Trauma 3 - immediate management

Question 1

a patient presents with trauma - what must you assess first?

Answer 1

full assessment ruling out head injury and other body injuries that need prioritised

Question 2

how do you assess for signs of head trauma?

Answer 2

history of loss of consciousness
was the incident witnessed?
child ‘acting out of character’?
history of vomiting, nausea?
visual disturbances?

Question 3

what must be assessed extra orally?

Answer 3

abrasions
lacerations
palpate and look for signs of skeletal fractures (asymmetry)
inferior border of mandible
zygomatic arch
battle signs
bilateral periorbital bruising

Question 4

what are battle signs?

Answer 4

bruising of mastoid process behind ear - sign of a bad hit and potential brain injury

Question 5

what must be assessed intra orally?

Answer 5

bruising
haematoma
floor of mouth
lacerations
degloving injuries
displacement of soft tissue
steps in occlusion
mandibular deviation on opening

Question 6

what do steps in occlusion suggest?

Answer 6

mandibular/ maxillary fracture

Question 7

what investigation may you want to carry out if you suspect a condylar or mandibular fracture?

Answer 7

DPT

Question 8

list some indicators of non accidental injury (NAI)

Answer 8

repeated injury
bruising of ‘protected areas’
‘quiet watchfulness’

Question 9

what is known as a protected area of the face?

Answer 9

cheeks

Question 10

what guidelines should be consulted if NAI suspected?

Answer 10

practice policy
regional health board policy

Question 11

list some typical types of NAI

Answer 11

both sides of body
soft tissues
particular patterns
injury doesnt fit explanation
delays in presentation
untreated

Question 12

where is the ‘triangle of safety’?

Answer 12

ears
side of face
neck
top of shoulders

Question 13

what should you do if a child presents with a tooth/ tooth fragment?

Answer 13

place in saline
trauma assessment
treatment plan
ideally a full oral health assessment

Question 14

what questions should be included in trauma assessment?

Answer 14

when did it happen?
where did it happen?
was it witnessed?
first time experiencing trauma?
symptoms?
is pain getting worse?
tetanus status?

Question 15

what must be asked if a tooth is avulsed?

Answer 15

how long dry (extra alveolar dry time - EADT)?
how long in medium?
what medium?

Question 16

what are you looking for when assessing each tooth and the relationship between teeth?

Answer 16

arch form
emergence profile
occlusion
crown fracture
displacement
mobility

Question 17

if adjacent teeth move when assessing mobility, what does this suggest?

Answer 17

alveolar fracture

Question 18

what does a blood clot attached to gingival crevice suggest?

Answer 18

if within 24 hours - subluxation

Question 19

what must be checked of a bleeding socket?

Answer 19

is it empty - exclude intrusion
correlate with radiographs

Question 20

what must be assessed in primary teeth root trauma?

Answer 20

relationship/ proximity to permanent successor
root fracture
alveolus fracture
displacement

Question 21

what must be assessed with permanent teeth root trauma?

Answer 21

root fracture
crown - root fracture
alveolus fracture
root displacement

Question 22

what radiographs should be taken to rule out possible root fracture?

Answer 22

2 views at different angles i.e., max occlusal and PA

Question 22

what types of radiographs should be taken to view affected teeth immediately following trauma?

Answer 22

generally - anterior occlusal maxillary plus periapicals

Question 23

as well as the affected tooth what else should be radiographed?

Answer 23

contralateral tooth - to compare

Question 24

what are the desirable treatment outcomes for primary and permanent teeth?

Answer 24

eliminate pain/ symptoms
prevent infection/ further issues
preserve and minimise damage to permanent dentition

Question 25

explain the treatment for an enamel-dentin-pulp fracture in a permanent tooth

Answer 25

LA
gut back to healthy bleeding pulp
ensure 2mm of clean dentine walls above pulp
arrest bleeding with saline soaked cotton pellet
cap with non setting CaOH or MTA
RMGI
Composite

Question 26

what is the function of calcium hydroxide?

Answer 26

kills pulpal cells it contacts
bactericidal to allow pulpal healing

Question 27

what type of extra oral laceration would you refer to A+E?

Answer 27

lacerations with loose tissue/ requiring intervention

Question 28

what is the purpose of a splint?

Answer 28

stabilise teeth that have undergone injuries to the PDL until there is sufficient healing

Question 29

list the properties of a splint

Answer 29

flexible - allow normal biological movement
passive - apply NO force on teeth
user friendly - easy to shape by clinician

Question 30

what type of wire should be used for splints?

Answer 30

wire with no shape memory - soft stainless steel

Question 31

what requires longer splinting - lateral luxation or extrusive luxation?

Answer 31

lateral luxation

Question 32

list healing outcomes of horizontal root fractures

Answer 32

non healing
hard tissue union
investing of connective tissue
investing of connective tissue and bone

Question 33

explain non healing of horizontal root fracture?

Answer 33

granulation tissue is present in the horizontal fracture

Question 34

explain hard tissue union in horizontal root fracture

Answer 34

union of fractures part - like a broken bone

Question 35

explain investing of connective tissue in horizontal root fractures

Answer 35

PDL can invest the fracture

Question 36

what placement of root fractures required prolonged splinting?

Answer 36

cervical third - up to 4 months splinting

Question 37

what is the most common type of tooth trauma to primary dentition?

Answer 37

intrusion

Question 38

what do you do if a primary tooth has been avulsed and there is no sign of it?

Answer 38

contact A+E

Question 39

what do you do it a primary tooth is slightly displaced?

Answer 39

leave it - unless interfering with occlusion - if so, xLA

Question 40

what do you do if a crown has fractured off a primary tooth but roots are retained?

Answer 40

leave roots in situ unless infected in which case xLA

Question 41

what do you do if a primary tooth has gone dark?

Answer 41

xLA - unless risk of endocarditis

Question 42

what does an orange colour suggest in a tooth?

Answer 42

pulp canal obliteration

Question 43

what does pulp canal obliteration mean for the tooth?

Answer 43

it is still alive/ vital

Question 44

what main signs do we monitor following trauma?

Answer 44

swelling
sinus tract
suppuration
discolouration

Question 45

what main symptoms do we monitor after trauma?

Answer 45

avoiding brushing
upset
not letting parent/ gaurdian see teeth
not eating

Question 46

how may an extruded primary tooth be managed if there is no movement after 4 weeks?

Answer 46

orthodontic extrusion