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3. Paediatrics > Trauma 4 - (Examination) > Flashcards

Trauma 4 - (Examination) Flashcards

1
Q

What are causes of primary tooth trauma?

A

Falls

Bumps into objects - playing, poor coordination, learning how to walk

Non accidental - abuse - always consider

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2
Q

What are most commonly affected teeth?

A

Maxillary central incisors

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3
Q

Why is lunation most common injury in children

A

the bone is softer so bone yields to force and pressure and absorbs the pressure

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4
Q

How do we manage a pt with trauma?

A

Reassure and calm pt

pt history - CO, HPC, MH, DH, FH, SH

Exam

Diagnosis - allows us to formulate tx plan

Emergency tx

Advise parent of potential damage to permanent teeth - must record in notes

Further tx and reviews

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5
Q

What do we have to ask about the injury?

A 
When?
Where?
How?
Any other symptoms?
Lost teeth/fragments accounted for?
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6
Q

What must we consider in the medical history?

A

Is pt immunocompromised?
congenital heart defects or heart problems

rheumatic fever?

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7
Q

What dental history must w consider?

A

Have they had previous trauma

Past dental experience - gives us insight into what they can handle

parents and Childs attitude - how they feel towards tx

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8
Q

What do we look for extra orally?

A 
lacs
haematomas 
haemorrhage 
subconjunctival haemorrhage in eyes 
bony step deformities in eye sockets and jaw
mouth opening - normal or limited?
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9
Q

What do we look for intra orally?

A

soft tissue injuries - any penetrating wounds or foreign bodies

alveolar bone - is it solid?

occlusion - is it damage or is the tooth interfering?

teeth - any mobile teeth? - can indicate displacement , root fracture or bone fracture

transillumination - curing light can help show fracture lines in teeth, pulpal degeneration or caries

tactile test with pulp

percussion - dull note can indicate root # or if it sounds diff from other teeth

occlusion - traumatic occlusion needs urgent tx

radiographs

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10
Q

What does the trauma stamp contain?

A 
Tooth 
mobility 
colour 
ttp
sinus
percussion note 
radiograph
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11
Q

What tests are not useful in smaller children?

A

EPT, thermal pulp tests because the child can be too young to understand making the testing pointless - child may want to please us by telling us the answer they think we want to hear

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12
Q

What are the classifications of trauma injuries?

A 
Enamel #
Enamel dentine #
enamel dentine pulp # - complicated 
Crown root - uncomplicated
crown root - complicated 
concussion 
subluxation 
intrusion 
extrusion 
avulsion 
root # 
alveolar #
lateral luxation
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13
Q

What are the 3 types of crown fractures?

A

Enamel only
enamel and dentine
enamel dentine and pulp

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14
Q

What are the 3 luxation injuries?

A

Lateral
Intrusion
Extrusion

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15
Q

What is home management for all injuries dentally?

A

Soft diet for 10-14 days (esp when splint in place) - still eat a normal diet just cut food up, chew with molars

Brush teeth after every meal

topical CHX by parent twice daily for one week - children can’t swallow properly till age of 4 so risk of swallowing

review 1,3,6 monthly

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16
Q

What injury requires more freq reviews?

A

Intrusion as we want to monitor reeruption

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17
Q

How to we treat enamel fracture only?

A

Flowable composite

smooth off sharp edges

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18
Q

How do we repair enamel or enamel dentine #?

A

Restore/bandage with composite resin or compomer - NOT GI!!!

We need to ensure we cover up exposed dentine or bacteria can enter and pulp will die

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19
Q

how do we repair enamel dentine pulp fractures?

A

In children majority xla

but we can do end therapy - but children have wide canal with open apex so we need to fill with MTA 5-6mm and the backfill with GP

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20
Q

In primary molar ends how far back do we go from radiographic apex?

A

2mm to avoid risking follicle around perm tooth

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21
Q

Do we take radiographs of ends file in children?

A

No, risk they bite down on it

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22
Q

How do we deal with crown and root fractures?

A

Get rid of coronal fragment - extract coronal fragment

leave any non obvious root fragments - we don’t want to damage adult tooth - leave it to resorb

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23
Q

Why do we avoid going looking for any root fragments in children?

A

We don’t want to damage the adult tooth - leave it to resorb physiologically

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24
Q

How do we treat alveolar bone fracture?

A

Reposition the segment
splint to adjacent teeth for 3-4 weeks

teeth may need xla after alveolar stability has been achieved

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25
Q

What type of splint do we use for alveolar bone fractures?

A

Flexible splint

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26
Q

How do we treat concussion and subluxation?

A

Observation

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27
Q

How do we treat lateral luxation?

A

Radiograph - check the PDL space

Consider repositioning but sometimes we prefer to allow it to spontaneously reposition

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28
Q

Why do our teeth sit in arches?

A

Because of forces applied by lip and tongue - this can help move any luxated teeth back into position

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29
Q

In lateral luxation if there is no occlusal interference what do we do?

A

We allow spontaneous repositioning

30
Q

In lateral luxation if there is occlusal interference what do we do?

