency management?

A
  • try and retain vitality by protecting exposed dentine
  • treat exposed pulp tissue
  • reduction in mobilisation of displaced teeth
  • tetanus prophylaxis
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34
Q

What are the aims and principles of treatment in intermediate management?

A
  • pulp treatment (if indicated)
  • restoration- minimally invasive e.g. acid etch restoration
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35
Q

What are the aims and principles of treatment in permanent management?

A
  • apexification
  • root filling +/- root extrusion
  • gingival and alveolar collar modification if required
  • coronal restoration
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36
Q

What is apexification?

A
  • apexification is for non-vital teeth (no blood supply)
  • induction of the development of a root apex in immature tooth by the formation of osseo-cementum (bone like tissue)
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37
Q

When would gingival/alveolar collar modification be required?

A
  • this is soft tissue surgery
  • soft tissue surgery around the tooth to allow a restoration to be placed
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38
Q

What is an infraction?

A

this is an incomplete enamel fracture with no tissue loss

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39
Q

What is an enamel fracture?

A

fracture of tooth confined to enamel wit loss of tooth structure

40
Q

What is an enamel dentine fracture?

A

fracture confined to enamel and dentine with tooth loss, without pulpal involvement

41
Q

What is a complicated fracture?

A

a fracture with pulpal involvement

42
Q

What investigations are required for an enamel- dentine fracture?

A
  • PA radiograph
  • evaluate pulp size and stage of development
  • sensibility test
43
Q

What is the treatment for an enamel dentine fracture?

A
  • CaOH base if fracture is within 0.5mm of pulp
  • restore with either: rebonding of fragment/composite dressing
44
Q

When rebonding a tooth fragment, what must you do?

A

rehydrate the fragment in water or saline for 20 minutes before rebonding the tooth fragment

45
Q

How would you go about monitoring an enamel dentine fracture?

A
  • clinical test- trauma stamp
  • sensibility test (thermal and electrical)
  • radiographs
46
Q

When should you perform sensibility tests for enamel dentine fractures?

A
  • at time of injury
  • 1 month
  • 3 months
  • 6 months
  • 1 year
  • yearly for 5 years
47
Q

Radiographic assessment following an enamel denting fracture involves…

A
  • assessing root development- width and length of canal
  • comparison to contralateral side
  • internal and external inflammatory resorption
48
Q

What is the treatment of a complicated enamel dentine fracture dependent on?

A
  • size of exposure
  • time since exposure
49
Q

The prognosis of a complicated enamel dentine fracutre is also dependent on …

A

any associated luxation injuries (negative synergistic effect)

50
Q

What is the treatment of a complicated enamel dentine fracture with a small exposure within 24 hours of the trauma?

A
  • direct pulp cap with CaOH
  • then hermetic seal with composite

MTA can be used instead of CaOH however it causes discolouration

51
Q

What is the treatment option for a complicated enamel dentine fracture with a large exposure or more than 24 hours since trauma?

A
  • pulpotomy- full or partial (cvek) pulpotomy with bioceramic (biodentine/white MTA)
  • hermetic seal using composite
52
Q

What is the treatment should be provided for a complicated enamel- dentine fracture where there is a larger exposure with no vital tissue in remaining portion?

A
  • open apex tooth: pulpectomy, nonsetting CaOH first then MTA/biodentine to produce apical stop THEN obturate
  • closed apex tooth: pulpectomy and conventional RCT
53
Q

A pulpotomy is a treatment option for teeth that are _______ after trauma.

A

vital

54
Q

How would you decide on where or not to perform a full or partial pulpotomy?

A

this is clinical decision based on the state of the pulp when once you assess the tooth

55
Q

You should alwasy start with a partial pulpotomy first. True or false

A

true

56
Q

Briefly describe the process of a cvek (partial) pulpotomy

A
  • LA and rubber dam
  • pulp tissue (2-3mm) excised with a diamond bur
  • normal bleeding stops with moist cotton wool
  • rinse gently with sterile saline
  • apply bioceramic/calcium hydroxide to pulp
  • hermetic seal with composite
57
Q

When should you proceed to doing full coronal pulpotomy in a trauma case?

A
  • no bleeding at all (necrosis)
  • uncontrollable bleeding (hyperaemic)
58
Q

Briefly outline the process of a full coronal pulpotomy

A
  • excise all pulp chamber with excavator/round bur
  • normal bleeding stops with moist cotton wool then you are okay to proceed
  • rinse gently with sterile saline
  • apply bioceramic/CaOH to dress the pulp
  • hermetic seal with composite
59
Q

What is the follow up for assessment following a pulpotomy (partial/full)

A
  • 1 month
  • 3 months
  • 6 months
  • 1 year
  • then every year for 5 years
60
Q

Following a pulpotomy, there are signs of non vitality, what should you do?

A

proceed to pulpectomy

61
Q

What is the main aim of a pulpotomy following a trauma case?

A

keep vital pulp tissue within the canal to allow normal rooth growth (apexogenesis)

62
Q

What is the success rate of partial (cvek) pulpotomies?

A

97%

63
Q

What is the success rates for full coronal pulpotomies?

