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BDS3 - Paediatrics > trauma 4 > Flashcards

trauma 4 Flashcards

1
Q

what are the aetiologies or primary tooth trauma

A
  • falls
  • bumping into objects
  • non-accidental = mainly from being young and lacking coordination, but need to remember not always an accident
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2
Q

which teeth are most commonly affected with primary tooth trauma

A
  • maxillary central incisors
  • 17-54%
  • equal amounts male and female
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3
Q

what type of trauma is most common

A
  • luxation
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4
Q

what age is most common

A
  • 2-4 years
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5
Q

what are the different types of trauma

A
  • enamel crack
  • enamel dentine fracture
  • enamel dentine pulp fracture
  • crown root fracture
  • root fracture
  • luxation
  • avulsion
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6
Q

how do you manage the patient

A
  • reassure
  • take history
  • examination
  • diagnosis
  • emergency treatment
  • advise patient about sequelae to permanent teeth
  • further treatment and review
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7
Q

what is included in extra oral examination

A
  • laceration
  • haematomas
  • haemorrhages/CSF leak
  • subconjunctival haemorrhage
  • bony step deformities
  • mouth opening
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8
Q

what is looked at in intra oral examination

A
  • soft tissue
  • alveolar bone
  • occlusion
  • teeth
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9
Q

how are teeth tested

A
  • mobility = could indicate fracture
  • transillumination = can show fracture lines, pulpal degeneration, caries
  • tactile test with probe
  • percussion = duller note indicate fracture
  • occlusion = traumatic occlusion demands urgent treatment
  • radiographs = show if any foreign body or not
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10
Q

what is included in trauma stamp

A
  • tooth
  • mobility
  • colour
  • TTP
  • sinus
  • percussion note
  • radiograph
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11
Q

why are EPT and thermal testing missing from trauma stamp

A
  • no sensibility tests on primary teeth
  • if tooth is resorbing get different readings
  • child doesnt understand it
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12
Q

what are crown fractures

A
  • enamel fracture = uncomplicated
  • enamel dentine fracture = uncomplicated
  • enamel dentine pulp fracture = complicated
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13
Q

what can be seen in concussion/subluxtion

A
  • damage to pdl and often see bleeding around gingival crevice
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14
Q

what types of luxation can you get

A
  • lateral
  • intrusive
  • extrusive
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15
Q

what is the immediate management for all injuries

A
  • soft diet for 10- 14 days
  • brush teeth with soft toothbrush
  • topical chlorohexidine by parent on cotton wool roll twice daily
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16
Q

how often fo you see patient after initial treatment

A
  • 1,3,6 monthly appointments taking radiographs is possible 6 monthly
  • intrusion requires more frequent reviews
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17
Q

how to treat enamel only

A
  • smooth sharp edges
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18
Q

how to treat enamel dentine fractures

A
  • restore/bandage with composite or composer = not GI

- need to cover dentine otherwise it will dry out and die

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19
Q

how to treat enamel dentine pulp fractures

A
  • endodontic therapy or extract

- careful with endo files not to go too far and damage permanent tooth underneath

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20
Q

how to treat crown and root fractures

A
  • extract coronal fragment

- don’t try digging for root fragments as damage permanent

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21
Q

how to treat alveolar bone fracture

A
  • reposition segment = splint to adjacent teeth for 3-4 weeks
  • teeth may need extracted once alveolar stability is reached
  • used to do rigid splint as bone remodelling but guideline now say flexible splint
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22
Q

how to treat concussion and subluxation

A
  • observe
23
Q

how to treat lateral luxation

A
  • radiographs = will have increased pdl space apical
  • if no occlusal interference then could leave to sort itself out
  • forces from lip and tongue could move it back into position
  • if there is occlusal interference then extract
24
Q

how to treat intrusion luxation

A
  • monitor re-eruption of tooth

- if there is no re-eruption after 6 months then extract

25
Q

how to treat extrusion luxation

A
  • extract
26
Q

how to treat avulsion

A
  • radiograph to confirm avulsion
  • do not replant
  • never replant a primary tooth in case you damage permanent beneath
27
Q

