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Trauma Flashcards

1
Q

What is the follow up regimen for enamel fracture of primary teeth?

A

No follow up

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2
Q

What is the follow up regimen for enamel/dentin fracture of primary teeth?

A

8 weeks

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3
Q

What is the follow up regimen for crown fracture of primary teeth?

A
  • 1 week
  • 8 weeks
  • 1 year
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4
Q

What is the follow up regimen for crown/root fracture of primary teeth?

A
  • 1 week
  • 8 weeks
  • 1 year
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5
Q

What is the follow up regimen for root fracture of primary teeth?

A
  • 1 week
  • 4 weeks (IF SPLINTED, SPLINT REMOVAL)
  • 8 weeks
  • 1 year
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6
Q

What is the follow up regimen for alveolar fracture of primary teeth?

A
  • 1 week
  • 4 weeks (IF SPLINTED, SPLINT REMOVAL + RADIOGRAPH)
  • 8 weeks
  • 1 year (RADIOGRAPH)
  • At 6yo
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7
Q

What is the follow up regimen for concussion of primary teeth?

A
  • 1 week
  • 8 weeks
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8
Q

What is the follow up regimen for subluxation of primary teeth?

A
  • 1 week
  • 8 weeks
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9
Q

What is the follow up regimen for extrusion of primary teeth?

A
  • 1 week
  • 8 weeks
  • 1 year
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10
Q

What is the follow up regimen for lateral luxation of primary teeth?

A
  • 1 week
  • 4 weeks (IF SPLINTED, REMOVE SPLINT)
  • 8 weeks
  • 6 months
  • 1 year
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11
Q

What is the follow up regimen for intrusion of primary teeth?

A
  • 1 week
  • 8 weeks
  • 6 months
  • 1 year
  • At 6yo
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12
Q

What is the follow up regimen for avulsion of primary teeth?

A
  • 1 week
  • 8 weeks
  • At 6yo
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13
Q

What is the follow up for infarction, permanent tooth?

A

No follow up

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14
Q

What is the follow up for enamel fracture, permanent tooth?

A
  • Clinical + radiographic follow up:
    • 6-8 weeks
    • 1 year
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15
Q

What is the follow up for enamel/dentin fracture, permanent tooth?

A
  • Clinical + radiographic follow up:
    • 6-8 weeks
    • 1 year
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16
Q

What is the follow up for crown fracture, permanent tooth?

A
  • Clinical + radiographic follow up:
    • 6-8 weeks
    • 3 mo
    • 6 mo
    • 1 year
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17
Q

What is the follow up for crown/root fracture, permanent tooth?

A
  • Clinical + radiographic follow up:
    • 6-8 weeks
    • 3 mo
    • 6 mo
    • 1 year
    • Yearly for at least 5 years
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18
Q

What is the follow up for root fracture (apical third, mid-third), permanent tooth?

A
  • Clinical + radiographic follow up:
    • 4 weeks (Splint removal)
    • 6-8 weeks
    • 4 mo
    • 6 mo
    • 1 year
    • Yearly for at least 5 years
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19
Q

What is the follow up for root fracture (cervical third), permanent tooth?

A
  • Clinical + radiographic follow up:
    • 4 weeks
    • 6-8 weeks
    • 4 mo (splint removal)
    • 6 mo
    • 1 year
    • Yearly for at least 5 years
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20
Q

What is the follow up for alveolar fracture, permanent tooth?

A
  • Clinical + radiographic follow up:
    • 4 weeks (splint removal)
    • 6-8 weeks
    • 4 mo
    • 6 mo
    • 1 year
    • Yearly for at least 5 years
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21
Q

What is the follow up for concussion, permanent tooth?

A
  • Clinical + radiographic follow up:
    • 4 weeks
    • 1 year
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22
Q

What is the follow up for subluxation, permanent tooth?

A
  • Clinical + radiographic follow up:
    • 2 weeks (splint removal)
    • 3 mo
    • 6 mo
    • 1 year
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23
Q

What is the follow up for extrusion, permanent tooth?

