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Paediatrics > Trauma 2 - PDL injuries > Flashcards

Trauma 2 - PDL injuries Flashcards

1
Q

List examples of PDL injuries (7)

A
  1. Concussion
  2. Subluxation
  3. Extrusive luxation
  4. Lateral luxation
  5. Intrusive luxation
  6. Avulsion
  7. Dento-alveolar fractures
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2
Q

Where should we consider the impact of the PDL injury on?

A
  1. Surrounding bone - fracture
  2. Neurovascular bundle
  3. Root surface
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3
Q

What is a concussion injury?

A

> Injury to tooth without increased mobility, displacement of tooth or gingival bleeding

> There is pain on percussion and sensibility tests may be negative on initial assessment (nerve not working)

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4
Q

What is a subluxation injury?

A

> Traumatic injury to PDL has occurred leading to increased mobility but no displacement

> Gingival bleeding is often detected
- Often bleeding around gingival margin

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5
Q

Tx for concussion/subluxation (2)

A
  1. Occlusal relief

2. Flexible splint 2 weeks if necessary to make patient feel more comfortable (don’t need to for subluxation)

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6
Q

What is occlusal relief? (2)

A
  1. Take away a bit of tooth structure

2. Or build up tooth with GI on the posterior teeth which will then take pressure off the anterior teeth

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7
Q

Compare concussion + subluxation for:

  1. Increased mobility
  2. TTP
  3. Follow up clinical + radiographs
  4. Splint
A
  1. INCREASED MOBILITY
    Concussion - No
    Subluxation - Yes
  2. TTP
    Concussion - Yes
    Subluxation - Yes
  3. CLINICAL FOLLOW UP + XRAYS
    Concussion - 4wks, 6-8wks, 1yr
    Subluxation - 2wks, 4wks, 6-8wks, 1yr
  4. SPLINT
    Concussion - No
    Subluxation - 2 weeks flexible
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8
Q

OHI + diet advice for all PDL luxation injuries (3)

A
  1. Instruct on OHI with chlorhexidine gluconate + gentle brushing
  2. Soft diet
    Bite gently
    Cant avoid eating as we need proper healing from PDL so we must stimulate it or the PDL will stop regenerating
  3. Avoid contact sports
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9
Q

How do we monitor concussion + subluxation injuries? (3)

A
  1. Clinical test - trauma sticker
2. Sensibility tests: 
Thermal + electrical 
> At time of injury 
> Lack of sensibility can occur 
> This can relate to future pulp necrosis 
3. Radiographs 
> Root development 
   Width of canal + length 
> Comparison with other side 
> Internal + external inflammatory resorption
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10
Q

What does a trauma sticker include? (8)

A
  1. Mobility
  2. Displacement
  3. TTP
  4. Colour
  5. Sinus/tender in sulcus
  6. Thermal (Ethyl chloride)
  7. Electric (EPT)
  8. Radiograph
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11
Q

What type of PDL injury has the highest 5 year pulpal survival for open/closed apex?

A
  1. Concussion

2. Subluxation

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12
Q

What type of PDL injury has the lowest 5 year resorption survival for open/closed apex?

A
  1. Avulsion

2. Intrusion

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13
Q

What is an extrusion injury? (2)

A
  • Partial or total separation of PDL resulting in displacement of the tooth out of the socket
  • Alveolar socket intact
  • Tooth hangs lower than it should
  • Tearing injury
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14
Q

Radiographic finding for extrusion injury (theres no radiographic findings for subluxation + concussion)

A

Increased PDL space apically

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15
Q

Tx protocol for extruded permanent tooth

A
  1. Reposition under LA (buccal + palatal)
  2. Flexible splint
    - 2 weeks
REVIEW
Clinical + radiographic control:
4weeks
6 -8 weeks
6 months 
Yearly for 5 years
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16
Q

What injuries have the highest 5 year pulpal + resorption survival? (4)

A

Concussion
Subluxation
Extrusion
Lateral luxation

17
Q

What is a lateral luxation injury?

A

Displacement of tooth other than axially (not just up and down)

Displacement accompanied with fracture of either labial or lingual bone

PDL SUFFERED TEARING + CRUSHING INJURIES

18
Q

Comparison of extrusion injury to lateral luxation

A

Alveolar bone intact in an extrusion injury, as opposed to a lateral luxation

19
Q

Tx protocol for lateral luxation

A
  1. Reposition under LA (Buccal + palatal
  2. Flexible splint for 4 weeks
REVIEW
Clinical + radiographie control 
4 weeks
6-8 weeks
6 months
Yearly for 5 years
20
Q

What is an intrusion injury?

A

Tooth driven into the alveolar process due to an axially directed impact (straight up injury)

Crushing injury to PDL

21
Q

What is the most severe form of displacement injury?

A

Intrusion injury

22
Q

What injuries act as crushing injuries to PDL? (2)

A

Intrusion

Lateral luxation

23
Q

Intrusion tx option for an open apex up to 7mm

A

Spontaneous repositioning

24
Q

Intrusion tx option for a closed apex more than 7mm

A

Orthodontic / surgical repositioning

25
Q

Intrusion tx option for a closed apex up to 3mm

A

Spontaneous repositioning

26
Q

Intrusion tx option for a closed apex between 3-7mm

A

Orthodontic / surgical repositioning

27
Q

Intrusion tx option for a closed apex more than 7mm

A

Surgical repositioning (with forceps)

Then comp wire splint for 4 weeks

28
Q

How should spontaneous tooth repositioning be reviewed?

A

Review patient monthly to observe re-eruption

Measure progress against fixed point (incisal edge of fully erupted non-displaced adjacent incisor)

29
Q

What type of injury has the highest risk of resorption + 0% pulpal survival ?

A
  • Intrusion
  • Endo tx usually necessary within 3-4wks post trauma to closed apex
  • Interim CaOH dressing recommended
30
Q

Review period for intrusion injuries (7)

A
  • Control after 2 weeks
  • Splint removal + control after - 4 weeks
  • 6-8 weeks
  • 6 months
  • 1 year
  • Yearly for 5 years
31
Q

Why is endo advised after an intrusion injury?

A

Can prevent the necrotic pulp from intimating infection related root resorption

Consider in all cases with completed root formation where the chance of pulp revascularusation is unlikely

32
Q

What type of injury has the lowest 5 year pulpal survival for an open/closed apex?

A

Avulsion

Intrusion

Paediatrics (12 decks)

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