how can you get localisation of intrusion injury with noe film

A
  • take a periapical radiograph

- or lateral premaxilla view

28
Q

what does a periapical radiograph show for luxation

A
  • if apical tip appears shorter than contralateral tooth then it has been displaced towards or through the buccal plate = better as displaced away from permanent tooth germ
  • if apical tip is indistinct and tooth appears elongated then apex is displaced toward permanent tooth germ
  • root not in focus and shorter then closer to you
  • root longer, then further away
29
Q

what does a lateral pre-maxilla radiograph view show

A
  • identifies direction of displacement as providing a lateral view
30
Q

what are the long term affects of trauma in primary teeth

A
  • discolouration
  • discolouration and infection
  • delayed exfoliation
31
Q

what to do if tooth is vital

A
  • no treatment
32
Q

what to do if tooth is non-vital

A
  • sinus or PAP on radiograph
  • RCT or extraction
  • if no sinus or PAP then leave and review
33
Q

what to do if tooth is opaque

A
  • no treatment

- if tooth is opaque, it is usually because there has been some sclerosis of the canal= natures own RCT

34
Q

what happens in immediate discolouration of tooth

A
  • may maintain vitality
  • pink coloir
  • damage to pulp caused burst blood vessels and blood has nowhere to go so goes into dentine tubules
  • if pulp is still alive, it will get tidied up and tooth will go back to normal eventually
35
Q

what happens in intermediate change in colour

A
  • weeks
  • tooth non-vital
  • brown/black/grey
  • coming from necrotic pulp products in dentine tubules
  • root treat or remove
36
Q

what happens in delayed exfoliation of primary tooth

A
  • primary tooth may not resorb normally after trauma
  • extraction is necessary or permanent successor will erupt ectopically
  • could not resorb, or tooth became ankylosed
  • tooth in weird shape
37
Q

what injuries are most likely to cause problem with permanent teeth

A
  • worse injuries at a young age
38
Q

how common is enamel defects

A
  • most common = 44%
39
Q

what is hypo mineralisation

A
  • white/yellow spot

- normal thickness of enamel

40
Q

what are treatment options for hypomineralisation

A
  • leave
  • mask with composite
  • localised removal and restore with composite
  • external bleaching
  • possibly micro abrasion
41
Q

what is hypoplasia

A
  • yellow/brown areas

- less than normal enamel thickness

42
Q

what are the treatment options for hypoplasia

A
  • restore with composite

- porcelain veneer when gingival level stabilised and at least 16 y/o = ideally into 20’s

43
Q

what is treatment for crown or root dilaceration

A
  • surgical exposure, ortho realignment, improve appearance
44
Q

what is the treatment for crown or root duplication

A
  • combining surgical and ortho
45
Q

what is ectopic tooth position

A
  • tooth in wrong place
46
Q

what is arrest in tooth formation

A
  • tooth germ at a specific site has been bumped and has just stopped developing so might never form rest of the tooth
  • treatment = RCT or extraction
47
Q

how can a tooth completely fail to form

A
  • damaged very early on
48
Q

how is a odontoma treated

A
  • surgical removal
49
Q

how is an underdeveloped tooth germ treated

A
  • may disappear spontaneously on its own or require removal
50
Q

what can cause delayed eruption

A
  • premature loss of primary tooth can result in delayed eruption of about 1 year due to thickened mucosa
51
Q

what should you do if there is a greater than 6 month delay in eruption from contra-lateral tooth

A
  • take a radiograph

- palpate mucosa to see if you can feel anything

52
Q

what are some long term complications of trauma to primary teeth

A
  • crown hypoplasia
  • crown dilaceration
  • crown root dilaceration
  • failure of eruption
  • crown at wrong angle and root hanging at different angle
  • root can develop at different trajectory after bumped
  • arrest of root development
53
Q

what is a odontoma

A
  • could be result of intrusion
  • swirly mass of dentine and enamel and cementum
  • compound odontomes look like a bag if little teeth on an x-ray
  • ordered denticles inside it
  • areas of dentine with enamel and cementum

BDS3 - Paediatrics (20 decks)

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