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Pediatric Dentistry Boards > Trauma > Flashcards

Trauma Flashcards

1
Q

What is the most common trauma? What is the most prone group to trauma?

A

Approx 2300 injuries/yr w/bottles pacifiers sippy cups
<3 yo
Mouth lacerations most common

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2
Q

Anticipatory trauma guidance for infants? Toddlers? Children? Teens? Atheletes?

A

Infants: pacifier safety, danger of ‘walkers’
Toddlers: dont let babies run with scissors, ambulatory skills
Kids/Teens: bike helmets
Athletes: sports activities

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3
Q

Aspects of neurological exam

A

III-Occulomotor Penlight PERRLA
III, IV, VI Occulomotor tochlear and abducens- track movements
VII: Facial ask pt to close eyes, smile, frown. No asymmetry of movement

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4
Q

Injuries to which cranial nerves are more common after trauma?

A

III (occulomotor), IV-trochlear, VI-abducens, VII-facial

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5
Q

Post op instructions for observation post trauma?

A

Parents should watch out for:

Pt persistently sleepy, vomiting, severe headache, or abnormal behaviors

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6
Q

Comminuted fracture? Simple, compound?

A

Comminuted- bone is splintered. Simple overlying soft tissue are intact; compound bone exposed to skin or mucosa

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7
Q

Causes of craniofaction trauma in descending order?
Distribution of Craniofacial trauma?
How often do concomitant injuries occur? What kind of injury?

A 
Causes:
Falls 64%
Traffic 22%, Sports 9%, Violence 5%
Distribution:
skull vault 54%
Upper/middle facial third 37%

Concomitant injuries occur 1/3 of the time-usually a concussion

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8
Q

What facial bones are most likely to fracture? (midface fractures)

A

Nasal bone and zygoma

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9
Q

Describe LeFort fractures in children?

A

Least common midface fracture in children due to prominent calvaria

Many LeFort 1 tx, no fixation. Class II and III req open reduction w/caution for developing teeth.

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10
Q

From least (30G) to most (200G) force, order the following facial bones:

Zygoma, angle of the mandible, nasal, supraorbital rim, midline maxilla, frontal glabellar region, symphysis of mandible

A 
Nasal 30
Zygoma 50
Angle of mandible 70
Frontal-glabellar region 80
Midline maxilla 100
Symphysis of mandible 100
Supraorbital rim 200
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11
Q

Diagnostic aid for facial fractures?

A

CT scan

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12
Q

pt with limited upward gaze, periorbital swelling suspect?

A

Zygomatic fracture:
hx of blow to the cheek, periorbital swelling, ecchymosis, hematoma, conjunctival hemorrhage, palpable step deformity, paresthesia in dist of 2nd division of trigeminal nerve, limited upward gaze

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13
Q

What is the most common facial skeletal injury in hospitalized pediatric trauma patients? What is the incidence, causes, and characterstics?

A

Mandibular fracture

Boys 2xgirls
Younger patients : condylar/subcondylar fractures
Adolescents: fracture of angle of the mandible-think developing 3rd molars
Causes: bicycles, steps, swings

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14
Q

What are signs and charactersitcs of a subcondylar/condylar fracture?

A

Blunt injury to chin
Bite is “off” (retrognathic when they werent before) or deviated
Unilater vs bilateral (deviated chin)
Palpate external auditory meatus

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15
Q

Which fractures carry the greatest risk of growth disturbance?
How is it treated?
And what are possible complications of the injury?
Likely outcomes?

A

Condylar fractures- ramus height may not be maintained and may cause a huge asymmetry

tx: not rigid fixation, elastic
- Possible complications: ankylosis of the jaw, asymmetry, development of malocclusion
- condylar head resorbs, and the ramus remodels to maintain height

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16
Q

Describe an intracapsular condylar fracture in mandibular fractures. Risks? and Treatment?

A

Ankylosis risk in children less than 3 years old
Crushing injury
Treatment mandibular exercises and jaw stretching

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17
Q

Fracture of the body of the mandible: age group, best tx? dx by? Signs/Symptoms

A

Older patients
Closed reduction better than open
Pano
Signs: bruising in the floor of the mouth, hematoma in buccal vestibule, mobility along fracture site on palpation, possible paresthesia

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18
Q

Radiographs for soft tissue lacerations?