A
  • Clinical + radiographic follow up:
    • 2 weeks (splint removal)
    • 4 weeks
    • 6-8 weeks
    • 3 mo
    • 6 mo
    • 1 year
    • Yearly for at least 5 years
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24
Q

What is the follow up for lateral luxation, permanent tooth?

A
  • Clinical + radiographic follow up:
    • 2 weeks
    • 4 weeks (splint removal)
    • 6-8 weeks
    • 3 mo
    • 6 mo
    • 1 year
    • Yearly for at least 5 years
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25
Q

What is the follow up for intrusion, permanent tooth?

A
  • Clinical + radiographic follow up:
    • 2 weeks
    • 4 weeks (splint removal)
    • 6-8 weeks
    • 3 mo
    • 6 mo
    • 1 year
    • Yearly for at least 5 years
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26
Q

What is the follow up for avulsion (mature), permanent tooth?

A
  • Clinical + radiographic follow up:
    • 2 weeks (splint removal)
    • 4 weeks
    • 3 mo
    • 6 mo
    • 1 year
    • Yearly for at least 5 years
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27
Q

What is the follow up for avulsion (immature), permanent tooth?

A
  • Clinical + radiographic follow up:
    • 2 weeks (splint removal)
    • 4 weeks
    • 6-8 weeks
    • 3 mo
    • 6 mo
    • 1 year
    • Yearly for at least 5 years
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28
Q

Concurrent crown fractures significantly increase risk of pulp necrosis + infection in teeth w/ what type of dental trauma?

A

Concussion + subluxation

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29
Q

Crown fractures w/ and w/o pulp exposure significantly increase the risk of pulp necrosis + infection in teeth w/ what type of dental injury?

A

Lateral luxation

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30
Q

Radiographs to take for dental trauma

A
  • One parallel PA aimed through the midline to show the two maxillary central incisors
  • One parallel PA aimed at the maxillary right lateral incisor (should also show the right canine + central incisor)
  • One parallel PA aimed at the maxillary left lateral incisor (should also show the left canine + central incisor)
  • One maxillary occlusal radiograph
  • At least one parallel PA of the lower incisors centered on the two mandibular centrals
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31
Q

Why do we also take an occlusal radiograph in addition to PA’s for dental trauma?

A

Occlusal radiograph provides a different vertical view of the injured teeth + surrounding tissue, which is helpful in detecting lateral luxation, root fracture, and alveolar bone fractures

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32
Q

What type of dental injuries is CBCT helpful for?

A
  • Root fractures
  • Crown/root fractures
  • Lateral luxations
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33
Q

How do you rehydrate a tooth fragment that you will bond back on to a tooth that sustained dental trauma?

A

Soak the fragment in water or saline for 20 min before bonding

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34
Q

What materials should you use for a partial pulpotomy following traumatic pulp exposure?

A

Non-setting calcium hydroxide or non-staining calcium silicate

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35
Q

Marginal bone loss + periodontal inflammation is an unfavorable outcome for what type of dental trauma?

A

Uncomplicated + complicated crown-root fractures

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36
Q

What dental injury might you see bleeding from the gingival sulcus?

A

Root fracture

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37
Q

What dental injury might you have negative sensibility testing?

A
  • Root fracture
  • Subluxation
  • Extrusive luxation
  • Lateral luxation
  • Intrusive luxation
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38
Q

What type of root fractures have the potential to heal?

A

Cervical root fractures

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39
Q

What dental injuries might you see external inflammatory resorption as an unfavorable outcome?

A
  • Alveolar fracture
  • Subluxation
  • Extrusive luxation
  • Lateral luxation
  • Intrusive luxation
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40
Q

Ankylosis is an unfavorable outcome with what dental injury?

A
  • Lateral luxation
  • Intrusive luxation
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41
Q

What is likely to happen with the pulp of a subluxated permanent tooth?

