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BDS4 Paeds Tutorials > Trauma 2 - hard tissue injuries > Flashcards

Trauma 2 - hard tissue injuries Flashcards

1
Q

how would you treat an ED# in an emergency situation where there is little time

A
  • clean area with water spray or saline
  • disinfect with NaOCl or CHx
  • account for fragment
  • bond fragment back on, or place composite bandage
  • clinical follow up 1 week, 6-8 weeks and 1 year
  • radiographic follow up 1 year after RCT or pulpotomy
  • take 2 PA’s to rule out root # or luxation, evaluate tooth maturity
  • radiograph any soft tissue injuries if can’t find fragment
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2
Q

when are more radiographs needed to be taken after initial ones

A
  • indicated where clinical findings are suggestive of pathosis = unfavourable outcome
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3
Q

what should parents be advised about regarding possible complications after ED#

A
  • swelling, dark discolouration of the crown, increased mobility or a fistula
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4
Q

what definitive restoration would you place after ED#

A
  • composite build up to restore crown of tooth
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5
Q

when getting radiographic follow-ups what are you looking fro

A
  • root development = width and length of canal
  • comparison with other side
  • Internal and external inflammatory resorption
  • any periapical pathology
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6
Q

if you think patient has inhaled tooth fragment what do you do

A
  • send for a chest x-ray
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7
Q

if you think fragment in soft tissues what d o you do

A
  • want a soft tissue radiograph to check lacerations
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8
Q

if you think patient has swallowed fragment what do you do

A
  • nothing
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9
Q

what is a subluxation injury

A
  • an injury to the tooth supporting structures resulting in increased mobility, but without displacement of the tooth
  • bleeding from gingival sulus confirms the diagnosis
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10
Q

what are the treatment options for an EDP#

A
  • pulp capping
  • partial pulpotomy
  • avoid full extirpation unless tooth clearly non-vital
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11
Q

when do you do a pulp cap and when do you do a partial pulpotomy

A
  • pulp cap if exposure <1mm and its <24hrs since injury
  • pulpotomy if exposure >1mm and it’s been >24hrs since injury
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12
Q

how do you do pulp capping

A
  • apply LA
  • is possible, isolate tooth with rubber dam
  • clean area with water spray, saline or CHx
  • disinfect with NaOCl
  • apply pulp capping material = CaOH or MTA
  • sealed exposed dentine with GI or composite
  • restore tooth with composite
  • follow up 1week, 6-8 weeks, 3 months, 6 months and 1 year
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13
Q

how to do partial pulpotomy

A
  • apply LA
  • isolate if possible with dam
  • disinfect with NaOCl
  • perform pulpotomy to a depth of 1-2mm using round diamond
  • place saline moistened cotton pellet upon pulp wound until bleeding ceased
  • apply pulpotomy material = CaOH
  • seal exposed dentine with GI or composite
  • restore with composite
  • follow up = 1 week, 608 weeks, 3 months, 6 months and 1 year
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14
Q

when may full pulpotomy be indicated

A
  • if pulp necrotic or hyperaemic
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15
Q

what is the problem with a full pulpotomy on immature teeth

A
  • no apical stop for obturation
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16
Q

what are the options when obdurating an immature tooth

A
  • CaOH placed in canal aiming to induce hard tissue barrier to form = can take 9 months and has holes in it
  • MTA/biodentine placed at apex of canal to create cement barrier
  • or regenerative Endodontic technique to encourage hard tissue formation at apex
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17
Q

what is the first choice of splint

A
  • composite and wire splint using 0.4mm stainless steel wire
18
Q

when might you need to use an acrylic URA type splint

A
  • if not got any abutment teeth to splint a wire on
19
Q

what type of splint and how long for would you want it in a luxation injury

A
  • flexible for 4 weeks
20
Q

what is external inflammatory resorption initiated by and how is it treated

A
  • damage to pdl
  • maintained and propagated by necrotic pulp tissue via dentinal tubules
  • pulp extirpation and mechanical debridement and chemical irrigation, non-setting CaOH 4-6 weeks then obturate
21
Q

what is internal inflammatory resorption initiated by and how is it distinguished from other types and how is it treated

A
  • damage to pulp
  • initiated by non-vital pulp
  • tramlines or root canal indistinct
  • extirpation
22
Q

what is an extrusion injury

A
  • tooth characterised by partial or total separation from pal resulting in displacement of tooth out of socket
  • aveolar socket intact
  • tearing injury
23
Q

treatment of extrusion injruy

A
  • apply LA
  • exposed dentine root surface of displaced tooth cleansed with saline
  • reposition tooth by gently re-inserting it into the tooth socket with axial digital pressure
  • stabilise for 2 wks with flexible splint
24
Q

what is included on trauma stamp

A
  • colour
  • sinus
  • TTP
  • percussion note
  • EPT
  • ethyl chloride
  • radiographs
  • mobility
25
Q

what is lateral luxation injury

A
  • displacement of tooth other than axially
  • displacement is accompanied by communication or fracture of either labial or palatal/lingual bone
  • pdl suffered both tearing and crushing
26
Q

what type of splint is used for lateral luxation

A
  • flexible for 4 weeks
27
Q

what is the process of making a composite and wire splint

A
  • cut and bend 0.3mm SS wire
  • apply composite resin to traumatised tooth and those adjacent
  • sink contoured, passive wire into composite
  • shape and cure composite
  • smooth rough edges
28
Q

what is an avulsion injury

A
  • where tooth comes completely out of the socket
  • separation of the pdl and exposure of the root surface
29
Q

advice to give parents if phoning about avulsed tooth

A
  • hold tooth by crown only
  • wash tooth in cold running water if there is obvious debris - no longer than 10 seconds
  • replace in socket and get child to bite down on some tissue
  • If can’t replant, store in milk or saliva or blood
  • get immediate dental advice
30
Q

what are the possible periodontal healing outcomes after avulsion has occurred

A
  • regernation - most likely to occur if tooth put back in socket
  • pdl/cemental healing - this can occur if tooth was not put straight back in
  • uncontrolled infection - not healing at all, create granulation tissue, infection, abscesses etc
31
Q

what type of injury is most likely to be locked in bone

A
  • intrusion
32
Q

what does a yellow tooth mean after trauma

A
  • enamel thins
  • tertiary dentine protects tooth
  • pulp canal obliteration from tertiary dentine being laid down
  • dentine is yellow so shines through
33
Q

what would be the clinical findings of a permanent tooth with a concussion injury

A
  • normal mobility
  • tooth is TTP
  • will respond to pulp sensibility testing
34
Q

clinically what would a tooth that has has an extrusion injury look like

A
  • elongated incisally
35
Q

what is lateral luxation injury

A
  • displacement of tooth in any lateral direction, usually associated with a fracture or compression of the alveolar socket wall or facial cortical bone
36
Q

what fracture is usually associated with a lateral luxation injury

A
  • fracture of alveolar bone
37
Q

why are teeth that have had a lateral luxation injury often immobile

A
  • because apex of teeth are locked in by the bone fracture
38
Q

what can happen differently after a lateral luxation injury in immature teeth compared to mature

A
  • open apex can get spontaneous revascularisation but closed apices more likely to become necrotic
39
Q

what kind of sound will percussion give on an intrusive luxation injury

A
  • high metallic sound = ankylosed
40
Q

what thickness of wire is used for splinting

A
  • less than 0.4mm SS

BDS4 Paeds Tutorials (8 decks)

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