A

1/4 usual exposure for intraoral xray and 1/2 usual exposure of an extraoral xray

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19
Q

Electric Burns: age? type of injury? and clinical course?

A

2-4 yo
Coagulation tissue necrosis
Immediately post injury- paresthesia or anesthesia and no hemorrhage.
W/in a few hours: edema that may last 7-10 days, drooling (lost sensation), after several days center of lesion becomes gray/yellow w/erythema
Spontaneous hemorrhage w/in first 3 weeks after born
fibrous tissue forms can result in microstomia

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20
Q

WHO classification of dental trauma Class 1, 2, 3

A

Class 1: injury to dental structures and pulp (enamel fracture, enamel/dentin frac, uncomplicated; enamel/dentin/complicated w/pulp exposure)

Class 2: injury to dental structures, pulp & alveolar process (crown root fracture, root fracture, alveolar fracture)

Class 3: injury to periodontal tissues (concussion, sublux, lux, avulsion)

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21
Q

Primary tooth root fractures require extractions T/F.

A

F: If the coronal section is not displaced, no occlusal interference, can allow tooth to remain.

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22
Q

Treatment for:

Extrusive luxation in primary teeth?

A

If interfering with occlusion, likely ext.

23
Q

Intrusion in primary dentition:
Percent of which are intruded in which direction?
Duration and prognosis?
Later findings?

A

Intrusion if no movement after 6-8 weeks : EXT
80% of intruded teeth are pushed labially (away from permanent successor); majority re-erupt and survive >36mo
-PCO is a common finding as is ectopic position (rotation) following re-eruption.

24
Q

What are the most common findings in primary teeth post trauma? Relative percentages?

A 
Color changes 53%
Premature tooth loss 46%
Pulp canal obliteration 36%
Pulp necrosis 25%'
Gingival retraction 6%
Disturbances in physiologic resorption 4%
25
Q

Discolored primary teeth: differences in colors? When to extract?

A

> 50% dark coronal discoloration fades
Yellowish teeth develop less pathology
50% of dark teeth remain asymptomatic until eruption of permanent successor
-RCT of asymptomatic darkened primary incisors is unnecessary
Indications for EXT: swelling, sinus tract, increased mobility and sensitivity to percussion

26
Q

What primary tooth trauma poses the greatest risk to the permanent successor? Timing of trauma associated with highest risk?

A

Intrusion and avulsion of primary teeth

Age less than 3 years at time of trauma

27
Q

What kind of permanent teeth injuries need to see immediately?

A

Avulsion
Alveolar Fracture
extrusive or lateral luxation

28
Q

Crown fracture of a permanent tooth with pulp exposure healing is dependent upon: ?

A

Degree of fracture
Any luxation of tooth, as this is the primary source of pulpal contamination
Stage of root development
Effectiveness of dentin seal
Reattachment of fractures segment w/GI or composite resin

29
Q

Mechanism of Ca(OH)2 in pulpotomy for traumatized permanent teeth

A
  • High pH causes necrosis that stimulates hard tissue bridge
  • Excellent antibacterial property
  • Hard tissue bridge my have vascular inclusions
30
Q

Mechanism of MTA in pulpotomy for traumatized permanent teeth

A
  • High pH causes coagulation necrosis
  • zone of reparative dentinogenesis forms
  • Dentin bridge w/fewer vascular inclusions
  • Physical bond to dentin
31
Q

MTA vs Ca(OH)2 for direct pulp cap and pulpotomy: speed? compatibility?

A

MTA faster formation of hard tissue bridge

  • less pulpal irritation w/MTA; biocompatible
  • more predictable pulp barrier w/MTA
  • MTA aids in bone turnover via interleukin regulation
  • no thining of dentinal walls, better fracture resistance over time
  • may help stop inflammatory root resorption: stimulates interleukin regulation,
32
Q

Likely outcomes post cvek pulpotomy?

A

Pulp survival (most likely outcomes)
PCO
Necrosis

33
Q

Intra-alveolar root fractures should always be splinted and stabilized. T/F

A

False
- If there is no mobility, do not splint.
Mobile coronal segment reposition and splint for 4 weeks, if fracture is in cervical third reposition and splint for longer period of time

34
Q

CaOH2 and MTA both decrease root fracture strength. T/F

A

True:
Initially both decrease the fracture strength, however MTA reverses the process and increases the fractures strength between 2-12 months which CaOH2 continues to decrease the strength

35
Q

Intraalveolar Root fractures : survival/healing rates? outcomes? Poorest prognosis?