A

Necrosis - RCT should be started w/ corticosteroid-abx OR calcium hydroxide to prevent external resorption

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42
Q

Intrusive luxation: immature permanent teeth tx

A
  • Allow re-eruption
  • If no re-eruption in 4 wks, initiate orthodontic repositioning
  • Monitor
  • Spontaneous revascularization may occur
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43
Q

Intrusive luxation: mature permanent teeth tx

A
  • If <3mm: Allow re-eruption
  • If no re-eruption in 8 wks, reposition surgically + splint for 4 weeks OR reposition orthodontically before ankylosis develops
  • If 3-7mm, reposition surgically (preferable) or orthodontically
  • >7mm reposition surgically
  • Monitor
  • Spontaneous revascularization may occur
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44
Q

Why is sensibility testing unreliable following dental trauma?

A
  • Due to a transient lack of neural response or undifferentiation of A delta nerve fibers of young teeth
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45
Q

What is used to measure blood flow of traumatized teeth?

A

Pulse oximetry

Limited due to lack of sensors

Laser + ultrasound doppler are also being investigated

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46
Q

Short term, passive, flexible splint dimensions

A

SS 0.4mm in diameter

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47
Q

Pulp canal obliteration in dental trauma

A
  • Occurs more frequently in teeth w/ open apices which have suffered a severe luxation injury
  • Indicates presence of viable tissue w/in the root canal
  • Extrusion, intrusion + lateral luxation have high rates of PCO
  • Common following root fractures
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48
Q

What type of dental injuries will you see pulp canal obliteration?

A
  • Extrusion, intrusion + lateral luxation have high rates of PCO
  • Common following root fractures
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49
Q

How long can CaOH2 sit in canal of initiated RCT following trauma?

A

up to 1 mo

Should be placed 1-2 wk after trauma

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50
Q

How long can corticosteroid/abx sit in canal of initiated RCT following trauma?

A

up to 6 wks

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51
Q

Would you consider early RCT w/ immature tooth that has been intruded + crown fracture (combined injury)?

A

Yes - at a higher risk of pulp necrosis

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52
Q

When should RCT be initiated if external resorption is detected?

A

Immediately. CaOH2 should be placed for 3 weeks + replaced every 3mo until radiolucencies of the resorptive lesions disappear.

Final obturation can be completed when boen repair is visible radiographically

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53
Q

What type of dental injury is most frequent in the primary dentition?

54
Q

What type of dental injury is most common in permanent dentition?

A

Crown fracture

55
Q

TDI comprise _% of all injuries?

56
Q

What % of school children experience dental trauma?

57
Q

What % of adults experience dental trauma?

A

33%; majority of injuries occur before 19yo

58
Q

What % of dental injuries is avulsion of permanent teeth?

59
Q

What type of situations is replantation of an avulsed permanent tooth not indicated?

A
  • Severe caries or periodontal disease
  • Uncooperative patient
  • Severe cognitive impairment requiring sedation
  • Severe medical conditions such as immunosuppression
  • Severe cardiac conditions
60
Q

What do you do if an avulsed permanent tooth is dirty?

A

Rinse in milk, saline or patient’s saliva prior to replanting it

61
Q

Storage mediums for an avulsed permanent tooth

A
  • Milk
  • HBSS
  • Saliva
  • Saline

Water is a poor medium but it is better than the tooth being dry

62
Q

What is the condition of PDL cells of avulsed permanent tooth dependent on?

A

EO dry time + storage medium

63
Q

What is critical for survival of PDL cells of an avulsed permanent tooth?

64
Q

After what amount of EO dry time are most PDL cells non-viable?

A

EO dry time of 30 minutes

65
Q

When are PDL cells most likely viable (avulsed permanent tooth)?

A
  • Tooth has been replanted immediately or w/in a very short time (~15min) at the place of accident
66
Q

When are PDL cells viable but compromised (avulsed permanent tooth)?

A
  • Tooth has been kept in a storage medium + total EO dry time is <60min
67
Q

When are PDL cells likely not viable (avulsed permanent tooth)?

A
  • Total EO dry time is >60min regardless of storage medium
68
Q

How long following dental trauma can you reposition a malpositioned avulsed permanent tooth?

