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BDS3 - Paediatrics > Trauma 3 > Flashcards

Trauma 3 Flashcards

1
Q

when is a flexible splint used for 2 weeks

A
  • subluxation
  • extrusion
  • avulsion only if under 60 mins EADT
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2
Q

when is a flexible splint used for 4 weeks

A
  • luxation
  • apical/middle 1/3 root fracture
  • intrusion
  • dento-alveolar fractures
  • avulsion if closed apex and >60 minsEADT
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3
Q

when do you use a flexible splint for 4 months

A
  • if coronal 1/3 fracture
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4
Q

which is the best splint to do

A
  • composite wire
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5
Q

how do you do composite splint

A
  • bend wire to appropriate shape and then fix it in place with composite
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6
Q

which is a good material to use for splinting but is expensive

A
  • titanium helix
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7
Q

how do you splint a re-implanted tooth

A
  • cut and bend 0.3mm stainless steel wire
  • apply composite resin to traumatise tooth and those adjacent
  • sink contoured, passive wire into composite
  • shape and cure composite
  • smooth rough composite and wire ends
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8
Q

why is it best not to use ortho wire for splints

A
  • it is very difficult to get them to be passive
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9
Q

what are vacuum splints

A
  • gum shield splints

- mouthguard type splint

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10
Q

what is a problem with vacuum splints

A
  • oral hygiene is often very poor

- patients are scared to take them in and out incase tooth was to move

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11
Q

when are acrylic splints useful

A
  • when there are few abutment teeth
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12
Q

what is foil temporary splint

A
  • very old method of splinting
  • bit of foil cemented with Kalzinol
  • doesn’t last long
  • temporary fix
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13
Q

what is kalzinol

A
  • a ZOE based material to cement it in place
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14
Q

what are dento-alveolar fractures

A
  • don’t have displacement of teeth in sockets
  • some mobility
  • there has been damage to alveolar bone holding teeth in
  • normally 3 or 4 teeth
  • teeth are secure in sockets but bone holding them in has been fractured
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15
Q

how do you fix dento-alveolar fracture

A
  • numb area and lift bone and put it back where it should be
  • reposition
  • flexible splint for 4 weeks
  • antibiotics
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16
Q

what is apical lock

A
  • a bit of bone from a dento-alveolar fracture is unable to get back into its proper place
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17
Q

what is the follow-up for dento-alveolar fracture

A
  • monitor clinically and radiographically
  • checking for root development
  • check for signs of inflammatory resorption
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18
Q

what should patient do after dento-alveolar fracture

A
  • soft diet for 7 days
  • avoid contact sports whilst splint in place
  • careful OH with use of chlorohexidine gluconate mouthwash 0.1%
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19
Q

what is the follow up timeline for a dento-alveolar fracture

A
  • 2 weeks
  • 4 weeks
  • 8 weeks
  • 4 months
  • 6 months
  • 1 year
  • yearly for 5 years
20
Q

what is included in a trauma sticker/stamp

A
  • mobility
  • TTP
  • percussion note
  • colour
  • sinus/tender
  • thermal
  • Electric
  • radiograph
21
Q

what is an avulsion

A
  • tooth comes completely out of socket
22
Q

what are the critical factors for avulsion re-implantation

A
  • extra-alveolar dry time (EADT)
  • extra-alveolar time (EAT)
  • type of storage medium
23
Q

what is EADT

A
  • extra alveolar dry time

- tooth out of mouth in air, not in any storage medium or anything

24
Q

what is EAT

A
  • extra-alveolar time

- amount of time out of mouth and dry including time it has been in storage medium