A

80% Surival; 20% No healing

  • Poorest prognosis: horizontal fracture in cervical root (30% chance of surivival)
  • Fracture in the cervical-middle, middle and apical have 88% survival
  • likely outcomes: obliteration of the pulp, no effect on healing
36
Q

Describe subluxation and likely outcomes

A

Subluxation: sensitive to percussion, no displacement, increased mobility, sulcular bleeding.
-observe

37
Q

Describe Extrusive luxation

A

Tooth appears elongated
-excessive mobility
-widened PDL noted on rgs
reposition and splint 2 weeks

38
Q

Definition of lateral luxation injury? Presentation clinically/radiographically?

A

Displacement of the tooth in a direction other than axial

Pulp supply is ruptured and the PDL is compressed

39
Q

Possible outcomes of lateral luxation injuries? treatment?

A

Outcomes: root resorption, PCO (40%) most which get PCO have a closed apex. If PCO forms, less likely to see pulp necrosis.

Tx: reposition, splint w/light wire 4 weeks

40
Q

Pulp Canal Obliteration: % discolor? Relation to PN?

A

Tooth discoloration occurs in up to 80% of teeth w/PCO
Color change alone not a predictor of pulp necrosis
- Teeth w/total PCO are more likely to have PN than teeth w/partial PCO

41
Q

Factors involved in intrusive luxtions- what makes for better or worse outcomes?

A

If age of pt <12 less fewer complications
Concurrent gingival laceration = more necrosis
multiple intrusions more bone loss

42
Q

Incidence of intrusion luxations?

A

Rare 7mm = more complications

intrusions 1-3 mm less root resorption

43
Q

Avulsion : factors effecting prognosis

A

Extraoral dry time

  • loss of PDL vitality
  • storage media
  • handling of tooth before replantation
  • patient immune response
44
Q

Avulsion storage media what is best/worst?

A

Worst: gatorade, contact lens solution
Cooler/ice solutions showed less apoptosis
Best: HBSS, cold milk

45
Q

systemic antibiotics post avulsion if patient is older than 12? Younger than 12?

A

Older than 12: doxycycline

Younger than 12: Pencillin V

46
Q

Post op avulsion instructions

A

Tetanus prophylaxis
Chlorhediine bid while splinted
soft diet
OH
f/u 1 week
Closed apex remove splint: 7-14 days; extirpate pulp w/in 14 days, place Ca(OH)2
Open apex: 7-14 days remove splint, observe for revasc, sings of pulp necrosis, resorption, apexification as indicated

47
Q

Normal healing mechanism and timing post avulsion?

A

4 days: pulp revascularization- this continues at .5mm/day
1 week: gingival attachment re-est and PDL
2 weeks: PDL has regained nearly all of its strength

48
Q

When do signs of negative sequala of traumabegin to show? What are they?

A

2 weeks on radiograph can see evidence of ankylosis and inflammatory resorption

49
Q

Prognosis of a tooth is primarily related to the length of time it is splinted. T/F

A

False

Prognosis is related to the type of injury rather than splinting.

50
Q

What children are at highest risk for child abuse?

A

Low birth weight (premature birth), physical/mental disability, hyperactive or aggresive, 1 of many (4 or more) siblings, age 2-4 yrs

-low SES neighborhood, vacant homes, high unemployment, etc

51
Q

Characteristics of child abusers

A

Young maternal age, unmarried, low education, low employment, poverty, low self esteem, substance abuse, mother not living with her mother at age 14, presence of surrogate in home

52
Q

Who is mosty likely to abuse the child

A

27% mother; 26% father; 13% mother’s partner
53% occurs in home
23% punched/slapped around head/neck/face

53
Q

What is the name of a syndrome where parent put children through all sorts of unnecessary tests/fabricated illnesses?

A

Munchausen syndrome

54
Q

Splinting times for the following injuries:
subluxation, extrusive luxation, avulsion, avulsion (>60min dry), lateral lux, root fracture (middle and apical), alveolar fracture, and root fracture (cervical third)

A

2 weeks: sublux, extrusive lux, avulsion

Pediatric Dentistry Boards (23 decks)

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