A

up to 48 hours

69
Q

Ideal splint dimensions for avulsed permanent tooth

A

0.016” or 0.4mm wire

Nylon fishing line (0.13-0.25mm)

70
Q

What is the expected outcome w/ delayed replantation? (avulsed permanent tooth)

A

Ankylosis (replacement root resorption)

71
Q

What are examples of osmolality balanced media?

A

milk + HBSS

72
Q

Why are systemic abx recommended after replantation? (avulsed permanent tooth)

A

Prevent infection-related rxns + ⇓ occurrence of inflammatory root resorption

73
Q

What is the 1st line abx? (avulsed permanent tooth)

A

PCN/amoxicillin

Allergy: Doxycycline (anti-microbial, anti-inflammatory, anti-resorptive effects) – not recommended <12yo

74
Q

Oral injuries account for _% of all physical injuries in children 0-6yo?

A

18%

Mouth is second most common area of body to be injured

75
Q

World prevalence of TDI of primary teeth?

76
Q

At what age do TDI of primary teeth most commonly occur?

A

2-6yo, w/ injury to periodontal tissues most frequently

77
Q

What age group are ST injuries most commonly found?

78
Q

What type of TDI is most commonly associated w/ development anomalies in permanent teeth?

A

Intrusion + avulsion

79
Q

When do you EXT an extruded primary tooth?

A

Excessive mobility or extruded >3mm

80
Q

What will an intruded primary tooth look like radiographically if apex is displaced toward or through the labial bone plate?

A

The apical tip can be seen + the image of the tooth will appear shorter (foreshortened) than the contralateral tooth

81
Q

What will an intruded primary tooth look like radiographically if apex is displaced toward the permanent tooth germ?

A

The apical tip cannot be seen + the image of the tooth will appear elongated

82
Q

Reasons why we don’t replant avulsed primary teeth

A
  • Treatment burden for a child
  • May cause further damage to permanent tooth or its eruption
  • To avoid a medical emergency from aspiration of the tooth
83
Q

Tetanus vaccines w/ wound management

A
  • <7yo w/ h/o 3+ vaccine: For all wounds except clean + minor, give DTaP if >5yo since last dose.
  • >7yo w/ h/o 3+ vaccine:
    • Clean + minor wounds: give Tdap or Td if >10yr since last dose
    • All other wounds: Give Tdap or Td if >5yr since last dose
  • Tdap is preferred for 11yo+ who have not previously received Tdap or whose Tdap hx is unknown
  • If a tetanus vaccine is indicated for a pregnant patient – use Tdap
84
Q

What % of children ages 6-17yo participate in sports per 2020 health survey?

85
Q

What % of athletes experience dental trauma?

86
Q

What % of injuries in children occur during sports activities?

87
Q

Children ages 17yo and younger represent what % of the total dental injuries that presented to US emergency rooms from 1990-2003?

What age range comprise the majority of these ER visits?

A

80.6%

Children younger than 7yo

88
Q

What sports require protective equipment in the US?

A
  • High school field hockey
  • Football
  • Ice hockey
  • Lacrosse
  • Wrestling (if student has braces)
89
Q

What sport accounts for the most injuries in 7-12yo?

90
Q

What sport has the highest incidence of sports-related dental injuries for high school boys?

A

Basketball (2.4 per 100,000 athletic exposures)

91
Q

What sport has the highest rate of injuries for high school girls?

A

Field hockey (3.5 per 100,000 athletic exposures)

92
Q

Most common consumer sports products related to dental injuries in children?

A
  • Bicycle
  • Playground equipment
  • Skates, inline skates
  • Trampolines
93
Q

Is the rate of dental injuries in high school athletes higher in competition or practice?

A

3x higher in competition

94
Q

Type I mouthguard

A

Custom-fabricated

95
Q

Type II mouthguard

A

Mouth-formed (i.e. boil and bite)

96
Q

Type III mouthguard

A

Stock
Must be held in place with clenching the teeth

97
Q

How should the fit of a custom mouthguard be for maximum protection?

