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Clinical Knowledge 2 > Trauma 2 > Flashcards

Trauma 2 Flashcards

1
Q

What are causes of primary (baby teeth) trauma?

A
  • falls
  • bumbing into objects
  • non-accidental
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2
Q

What teeth are the most affected in primary trauma?

A

maxillary centrals

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3
Q

What type of injury is the most common in primary trauma?

A

luxation injuries

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4
Q

What is a luxation injury?

A

this is an injury that results in the movement of the tooth within the bone

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5
Q

Why are luxation injuries the most common injuries observed in children?

A

this is because their bone is elastic and thus more yielding

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6
Q

What is an indication for the use of soft tissue radiographs?

A

inspection of lacerations where fragment is lost

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7
Q

Outline the patient management for primary trauma

A
  • reassure
  • history (when, where, how)
  • examination (clincal, radiographical)
  • photographs (intra and extra oral)
  • diagnosis
  • emergency treatment
  • advise patients of sequalae to permanent teeth
  • further treatment and review
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8
Q

What is the required exposure for a soft tissue radiograph?

A

should be 25% of the normal radiograph/go for lowest possible exposure available

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9
Q

The medical history for primary trauma cases should determine…

A
  • congenital heart defects
  • immunosuppression - possible indication for antibiotics
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10
Q

The DH for primary trauma cases should include…

A
  • previous trauma
  • treatment experience
  • child/parent attitude
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11
Q

What must you make note of in an extraoral assessment in a primary trauma case?

A
  • laceration
  • haematoma
  • subconjunctival haemorrhage (infraorbital fractures)
  • haemorrhage/CSF (base of skull fracture)
  • bony step deformities
  • mouth opening
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12
Q

How must you assess for bony step deformities?

A

palpate bony margins- nose, orbit, border of mandible

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13
Q

In an I/O examination in a primary trauma case, what should you assess?

A
  • soft tissue
  • alveolar bone
  • occlusion
  • teeth- mobility, displacement
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14
Q

What is the benefit of transillumiation?

A
  • caries
  • pulpal degeneration- pulp will appear darker
  • fracture lines in teeth
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15
Q

Tactile probe test can help you identify…

A
  • horizontal fracture
  • vertical fracture
  • pulpal involvement
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16
Q

A dull TTP note may be an indication of …

A

root fracture

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17
Q

What is a traumatic occlusion?

A

this is when a tooth has been moved into a position where the jaws can no longer meet

jaw can no longer meet due to formation of premature contacts

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18
Q

You must take radiographs in at least 2 angles for what types of injury? Why is this ?

A
  • root fractures
  • this is because root fractures may not be visible in one plane
  • (PA/standard occlusal radiograph)
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19
Q

What is pulp canal obliteration?

A

the deposition of calcified/hard tissue along the walls of the canal
often an indication of vitality

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20
Q

What is a concussion injury?

A

a tooth that has been hit but remains immobile
TTP
immobile

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21
Q

What is a subluxation injury?

A

this is where there is small amount of displacement of the tooth
mobile
TTP
bleeding

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22
Q

What is a luxation injury?

A
  • displacement of tooth due to detachment from PDL and bone
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23
Q

What are the types of luxation injury?

A

lateral
extrusion
intrusion

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24
Q

What is the treatment guidelines for all trauma injuries?

A
  • soft diet for 10-14 days
  • brush teeth with soft brush after every meal
  • topical CHX by parent daily for one week
  • after initial treatment review after 1 week, 1 month, 3 months, 6 months, 1 year and every year for 5 years (radiograph)
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25
Q

What are the review guidelines for intrusion injuries?

A

review at 1 week
4 weeks
2 months
6 months
1 year

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26
Q

What are the treatment guidelines for enamel and enamel dentine fractures?

A
  • smooth edges
  • restore with compomer/composite

if 0.5mm to pulp then place CaOH

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27
Q

What are the treatment guidelines for complicated enamel dentine fractures?

