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Paediatrics > Trauma 1 > Flashcards

Trauma 1 Flashcards

1
Q

Whats the most common injury in primary dentition?

A

Luxation injury

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2
Q

Whats the most common injury in permanent dentition?

A

Crown fractures

- Enamel dentine fracture

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3
Q

What malocclusion increases the risk of trauma?

A

Large OJ

OJ > 9mm doubles the incidence

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4
Q

Questions to ask in the trauma hx (4)

A
  1. How did it happen?
  2. When did it happen exactly?
  3. Where are the lost teeth/fragments?
  4. Any other symptoms
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5
Q

What conditions may require additional tx for dental trauma tx?

A
  1. Rheumatic fever
  2. Congenital heart defects
  3. Immunosuppression
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6
Q

Extraoral checks for a trauma patient (6)

A
  1. Laceration
  2. Haematomas
  3. Haemorrhage/CSF
  4. Subconjunctival haemorrhage
  5. Bony step deformities
  6. Mouth opening
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7
Q

Intraoral checks for a trauma patient (4)

A
  1. Soft tissue
  2. Alveolar bone
  3. Occlusion
  4. Teeth
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8
Q

What 3 things can tooth mobility indicate?

A
  1. Displacement of tooth within socket
  2. Root fracture
  3. Bone fracture
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9
Q

When you’re doing a tactile test for trauma, what do you look for?

A
  1. Fracture lines
    - Horizontal or vertical
  2. Pulpal involvement
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10
Q

List examples of tests to undertake for a detailed intraoral exam (4)

A
  1. Sensibility tests
    Thermal: ECL or warm GP
    Electrical: EPT
  2. Percussion
    - Duller note may indicate root fracture
  3. Occlusion
    - Traumatic occlusion demands urgent tx
  4. Radiographs
    - Intraoral, occlusal, periapicals, OPT, soft tissue

CLASSIFY THE TRAUMA

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11
Q

What does sensibility testing check?

A

Nerve supply

If you have a + nerve supply then must have blood supply too

Sensibility testing confirms vitality too

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12
Q

What does vitality testing check?

A

Blood supply

Laser dopler

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13
Q

How does an ECL work?

A

Ethyl chloride placed on a cotton wool pellet and placed on the labial 3rd of the patients tooth

They then say whether they feel cold or hot

> Can do ECL with warm GP to see if they feel heat

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14
Q

How does an EPT work?

A

Electric machine you use on the labial 1/3rd of the patients tooth to stimulate an electrical impulse into the tooth

Patient lets you know when they can feel it, patient creates an electrical circuit by holding on to an EPT

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15
Q

What radiographs are used for detecting any bony fractures?

A

Occipital mental radiographs

PA mandibles

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16
Q

What teeth should be tested for sensibility + looked at in radiographs when examining an injured tooth?

A

Test adjacent and opposing teeth in adjacent to those injured

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17
Q

Why do we need to test adjacent teeth for trauma too?

A

They may have received either direct or indirect concussive injuries

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18
Q

How long should sensibility testing be continued for after injury?

A

Continue for at least 2 years after an injury

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19
Q

What does a complicated root fracture mean?

A

Pulp is involved

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20
Q

What does a non-complicated root fracture mean?

A

Pulp is not involved

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21
Q

List the different types of uncomplicated root fracture (3)

A
  1. Enamel fracture
  2. Enamel dentine fracture
  3. Crown root fracture (can be complicated/uncomplicated)
22
Q

List the different types of complicated root fracture

A
  1. Crown root fracture
  2. Root fracture
    - Apical 3rd
    - Middle 3rd
    - Coronal 3rd
23
Q

What does the prognosis depend on? (5)

A
  1. Stage of root development
  2. Type of injury
  3. If PDL is damaged too
  4. Time between injury and tx
  5. Presence of infection
24
Q

Emergency tx protocol for trauma (5)

A
  1. Retain vitality of any damaged/displaced tooth by protecting exposed dentine with an adhesive dentine bandage
  2. Treat exposed pulp tissue
  3. Reduction and immobilisation of displaced teeth
  4. Tetanus prophylaxis
  5. Antibiotics
25
Q

When would you need tetanus prophylaxis?

A

Tooth dropped in mud

26
Q

Intermediate tx protocol for trauma (2)

A
  1. Consider if pulp needs tx
  2. Restoration
    - Minimally invasive
    - E.g. acid etch restoration
27
Q

Permanent tx protocol for trauma (5)

A
  1. Apexigenesis
  2. Apexification
  3. Root filling +/- root extrusion
  4. Gingival + alveolar collar modification if required
  5. Coronal restoration
28
Q

Compare apexogenesis + apexification

A

APEXOGENESIS
> Tx of vital pulp to allow continued growth of root + closure of open apex
> Thickening of RC walls
> RCT may be needed

APEXIFICATION
> Tx of necrotic pulp to allow closure of the apex to do an RCT later with obturation
> No thickening of RC walls
> RCT always needed

29
Q

How do we manage an enamel fracture? (3)

A
  1. Bond fragment to tooth or simply grind sharp edges
  2. Take 2 periodical radiographs to rule out root fracture or luxation
  3. Follow up:
    - 6-8wks
    - 6 months
    - 1 year
30
Q

Whats the prognosis for an enamel fracture?