A

Cover all teeth in at least one arch (usually the maxillary, less the third molar)

98
Q

What is the appropriate thickness of a properly fitting mouthguard?

99
Q

What percent of dental injuries involve the maxillary incisors?

100
Q

Majority of sport-related dental and orofacial injuries affect…?

A
  • Upper lip
  • Maxilla
  • Maxillary incisors
101
Q

Most common dental injuries in order of incidence?

A
  • Lacerations
  • Crown fractures
  • Avulsions
102
Q

Most common injury to permanent teeth?

A
  • Crown fractures
  • Subluxations
  • Avulsions
103
Q

Greater than __% of all dental injuries sustained by baseball, softball, and field hockey players are due to __ contact.

A

87%
Player-object

104
Q

Frequency of dental trauma is higher for children with increased overjet: greater than __mm in the primary dentition

105
Q

Frequency of dental trauma is higher for children with increased overjet: greater than __mm in the permanent dentition

106
Q

What type of mouthguard is recommended for Class III malocclusions?

A

Mandibular

107
Q

What mouthguard type is most used amongst athletes?

108
Q

What mouthguard type might be a good option for patients with orthodontic brackets, appliances, and periods of rapidly changing occlusion?

109
Q

Establishing __ can prevent or reduce injury by better absorbing and distributing the force of impact?

A

Proper anterior occlusion of the maxillary and mandibular arches.

Mouthguards may also reduce the incidence or severity of condylar displacement injuries as well as the potential for concussions.

110
Q

Cranial nerve check: CN I

A

CN I - Olfactory
Sense of smell w/ aromatics

111
Q

Cranial nerve check: CN II

A

CN II - Optic
Check visual acuity and light/dark

112
Q

Cranial nerve check: CN III

A

CN III - Oculomotor
Pupil reaction to light/ptosis

113
Q

Cranial nerve check: CN IV

A

CN IV - Trochlear
Check eye movement

114
Q

Cranial nerve check: CN V

A

CN V - Trigeminal
Check muscles of mastication

115
Q

Cranial nerve check: CN VI

A

CN VI - Abducens
Check range of movement of eyes

116
Q

Cranial nerve check: CN VII

A

CN VII - Facial
Check facial muscles and taste

117
Q

Cranial nerve check: CN VIII

A

CN VIII - Auditory
Check hearing (Weber, Rinne tests)

118
Q

Cranial nerve check: CN IX

A

CN IX - Glossopharyngeal
Gag reflex

119
Q

Cranial nerve check: CN X

A

CN X - Vagus
Check palatal function

120
Q

Cranial nerve check: CN XI

A

CN XI - Accessory
Check sternocleidomastoid, trapezius function

121
Q

Cranial nerve check: CN XII

A

CN XII - Hypoglossal
Check tongue function

122
Q

Signs of bony fracture

A
  • Change in occlusion
  • Inability to close
  • Step on mandibular border
  • Vertical laceration on alveolus
  • Facial asymmetry
  • Pain on mastication
  • Sublingual hematoma
  • Contusions
123
Q

What type of fracture has an increased likelihood of occurrence if impact is directly on chin?

A

Condylar fracture

124
Q

LeForte I fracture

A

Maxillary separation from midface

125
Q

LeForte II fracture

A

Nasomaxillary fracture

126
Q

LeForte III fracture

A

Cranial base facial separation, airway edema

127
Q

Battles sign

A

LeForte III fracture
Mastoid hematoma
Posterior cranial fracture

128
Q

Raccoon sign

A

LeForte III fracture
Orbital hematoma
Anterior cranial bone fracture

129
Q

What might you observe with a skull fracture?

A

Cerebral spinal fluid (clear) in nose

130
Q

Exposure time for soft tissue radiograph evaluating for tooth fragments in lip with sensor placed between the lip and the dental arch?

A

1/4 that of conventional radiographs

131
Q

Exposure time for soft tissue radiograph evaluating for tooth fragments in lip with sensor placed on the cheek with lateral exposure?

A

1/2 that of conventional radiographs

* (22 decks)

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