Trauma Flashcards
1
Q
The peak incidence of trauma in the primary dentition occurs at age:
A
2-3
2
Q
The peak incidence of trauma in the permanent dentition occurs at age:
A
9-10
3
Q
What is the number one cause of tooth trauma?
A
Falls (20%)
4
Q
List 8 signs of head injury
A
- Dizziness
- Nausea
- Vomiting
- Headache
- Lethargy/Irritability
- Loss of memory
- Pupil size and reaction to light
- Loss of consciousness
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
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”
7
Q
Should you take sensitibility tests following trauma?
A
Yes. Not always reliable but do it anyway for a baseline comparison.
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.
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.
10
Q
Is re-implantation recommeneded for avulsion injuries of the primary dentition?
A
No
11
Q
List indicators of mobility of teeth or alveolar fragments
A
12
Q
A
13
Q
What type of injury does this look like?
A
Luxation
14
Q
What type of injury is this?
A
Complete avulsion
15
Q
What injuries are seen here
A
Extrusion and luxation, and crown fracture
16
Q
Has the follice been invaded?
A
No
17
Q
A
18
Q
Has the follice been invaded?
A
Yes (elongation = palatal dispacement)
19
Q
Why are root fractures rare in children?
A
Bone elastic
20
Q
Immature root development is considered to be when the apical foramen size is greater than:
A
1mm
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
22
Q
findings supporting a diagnosis of tooth concussion:
A
- TTP
- No displacement of mobility
- May be hypersensitive to cold/EPT
- Radiographicaly normal
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
24
Q
What is the tx for subluxation?
A
No tx, monitor.
25
What may be a good idea for tx of traumatic enamel infractions?
May be a good idea to seal cracks with unfilled resin to prevent necrosis as hard to tell whether they penetrate dentine.
26
What is the tx for a complicated crown fracture
Partial pulpotomy.
Use sodium hypochlorite to stop bleeding then seal with endosequence or MTA. Then restore.
27
Age may be a contra-indication to partial pulpotomy
True or false
False
28
What is the biggest determinant of outcome for a partial pulpotomy?
Contamination. Larger exposure = higher chance of contamination
29
How long does a partial pulpotomy need to be followed up for?
2 years clinically and radiographically
30
Is partial pulpotomy still a viable tx for late presentation of large pulp exposure?
Yes but need to remove tissue until we can see fresh bleeding tissue, then control bleeding.
31
What is a crown root fracture?
A fracture which affects tooth below the alveolar crest.
32
What is often needed in order to retain teeth affected by crown-root fractures?
Crown lengthening to acquire a seal.
33
Which has the worst prognosis
a) Subluxation
b) Intrusion
c) Lateral Luxation
d) Extrusion
b) Intrusion
34
Which has a worse pronosis, lateral luxation, or extrusion
Lateral luxation worse than extrusion.
35
Grey discolouration of teeth involved in tramua is indicative of:
Internal haemorrhage
36
Which is more indicative or pulp necrosis following trauma
a) brown discolouration
b) grey discoloration
a) brown discolouration.
Grey discolouration may be temporary. Monitor.
37
What colour indicates pulp canal obliteration.
Yellow
38
Is RCT required for pulp canal obliteration?
No only a very small proportion go on to necrosis
39
Infractions are a common cause of pulp infection/necrosis following trauma.
True or false
True
40
List 6 common reactions of the pulp, to mild/moderate injuries
* Healing and normal function
* Pulpitis
* Internal haemorrhage
* Pulp canal obliteration
* Pulp infecton/necrosis
* Root resorption
41
What arey ou seeing in this picture?
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
Bulging gingiva is a classic sign of cervical resorption. What could you do clinically to check this diagnosis.
Use a probe to feel for a 'scooped out' anatomy
43
How many months following a concussion, subluxation and luxation injury should lack of sensibility be viewed as a strong sign of necrosis
3 months
44
which is more common:
a) internal resorption
b) external resorption
b) external resorption.
| (Internal resorption is very rare)
45
What are the three types of external resorption
* Inflammatory resorption
* Cervical resorption (late presentation)
* Replacement resorption
46
Loss of tooth substance and radiolucency adjacent to the PDL. Moth eaten appearance.