A

*75% success

64
Q

Outline the process of a pulpectomy

A
  • rubber dam (clamp free in children); LA not usually needed
  • access
  • irrigate with hypochlorite
  • diagnostic radiograph for WL
  • file 2mm short of estimated working length
  • dry canal, non setting CaOH, cotton wool, GIC
  • MTA/ biodentine for apical barrier
  • obturate (GP backfill)
65
Q

What are the advantages of using MTA?

A
  • sets in a wet environment
  • good sealing properties
  • easy to visualise radiographically
  • not soluble
  • inert- does not react with other materials
  • some antibacterial properties (pH- 12)

remember CaOH remains soluble in wet environment

66
Q

What are options for definitive coronal restorations following an enamel dentine fracture?

A
  • composite dowel core- bonded composite short way down canal as well as in access cavity
  • bonded core
  • crown
  • try to avoid post crown
  • go from most conservartive to least concservative
67
Q

How are root fracture classified ?

A
  • apical, mid or coronal third fracture
  • displaced or undisplaced
  • mature or immature (closed or open apex)
68
Q

The prognosis of a root fracture depends on…

A
  • age of child- open or closed apex
  • degree of displacement
  • combination of two different types of injuries on same tooth (negative synergistic effect)
  • time between injury and treatment
  • presence of infection
69
Q

What should the clinical examination of a root fracture include?

A
  • trauma stamp - mobility, displacement, TTP, colour, radiograph, thermal, EPT, sinus/tender in sulcus

Occlusion must also be checked in a root fracture; traumatic occlusion must be resolved!

70
Q

What investigations should be carried out for root fractures?

A
  • sensibility tests- ethylchloride, EPT
  • radiographs - periapical, upper standard occlusal
71
Q

Why must radiographs for root fractures be from at least two angles?

A
  • this is because you may not necessarily see a fracture in one plane, they may become more evident in another plane
72
Q

What treatment should be provided for an undisplaced, non- mobile root fracture?

A
  • soft diet
  • monitor vitality
73
Q

What treatment should be provided for displaced, mobile root fracture ?

A
  • reposition
  • flexible splint
74
Q

What is the splinting time for apical/mid third root fractures?

A

splint for 4 weeks

75
Q

What is the splinting time for coronal third root fractures? Why is this?

A

splint for 4 months
this is because coronal 1/3 fractures require longer for stability

76
Q

What are the outcomes of root fracture injuries?

A
  • healing injury
  • non-healing injury
77
Q

What are the different types of evidence of healing in a healing injury?

A
  • calcified union across the fracture line
  • connective tissue
  • calcified and connective tissue
78
Q

What is the evidence of a non-healing tissue?

A

granulation tissue
associated with loss of vitality
not laying down new calfied /connective tissue a sign of loss of vitality

79
Q

Pulpal prognosis of root fracture is affected by…

A

other injuries e.g. crown dentine fracture
negative synergistic effect

80
Q

Hard tissue union in a root fracture is affected by…

A
  • non vitality
  • original displacement of the coronal part (how far is the crown moved)
81
Q

How would you treat root fractures with pulpal necrosis?

A
  • extirpate pulp to fracture line
  • dress with non setting CaOH then MTA/biodentine just coronal to fracture line
  • obturate to fracture line

((((((IF MTA/ BIODENTINE IS PRESENT to the fracture line HOWWW do you then obturate to the fracture line as well????????)))

  • the distal fragment often requires no treatment
  • remains in PDL resorbs
  • risk of infection
82
Q

What are the treatment option for the distal fragment of root if an infection is present?

A

antibiotics
apicetomy

83
Q

What is the splinting time for a subluxation injury passive-flexible splint?

A

2 weeks

84
Q

What is the splinting time for an extrusion injury passive-flexible splint?

A

2 weeks

85
Q

What is the splinting time for a luxation injury passive-flexible splint?

A

4 weeks

86
Q

What is the splinting time for an avulsion injury passive-flexible splint?

A

2 weeks

87
Q

What is the splinting time for a dento-alveolar injury with a passive-flexible splint?

A

4 weeks

88
Q

What is the thickness of the wire required for a passive flexible splint?

A

0.4mm

89
Q

A passive flexible splint should be placed…

A

labially

90
Q

What type of splint is useful when there are feew abutment teeth present?

A

Acrylic URA splint

Upper removable appliance

91
Q

What is a crown-root fracture?

A

fracture involving enamel, dentine and cementum, loss of tooth strucuture

92
Q

What is a complicated crown-root fracture?

A

fracture involving enamel, dentine, cementum with loss of tooth struture and exposure of pulp

93
Q

What are the treatment options for a crown-root fracture

A
  • extract coronal portion
  • extract whole tooth and restore space (denture, bridge)
94
Q

Following the extraction of the coronal portion of the tooth in a crown-root fracture, what are the options for treatment?

A
  • root-fill, extrude then restore (extrusion)
  • root fill if possible then cover tooth wirh mucoperiostial flap and retain. This maintains height and width of alveolus- child may become candidate for implant
95
Q

Why are you not able to place implants in children?

A
  • bone is still elastic, continued bone development
96
Q

What are the requirements of an extrusion following a crown-root fracture?

A
  • good OH, low caries rate
  • sufficient adjacent teeth
  • eventual position of the extruded tooth; crown to root ratio should not be <50:50
  • some gingival and bone contouring (removal) is often needed after extrusion

will 4-6mm of rapid extrusion over 4-6 weeks bring the fractured surface coronal to the biological width?

Clinical Knowledge 2 (40 decks)

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