25
Q

what do you do if patient attend with tooth already replanted

A
  • do not remove
  • follow instructions on splinting
  • radiograph to establish root development
26
Q

when is PDL viable mostly after avulsion

A
  • replanted immediately or very shortly after
27
Q

when is PDL viable but compromised after avulsion

A
  • kept in saline/milk, total dry time <60 mins
28
Q

when is PDL non-viable after avulsion

A
  • dry time >60 mins regardless of what happened after this time
29
Q

when are all PDL cells non-viable after avulsion

A
  • after dry time of 60 mins or more
30
Q

what advice should you give teacher/parent over phone if tooth has avulsed

A
  • hold tooth by crown only
  • wash in cold running water for 10 seconds
  • replace in socket and child bites on tissue
  • or store in milk/saliva/normal saline if person doesn’t want to replant tooth
  • seek immediate dental advice
31
Q

what are the periodontal outcome of healing after avulsion

A
  • regeneration
  • PDL/cemental healing
  • bony healing
  • uncontrolled infection
32
Q

what are the pulpal outcomes of healing after avulsion

A
  • regeneration
  • controlled necrosis
  • uncontrolled infection
33
Q

what is controlled necrosis for pulpal outcomes after avulsion

A
  • elective disinfection
  • know that tooth is going to become non-vital so take live bit out of tooth before it dies and causes infection
  • stopping the inevitable
34
Q

what do you do if EAT<60 minutes and tooth has been stored in appropriate storage medium after avulsion

A
  • replant tooth under La
  • flexible splint 14 days
  • consider antibiotics and check tetanus status
  • carry out pulp extirpation at 0-10 days unless apex is open
35
Q

what do you do for immature teeth if EAT<60 mins after avulsion

A
  • if not going to root treat then need to monitor clinically and radiographically for signs of continued growth vs loss
  • review after 2 weeks to remove splint, 4 weeks, 2 months, 3 months, 6 months then yearly
  • if tooth non-vital extirpate pulp and refer to paeds specialist
36
Q

what do you do for mature teeth if EAT<60 mins after avulsion

A
  • after replantation and splinting, remove pulp ASAP
  • place antibiotic-steroid with non-setting CaOH
  • obturation with GP within 4-6 weeks
  • refer to specialist
  • review 3,6,12 months then yearly
37
Q

what to do for teeth than have been >60 mins EAT and apex is closed after avulsion

A
  • aim for bony healing
  • extra-oral endo can be carried out before replantation
  • replant tooth under LA
  • splint for 4 weeks
  • review 3, 6, 12 months then yearly
38
Q

why can you do extra-oral endo if tooth has been >60 mins EAT after avulsion

A
  • time isn’t a worry anymore as PDL cells are already lost now
39
Q

what to do for teeth that have been >60 mins EAT and apex is open

A
  • not going to get PDL healing
  • small chance pulp will revascularise
  • don’t root treat unless signs of loss of vitality
  • replant tooth under LA
  • splint for 4 weeks
  • consider antibiotics
  • check tetanus
  • monitor closely for signs of necrosis and root development
  • review 2 weeks, 4 weeks, 2 months, 3 months, 6 months then yearly
40
Q

when should you not replant tooth after avulsion

A
  • almost never
  • if very immature apex and EAT>90mins
  • child is immunocompromised
  • child needs other emergency treatment
  • young child finding it difficult to cope
41
Q

when should you carry out sensibility tests on avulsed teeth

A
  • at time of injury

- 1 month, 2 , 3 then 6-monthly for an average of 2 years

42
Q

what do you monitor with radiographs on avulsed teeth

A
  • root development = width or canal and length
  • comparison with other side
  • internal and external inflammatory resorption
43
Q

what should you do for pulpectomy

A
  • extirpate pulp and place CaOH for no longer than 4-6 weeks
  • MTA plug and heated GP obturation
44
Q

what is the name of MTA we use

A
  • MTA angelus

- sets in 15 minutes

45
Q

what is the 5-year pulp survival for avulsions

A
  • open apex = 30%

- closed apex = 0%

46
Q

what is the 5-year resorption for avulsions

A
  • frequent in both open and closed apex

BDS3 - Paediatrics (20 decks)

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