TRAUMA Flashcards
What are the 9 tests in a trauma table?
colour
transillumination
palpation
sinuses
percussion
mobility
EPT
thermal
radiograph
what is pulp vitality?
the presence of an intact blood supply not nerve supply
what must you look for before beginning endodontics?
at least 2 signs of pulpal necrosis especially if open apex
what questions should you ask the pt that comes in with trauma?
pain?
swelling?
bad taste?
specific tooth sore?
what makes it sore?
sore to touch or move?
noticed any darkening of teeth?
what type of pain is associated with irreversible pulpitis or dental abscess problems?
prolonged spontaneous pain
what symptoms indicate that the pulp is still vital?
sensitivity to cold foods or air
what are the 3 signs of infection?
sinus tract
suppuration
swelling
what does discolouration imply?
products of pulpal necrosis permeating the tubules - initially pink, then brown
it does not mean that the pulp is irreversible necrotic, the tooth may revascularise
how do you test colour of a traumatised tooth?
explain procedure to patient
look directly at the tooth then look at the light from your overhead light shining directly onto the tooth
what is transillumination used for?
detecting craze lines, enamel infraction and assessing colour of the tooth
how do you perform transillumination?
fibre optic transillumination if available
look at the light from overhead operating light shining through the crown by placing mirror in the shadow of the mouth
ensure the light is perpendicular to the long axis of the tooth
how do you examine alveolar tenderness?
gently palpate with finger and compare to healthy tissue elsewhere
ask pt if it feels tender or sore
what is also assessed when looking at alveolar tenderness?
sinus, swelling and inflammation
how do you percussion test a tooth?
test a vital tooth first
gently tap on tooth in an axial direction with the handle of a metal instrument
what is also assessed when checking a tooths sensitivity to percussion?
percussion note - ankylosis sounds like a cracked plate
what does a metallic percussion note suggest?
freshly intruded tooth or ankylosis following loss of PDL
what does mobility suggest?
if mobile in an axial direction weeks after trauma, often pathognomic of periapical infection
recently erupted teeth are more mobile than teeth in adult dentitions
how do you test mobility?
explain procedure to pt
test a non traumatised vital tooth first
place mirror handle on one side of the tooth and another instrument on the other side and gently rock the tooth
what classification is used for mobility?
millers classification
class 1 <1mm
class 2 >1mm
class 3 >1mm horizontal and vertical
what are the 2 types of sensibility testing?
thermal testing
electric pulp testing
what type of teeth are not likely to respond to sensibility testing?
vital teeth that have been traumatised
vital teeth with incomplete root development
do not use these on primary teeth
how do you carry out electric pulp testing?
- explain the test to the pt
- explain they need to indicate immediately
- when they feel the tingle in their tooth
test vital tooth first - dry the tooth
- place probe on incisal edge
- ask pt to complete circuit by holding the aluminium sheath
what is used for thermal testing?
ethyl chloride
how do you complete thermal testing?
- explain the procedure to pt
- test a vital tooth first
- soak a small pellet of cotton wool held in tweezers
- dab it intermittently onto the labial surface
- test the teeth with a dry cotton pellet as well
- alternate between
what do you look for in radiographs of traumatised teeth?
continued root development (narrowing of pulp space, continued growth apically)
signs of ankylosis
signs of resorption
signs of root fractures
what is used to cut wire for a splint?
orthodontic distal end cutters
what are the measurements for wire for a splint?
4 finger widths of 0.4mm stainless steel soft wire
what can you do to splinting wire to allow you to hold and adjust the splint?
form a “safety handle” by bending wire 1/3 from mesial end
what position should pt be in when applying a splint?
upright position
how do you protect the airway when applying a splint?
gauze
how should a splint lie?
passively
how is a splint secured?
inciso-gingivally
small amounts of composite onto the middle of labial surfaces if abutment teeth
what are the features of a splint?
passive
flexible
<2mm off tooth surface
no overhangs or plaque traps
no sharp edges
how long do you splint a cervical root fracture?
4 months
how long do you splint an alveolar fracture?
4 weeks
how long do you splint subluxation?
2 weeks
how long do you splint extrusive luxation?
2 weeks
how long do you splint lateral luxation after repositioning?
4 weeks
how long do you splint intrusive luxation after repositioning?
4 weeks
what is the purpose of a splint?
stabilise teeth allowing time for PDL/ fracture to repair/ stabilise
what are the 2 methods of splint removal?
1 - composite and wire splint removed using rotary instruments
2 - remove composite cubes using ortho bracket removing tools
what rotary instruments can be used to remove composite and splint?
slow speed rotary and tungsten carbide debond bur
or
composite finishing burs
what tooth do you remove the splint from first?
traumatised tooth
what do you do after you have removed the splint from the traumatised tooth?
check its mobility - if excessive, reattach and re-bond the splint
what must be done when removing the splint from the final abutment tooth?
hold firmly with spencer wells forceps
where do you dispose the splint?
sharps