A
  • pulpotomy (partial (cvek) and full pulpotomy)
  • pulpectomy (theoretical)
  • extraction
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28
Q

What is the treatment guideline for crown root fractures?

A
  • extraction of coronal fraction
  • root fill
  • extrusion?
  • restore
  • don’t be overzealous to remove any root fragments that aren’t obvious. These should be left to resorb physiologically
  • extract coronal fragment, leave root fragment, place flap over fragment and leave to maintain the width and length of the bone
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29
Q

What is the treatment guideline for alveolar bone fracture?

A
  • reposition segment
  • splint for 4 weeks
  • tooth may need to be extracted after alveolar stability has achieved.
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30
Q

___% of complications from concussion and subluxation injuries are diagnosed within a year

A

95%

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31
Q

What are the most common complications from concussion and subluxation injuries seen in children >4 years old?

A

pulpal necrosis
premature tooth loss

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32
Q

The treatment decisions of a lateral luxation injury are dependent on…

A
  • degree of displacement
  • mobility
  • occlusal interference
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33
Q

What happens to 95% of lateral luxation injuries?

A

realingn spontaneously

34
Q

What is the most common risk associated with lateral luxation injuries?

A
  • 95.7 experience pulpal necrosis /post traumatic tooth loss
35
Q

What are the treatment guidelines of lateral luxation injuries?

A
  • must take radiograph to see if there have been an increase in PDL space apically
  • if there is no occlusal interference allow the tooth to realingn spontaneously (occurs within a year)
  • if there is occlusal interference extraction is indicated
36
Q

What is a lateral luxation injury?

A

this is the displacement of a tooth other than apically

37
Q

What kind of lateral luxation injury increases the risk of collision with the permanent tooth bud?

A

when the crown has been displaced labially; the root tends to move palatally
this increases the risk of damage to the permanent bud

38
Q

What kind of lateral luxation injury reduces the risk of collision with the permanent bud?

A

when the crown is displaced palatally; the root moves buccally away from the permanent too bud

39
Q

How does a labially displaced lateral luxation injury appear on the radiograph?

A

tooth appears longer on the radiograph

40
Q

How does a palatally displaced lateral luxation injury appear on the radiograph?

A

tooth appears shorter on the radiograph

41
Q

What is the treatment guideline for intrusion injuries?

A
  • PA or anterior occlusal radiograph to establish baseline
  • allow spontaneous eruprtion
42
Q

What is the follow up for intrusion injuries?

A

1 week review
4 weeks
2 months
6 months
1 year

43
Q

What was the previous treatment guideline for lateral luxation and intrusion injuries?

A
  • extraction of the primary tooth where the tooth was displaced towards the permanent tooth germ however this is no longer advised
44
Q

Why have previous guidelines for lateral luxation and intrusion injuries changed?

A
  • this is because there is evidence of spontaneous eruption /repositioning in these cases
  • there is also concern about further damage to the permanent tooth germ from extractions
  • there is also a lack of evidence that an extraction will minimise damage to the perm tooth germ
45
Q

If there is an absence of spontaneous re-eruption after 6 months of an intrusion injury, what should you suspect? What further treatment can be suggested?

A
  • root resoprtion and ankylosis
  • extraction is indicated to prevent deflection of permanent successor as it tries to erupt
46
Q

What traumatic injury is most likely to cause injury to the permanent successor?

A

intrusive luxation injury
intrusion

47
Q

____% of intrusion injuries spontaneously erupt within a year

A

83.7%

48
Q

Nearly a third of intrusion injuries will show …

A

Pulpal necrosis
infection related resorption (of the root of the tooth)
ankylosis related resorption (of the root of the tooth)

49
Q

Treament decisions for extrusions are based on…

A
  • degree of displacement
  • mobility
  • occlusal interference
50
Q

What are the treatment options for a mild extrusion injury?

A
  • can be left
  • splinted for 2 weeks
51
Q

All extrusion injuries will undergo ______ and ______ within a year

A

pulpal necrosis
premature tooth loss

52
Q

What is the treatment guideline for avulsion injuries in PRIMARY teeth?

