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Endodontics > Trauma > Flashcards

Trauma Flashcards

1
Q

The peak incidence of trauma in the primary dentition occurs at age:

A

2-3

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2
Q

The peak incidence of trauma in the permanent dentition occurs at age:

A

9-10

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3
Q

What is the number one cause of tooth trauma?

A

Falls (20%)

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4
Q

List 8 signs of head injury

A
  1. Dizziness
  2. Nausea
  3. Vomiting
  4. Headache
  5. Lethargy/Irritability
  6. Loss of memory
  7. Pupil size and reaction to light
  8. Loss of consciousness
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5
Q

What are three injuries you should consider when someone has taken a blow to the chin?

A
  • Condylar fractures
  • Vertical crown fractures of posterior teeth
  • Soft tissue injuries
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6
Q

What symptoms might a patient report following trauma that could help with diagnosis

A
  • Spontaneous pain
  • Reaction to thermal changes
  • Disturbances in occlusion
  • “Tooth feels loose”
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7
Q

Should you take sensitibility tests following trauma?

A

Yes. Not always reliable but do it anyway for a baseline comparison.

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8
Q

The follicle of the permanent successor tooth develops where in relation to the primary tooth?

A

Palatal. Need to take x-ray to see if permanent follicle has been invaded.

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9
Q

If an x-ray shows that the primary tooth root is shortened, does this mean it is displaced labially away from the permanent follicle, or palatally toward it?

A

Labially, away from follicle.

So if the root is long it is displaced palatally toward the follicy.

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10
Q

Is re-implantation recommeneded for avulsion injuries of the primary dentition?

A

No

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11
Q

List indicators of mobility of teeth or alveolar fragments

A
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12
Q
A
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13
Q

What type of injury does this look like?

A

Luxation

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14
Q

What type of injury is this?

A

Complete avulsion

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15
Q

What injuries are seen here

A

Extrusion and luxation, and crown fracture

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16
Q

Has the follice been invaded?

A

No

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17
Q
A
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18
Q

Has the follice been invaded?

A

Yes (elongation = palatal dispacement)

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19
Q

Why are root fractures rare in children?

A

Bone elastic

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20
Q

Immature root development is considered to be when the apical foramen size is greater than:

A

1mm

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21
Q

Teeth with incomplete root development (>1mm foramen) have improved pulpal survival and fewer complications. Why is this (3)

A
  • Improved vascularity
  • Reduced distance to pulp horns
  • Thicker PDL
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22
Q

findings supporting a diagnosis of tooth concussion:

A
  • TTP
  • No displacement of mobility
  • May be hypersensitive to cold/EPT
  • Radiographicaly normal
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23
Q

Describe a sub-luxation injury

A
  • Tooth is loose, but not displaced.
  • May be some bleeding around the gingival margin.
  • Often also a crown fracture
  • May be TTP
  • Normal radiographically
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24
Q

What is the tx for subluxation?

A

No tx, monitor.

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25
Q

What may be a good idea for tx of traumatic enamel infractions?

A

May be a good idea to seal cracks with unfilled resin to prevent necrosis as hard to tell whether they penetrate dentine.

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26
Q

What is the tx for a complicated crown fracture

A

Partial pulpotomy.

Use sodium hypochlorite to stop bleeding then seal with endosequence or MTA. Then restore.

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27
Q

Age may be a contra-indication to partial pulpotomy

True or false

A

False

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28
Q

What is the biggest determinant of outcome for a partial pulpotomy?

A

Contamination. Larger exposure = higher chance of contamination

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29
Q

How long does a partial pulpotomy need to be followed up for?

A

2 years clinically and radiographically

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30
Q

Is partial pulpotomy still a viable tx for late presentation of large pulp exposure?

A

Yes but need to remove tissue until we can see fresh bleeding tissue, then control bleeding.

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31
Q

What is a crown root fracture?

A

A fracture which affects tooth below the alveolar crest.

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32
Q

What is often needed in order to retain teeth affected by crown-root fractures?

A

Crown lengthening to acquire a seal.

33
Q

Which has the worst prognosis

a) Subluxation
b) Intrusion
c) Lateral Luxation
d) Extrusion

A

b) Intrusion

34
Q

Which has a worse pronosis, lateral luxation, or extrusion

A

Lateral luxation worse than extrusion.

35
Q

Grey discolouration of teeth involved in tramua is indicative of:

A

Internal haemorrhage

36
Q

Which is more indicative or pulp necrosis following trauma

a) brown discolouration
b) grey discoloration

A

a) brown discolouration.

Grey discolouration may be temporary. Monitor.

37
Q

What colour indicates pulp canal obliteration.

A

Yellow

38
Q

Is RCT required for pulp canal obliteration?

A

No only a very small proportion go on to necrosis

39
Q

Infractions are a common cause of pulp infection/necrosis following trauma.

True or false

A

True

40
Q

List 6 common reactions of the pulp, to mild/moderate injuries

A
  • Healing and normal function
  • Pulpitis
  • Internal haemorrhage
  • Pulp canal obliteration
  • Pulp infecton/necrosis
  • Root resorption
41
Q

What arey ou seeing in this picture?

A

A tooth with a fracture, which is likely complicated and has not been sealed so has lead to infection. Hence draining sinus.

The lateral incisor bulging gingiva is a classic sign of cervical resorption.