A

0% risk

31
Q

How do we manage an enamel-dentine fracture? (6)

A
  1. Bond fragment to tooth or place composite manage
  2. Take 2 periodical radiographs to rule out root fracture or lunation
  3. Radiograph any lip or cheek lacerations to rule out embedded fragment
  4. Sensibility testing + evaluate tooth maturity
  5. Definitive restoration
  6. Follow up:
    - 6-8wks
    - 6 months
    - 1 year
32
Q

Whats the prognosis for an enamel dentine fracture?

A

5% risk of pulp necrosis at 10yrs

33
Q

What should we check the follow up radiographs for? (4)

A
  1. Root development
    - Width of canal + length
  2. Comparison with other side
  3. Internal + external inflammatory resorption
  4. Periapical pathology
34
Q

What associated injury with an ED fracture has the best pulp survival prognosis?

A

Concussion + subluxation

35
Q

What associated injury with an ED fracture has the worst pulp survival prognosis?

A

Intrusion

36
Q

Why do immature teeth have a higher chance of survival post trauma?

A
  1. Mature tooth with a complete apex + BV going into one narrow hole
  2. Immature tooth with a wide apex with more nerves, bvs going in
    > If displaced in any way the chances of the pulp, nerves + bfs staying alive + regenerating is much higher than if theres a single point of entry
37
Q

How do we manage ED pulp fractures?

A

Evaluate exposure

  • Size of pulp exposure
  • Time since injury
  • Associated PDL injuries

CHOOSE from

  1. Pulp cap
  2. Partial pulpotomy
  3. Full coronal pulpotomy
38
Q

When do we do a partial pulpotomy?

A

Pulp exposure >1mm
OR
24+ hrs since trauma

39
Q

How do we carry out a direct pulp cap? (4)

A
  1. LA + rubber dam
  2. Clean area with water then disinfect area with sodium hypochlorite
  3. Apply CaOH or MTA white to pulp exposure
  4. Restore tooth with quality composite restoration

REVIEW:
6-8wks
6 months
1 year

40
Q

When do we do a pulp cap?

A

When pulp exposure <1mm

24 hr window

41
Q

How do we carry out a partial pulpotomy?

A
  1. LA + dental dam
  2. Clean area with saline then disinfect area with Sodium hypochlorite
  3. Remove 2mm of pulp with hi-speed round diamond bur
  4. Place saline soaked CW pellet over exposure until haemostasis achieved
    - If no bleeding or can’t arrest bleeding proceed to full coronal pulpotomy
  5. Apply CaOH then GI (or white MTA) then restore with quality composite resin
42
Q

How do we carry out a full coronal pulpotomy?

A
  1. Begin with partial pulpotomy
  2. Assess for haemostasis after application of saline soaked cotton wool
    - If hyperaemic remove all the coronal pulp
  3. Place CaOH in pulp chamber
  4. Seal with GIC lining and quality coronal restoration
43
Q

How do we carry out a full coronal pulpotomy? (4)

A
  1. Begin with partial pulpotomy
  2. Assess for haemostasis after application of saline soaked cotton wool
    - If hyperaemic remove all the coronal pulp
  3. Place CaOH in pulp chamber
  4. Seal with GIC lining and quality coronal restoration
44
Q

Success rate for partial pulpotomy

A

97%

45
Q

Success rate for coronal pulpotomy

A

75%

46
Q

Root tx for immature incisors

A

If tooth is non vital –> then full pulpectomy is required

  1. CaOH placed in canal aiming to induce hard-tissue barrier to form (apexification)
  2. MTA/BioDentine placed at apex of canal to create cement barrier
  3. Regenerative Endodontic Technique to encourage hard tissue formation at apex
47
Q

Why would we not use setting CaOH in root canal for 4-6wks?

A

We will denature all of the dentine in the tooth and make it dry and brittle and snap off

It loses its elasticity so we prefer to place cement to create a barrier (MTA/BioDentine placed at the apex of the canal

48
Q

Pulpectomy open apex tx

A
  1. Rubber dam
  2. Access
  3. Diagnostic radiograph for WL
  4. File 2mm short of estimated WL
  5. Dry canal with paper points, non setting CaOH, cotton wool in pulp chamber
  6. GI temporary cement in access cavity and evaluate CaOH fill level with radiograph
49
Q

Crown root fracture with no PULP exposure tx

A
  1. Fragment removal only + restore
  2. Fragment removal + gingivectomy
  3. Orthodontic extrusion to gain access to supragingival margins
  4. Surgical extrusion
  5. Decoronation
  6. Extraction
50
Q

Crown root fracture with pulp exposure tx

A

Exact same as without pulp exposure EXCEPT

Can be temporised with composite for up to 2wks

Paediatrics (12 decks)

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