Inflammatory root resorption
47
Does radilucent resorption appearance at the apex in the early stages following trauma immediately indicate root resorption?
No. May be a transient response to allow revascularization. Monitor.
If on lateral walls need to do something.
48
What injuries are most likely to cause inflammatory root resorption?
* Avulsion
* Intrusion
* Lateral luxation/Extrusion
So in a nutshell, injuries where PDL affected
49
What is suggsted as a tx for inflammatory root resorption
Odontopatte in canals for 3 months to dampen down immune reaction
50
When is CBCT commonly used for trauma
* Root fractures
* Lateral luxations
* Monitoring of complications such as root resorption
51
List 7 injuries which require splinting
1. Subluxation
2. Extrusive luxation
3. Lateral luxation
4. Intrusive luxation
5. Root fracture
6. Avulsion
7. Alveolar fracture
52
What radiographic finding is indicative of a luxation injury
Widening of the PDL
53
What is the tx for extrusive luxation injury
Splint and RCT (in mature teeth). Monitor.
54
What is the tx for lateral luxation?
Disengage fro locked position, and splint.
RCT for mature teeth.
55
Why is CBCT often needed for luxation injury?
Often cooincide with alveolar fracture - failure to diagnose may lead to incorrect tx planning and complications
56
What is a common indicated of intrusive luxation?
Gingival asymmetry
57
2 Common complications of intrusion injuries-
Necrosis and ankylosis
58
Immediate replanation of mature teeth shows% healing in mature teeth
85%
59
Prognosis of avulsion injury becomes poor when the tooth is out of the mouth over how long?
30-60 mins
60
What are two common complications of avulsion injuries (following replantation)
Replacement and inflammatory resorption
61
What is the best storage medium for teeth
Milk or Hanks Solution
Saline ok for up to 2 hours
62
How to manage avulsed tooth with open apex, if replanted under 60 mins-
* 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
Management of avulsed tooth, closed apex, less than 60 mins out of mouth
* Soak root in saline, irrigate socket with saline
* Replant and verify radiographically
* Splint 2 weeks
* RCT in 7-10 days
* Antibiotics
64
What ab i usually prescribed for avulsion of an adult tooth with closed apex
Doxycycline
65
Management of avulsion injury which ahs been out of mouth over 60 mins
* Communite - poor prognosis esp closed apex
66
What is inevitable in teeth which are avulsed and replanted after 60 mins
Ankylosis and replacement resorption
67
Management for root fracture
Reposition, verify radiographically, splint 4 weeks, monitor pulp
68
What is the ideal for healing of root fractures
* Bone grows between fractured pieces
* Apical fragment vital
* Coronal fragment non vital, canal obliteraion, no tx needed
69
Ankylosis and replacement resorption is more common following what type of injuries
Severe eg avulsion, extrusive and intrusive luxation
70
71
Peak trauma incidence occurs at age:
10
72
3 predisposing risk factors for trauma
* Overjet
* Protrusion of upper incisors
* Insufficient lip closure
73
What five concussion questions should you ask trauma patient
* Amnesia
* Unconsciousness
* Drowsiness
* Vomiting
* Headache
74
List the process for clinical exam for trauma
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
Initial tests following an injury frequently give negative results
True or false
True.
| (transient lack of pulpal response)
76
Sensibility and percussion tests are reliable in primary teeth
True or false
False
77
List 4 effects which trauma to primary dentition may have on the developing permanent dentition
* Tooth malformation eg dilaceration
* Impacted teeth
* Eruption disturbances
* White or yellow-brown discolouration of crown and hypoplasia or hypomin of permanents
78
What are the challenges when immature teeth become non-vital?
* Wide canals
* Thin dentinal walls
* Open apices
* More prone to fracture
79
What is the child dose of paracetamol?
15mg/kg
No more than 4x daily