42
Q

Bulging gingiva is a classic sign of cervical resorption. What could you do clinically to check this diagnosis.

A

Use a probe to feel for a ‘scooped out’ anatomy

43
Q

How many months following a concussion, subluxation and luxation injury should lack of sensibility be viewed as a strong sign of necrosis

A

3 months

44
Q

which is more common:

a) internal resorption
b) external resorption

A

b) external resorption.

(Internal resorption is very rare)

45
Q

What are the three types of external resorption

A
  • Inflammatory resorption
  • Cervical resorption (late presentation)
  • Replacement resorption
46
Q

Loss of tooth substance and radiolucency adjacent to the PDL. Moth eaten appearance.

A

Inflammatory root resorption

47
Q

Does radilucent resorption appearance at the apex in the early stages following trauma immediately indicate root resorption?

A

No. May be a transient response to allow revascularization. Monitor.

If on lateral walls need to do something.

48
Q

What injuries are most likely to cause inflammatory root resorption?

A
  • Avulsion
  • Intrusion
  • Lateral luxation/Extrusion

So in a nutshell, injuries where PDL affected

49
Q

What is suggsted as a tx for inflammatory root resorption

A

Odontopatte in canals for 3 months to dampen down immune reaction

50
Q

When is CBCT commonly used for trauma

A
  • Root fractures
  • Lateral luxations
  • Monitoring of complications such as root resorption
51
Q

List 7 injuries which require splinting

A
  1. Subluxation
  2. Extrusive luxation
  3. Lateral luxation
  4. Intrusive luxation
  5. Root fracture
  6. Avulsion
  7. Alveolar fracture
52
Q

What radiographic finding is indicative of a luxation injury

A

Widening of the PDL

53
Q

What is the tx for extrusive luxation injury

A

Splint and RCT (in mature teeth). Monitor.

54
Q

What is the tx for lateral luxation?

A

Disengage fro locked position, and splint.

RCT for mature teeth.

55
Q

Why is CBCT often needed for luxation injury?

A

Often cooincide with alveolar fracture - failure to diagnose may lead to incorrect tx planning and complications

56
Q

What is a common indicated of intrusive luxation?

A

Gingival asymmetry

57
Q

2 Common complications of intrusion injuries-

A

Necrosis and ankylosis

58
Q

Immediate replanation of mature teeth shows% healing in mature teeth

A

85%

59
Q

Prognosis of avulsion injury becomes poor when the tooth is out of the mouth over how long?

A

30-60 mins

60
Q

What are two common complications of avulsion injuries (following replantation)

A

Replacement and inflammatory resorption

61
Q

What is the best storage medium for teeth

A

Milk or Hanks Solution

Saline ok for up to 2 hours

62
Q

How to manage avulsed tooth with open apex, if replanted under 60 mins-

A
  • Soak root in saline
  • Irrigate socket with saline
  • Replant and verify on radiograph
  • Prescribe ABs
  • Splint 2 weeks
  • No RCT required unless evidence of infection
63
Q

Management of avulsed tooth, closed apex, less than 60 mins out of mouth

A
  • Soak root in saline, irrigate socket with saline
  • Replant and verify radiographically
  • Splint 2 weeks
  • RCT in 7-10 days
  • Antibiotics
64
Q

What ab i usually prescribed for avulsion of an adult tooth with closed apex

A

Doxycycline

65
Q

Management of avulsion injury which ahs been out of mouth over 60 mins

A
  • Communite - poor prognosis esp closed apex
66
Q

What is inevitable in teeth which are avulsed and replanted after 60 mins

A

Ankylosis and replacement resorption

67
Q

Management for root fracture

A

Reposition, verify radiographically, splint 4 weeks, monitor pulp

68
Q

What is the ideal for healing of root fractures

A
  • Bone grows between fractured pieces
  • Apical fragment vital
  • Coronal fragment non vital, canal obliteraion, no tx needed
69
Q

Ankylosis and replacement resorption is more common following what type of injuries

A

Severe eg avulsion, extrusive and intrusive luxation

70
Q
A
71
Q

Peak trauma incidence occurs at age:

A

10

72
Q

3 predisposing risk factors for trauma

A
  • Overjet
  • Protrusion of upper incisors
  • Insufficient lip closure
73
Q

What five concussion questions should you ask trauma patient

A
  • Amnesia
  • Unconsciousness
  • Drowsiness
  • Vomiting
  • Headache
74
Q

List the process for clinical exam for trauma

A
  1. Check soft tissues
  2. Check occlusion
  3. Count all teeth
  4. Chart fractures, extent, pulpal involvement
  5. Mobility
  6. Percussion
  7. Sensitivity
  8. Infraction
75
Q

Initial tests following an injury frequently give negative results

True or false

A

True.

(transient lack of pulpal response)

76
Q

Sensibility and percussion tests are reliable in primary teeth

True or false

A

False

77
Q

List 4 effects which trauma to primary dentition may have on the developing permanent dentition

A
  • Tooth malformation eg dilaceration
  • Impacted teeth
  • Eruption disturbances
  • White or yellow-brown discolouration of crown and hypoplasia or hypomin of permanents
78
Q

What are the challenges when immature teeth become non-vital?

A
  • Wide canals
  • Thin dentinal walls
  • Open apices
  • More prone to fracture
79
Q

What is the child dose of paracetamol?

A

15mg/kg

No more than 4x daily

Endodontics (2 decks)

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