A
  • radiograph to confirm avulsion
  • do NOT reimplant
53
Q

Why should you never re-implant primary teeth in avulsion injuries

A
  • aspiration
  • risk of damage to permanent tooth
54
Q

What are the long term effects of injury to primary teeth?

A
  • discolouration
  • discolouration and infection
  • delayed exfoliation
55
Q

What is a potential cause for delayed exfoliation of primary teeth?

A
  • pulp canal obliteration (mineralisation of the inner lining of pulp canal); makes resorption more difficult?
56
Q

What are the long term effects of trauma to permanent succesors?

A
  • enamel defects (44%)
  • abnormal root/root morphology
  • delayed eruption
  • permanent teeth can erupt etopically following damage to primary tooth
57
Q

Why are children under 4 more likely to experience damage to the permanent successor?

A

this is because they have longer roots as root resorption has not begun yet
therefore they are more likely to damage their successor

58
Q

Immediate discolouration of primary teeth is due to …

A

haemosiderin in tubules

59
Q

What is haemosiderin?

A

break down product of the blood

60
Q

Haemosiderin in the tubules may regress/remain and maintain vitality. True or false

A

True

61
Q

How does intermediate (weeks) discolouration appear in primary teeth?

A
  • brown/black
62
Q

What causes the discolouration present weeks after the injury in primary teeth (intermediate discolouration)?

A

pulp break down products are found in the tubules

tooth no longer vital

63
Q

What discolouration is present months after the injury to primary teeth (long term)?

A

yellow/opaque
pulp calcification

64
Q

What causes regression of haemosiderin?

A

it is broken down

65
Q

The more profound the discolouration of the tooth , the more likely it is for the tooth to lose vitality. True or false

A

True

66
Q

What treatment should be offered to discoloured vital primary teeth?

A

no treatment

67
Q

What treatment should be offered to opaque teeth following injury?

A

no treatment

68
Q

What are indicators of non-vitality?

A
  • pain
  • infection (sinus)
  • periapical pathology
69
Q

In a case where pulp canal obliteration leads to delayed exfoliation, what is treatment is indicated and why ?

A

extraction
permanent tooth may erupt ectopically

70
Q

What is a dilacerated primary tooth?

A

this is when there is an abnormal angulation or bend in the root; less frequently occurs in the crown

71
Q

What is hypomineralisation?

A
  • poor quality enamel
  • right amount of enamel (thickness) but not mineralised sufficiently
  • appears as a white or yellow spot
72
Q

How can you treat hypomineralisation?

A
  • mask with composite (microabrassive technique, etch and pumice)
  • localised removal and restore with composite
73
Q

What is hypoplasia?

A

this is when there is not enough enamel (thickness)

74
Q

How can you treat a combination of hypomineralisation and hypoplasia ?

A

yellow/brown with missing enamel
restore with composite
final restoration with porcelain veneer

75
Q

What are the sequalae of to tooth and root morphology after trauma treatment?

A
  • crown dilaceration
  • root dilaceration/angulation/duplication
  • arrest root development in permanent tooth
  • odontome
  • undeveloped tooth germ- may sequestrate spontaneously or require removal
76
Q

What is the treatment for odontomes?

A

surgical removal

77
Q

What is the treatment for a root dilaceration?

A

combined surgical and ortho treatment

78
Q

What is the treatment for crown dilacerations?

A

surgical exposure
orhto-realignment

79
Q

What is an odontome?

A

mass of enamel and dentine
epithelian and mesenchymal cells exhibit complete differentiation with the result that functional ameoloblasts and odontoblasts form enamel and dentine

80
Q

Why may delayed eruption be caused following premature loss of a primary tooth?

A

Premature tooth loss can lead to thickened mucosa

81
Q

How can you detemine delayed eruption in a tooth following trauma ?

A
  • take radiograph if greater than 6 month delay compared to contralateral tooth
82
Q

How would you manage a delayed eruption case for a tooth with abnormal morphology?

A

surgical exposure
ortho

Clinical Knowledge 2 (40 decks)

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