A

Extract

31
Q

What types of film can we use to localise intrusion injury?

A

PA

Lateral premaxilla

32
Q

How do we localise intrusion injury with one PA?

A

Take PA

if apical tip appears shorter than contralateral tooth - displaced towards or through buccal plate

if apical tip indistinct and elongated then apex is displaced towards tooth germ

33
Q

If the apical tip appears shorter than contralateral tooth in PA for intrusion injury what does this mean ?

A

This means the tooth has been displaced towards or through the buccal plate

34
Q

What is the preferred direction of an intruded tooth?

A

Towards or through buccal plate AWAY from developing tooth germ

35
Q

What does it mean if the apical tip is indistinct and tooth appears elongated?

A

This mean tooth has been displaced towards permanent tooth germ

36
Q

How do we manage intrusion injuries?

A

Monitor re-eruption - draw a pic as reminder

If no re-ruption within 6 months consider xla to avoid problems with adult tooth

37
Q

When would we consider other options if intruded tooth hasn’t re-erupted ?

A

6 months - we would want to xla to avoid issues with eruption of adult tooth

38
Q

How do we tx extrusion injuries?

A

Extract

or reposition under la and then flexible splint for 2 weeks

39
Q

If we reposition extruded tooth what are risks?

A

Damage to perm tooth

40
Q

How to we treat avulsions in kids?

A

NEVER replant primary tooth - damages permanent tooth!!!

41
Q

What are some long term effect of trauma in primary teeth?

A

Discolouration

discolouration and infection

delayed exfoliation

42
Q

What do we investigate if tooth is discoloured?

A

Vitality

43
Q

What if tooth id discoloured ad vital?

A

Leave it - no tx needed

44
Q

What if tooth is discoloured and non vital?

A

PA abscess, sinus then consider xla or Rct

if no abscess or sinus then leave and review

45
Q

What does opaque tooth on x-ray suggest?

A

Canal have sclerosed - natures own rct

46
Q

What do we do if tooth id discoloured and infected?

A

RCT or XLa

47
Q

Why may be need to extract a primary tooth that won’t resorb?

A

To ensure perm successor doesn’t erupt ectopically

48
Q

What does a pink colour of tooth suggest?

A

Pink:

immediate colour, tooth can maintain vitality and get better

the reason for pink is because BV is pulp ruptures and blood goes into dentinal tubules as it has nowhere else to go

if pulp repairs = normality returns

49
Q

What are intermediate colours changes?

A

Brown black grey

50
Q

What does an intermediate colour change suggest?

A

Happens weeks after trauma

indicates tooth is NV

51
Q

Where does intermediate discolour come from?

A

Necrotic pulp products in the dentine tubules - haemosiderin and eosin

52
Q

What does immediate discolouration suggest:?

A

Tooth may maintain vitality

53
Q

What can happen to primary tooth after trauma?

A

it can fail to resorb or may become ankylosed

54
Q

If primary tooth doesn’t resorb or becomes ankylosed what do we do?

A

Xla may be needed to ensure perm successor erupts normally or else it can be pushed ectopically

55
Q

What is most likely complication of primary trauma?

A

Enamel defect

then abnormal tooth or root morphology (such as crown ir root dilac and crown or root duplication)

56
Q

What are some long term effects of trauma in perm teeth?

A

Enamel defects

abnormal tooth or root morphology

delayed eruption

ectopic tooth position

arrest in tooth formation

complete failure of tooth to form

odontome formation

57
Q

What age and type of injuries has worst prognosis for adult teeth?

A

Bad injury

young age

0-2 yrs = 63% chance of complication but 7-8 only 25%

58
Q

What are some enamel defects?

A

hypo mineralisation

hypoplasia

59
Q

What is hypo mineralisation?

A

White yellow spots with normal enamel thickness

60
Q

What are tx options for hypo mineralisation?

A

No tx - leave
mask with Comp
localised removal and comp restoration
external bleaching - icon and micro abrasion

61
Q

What is hypoplasia?

A

This is when there are yellow and brown areas with less than normal enamel thickness

62
Q

What are tx options for hypoplasia?

A

Restore with comp - restores appearance and replaced missing tissue

or when pt is old enough - youngest 16 but realistically 20ish then we can do a porcelain veneer when gingival level stabilised

63
Q

How do we treat crown dilacerations?

A

Surgical exposure
ortho realignment
improve appearance restoratively

64
Q

How do we tx root dilacs/angulations/duplications

A

Combo of surgical and ortho

65
Q

How do we tx arrest of root development?

A

RCT/xla

RCT - if enough root if not then consider pt as hypodontia pt

66
Q

How do we tx odontome?

A

XLa

67
Q

How do we tx undeveloped tooth germ?

A

may erupt spontaneously but may need to be removed if causing problems with other teeth erupting

68
Q

Why can premature loss of a primary tooth delay eruption?

A

Due to thickened mucosa in the area

69
Q

How long can premature loss of primary tooth delay eruption by?

A

1 year

70
Q

What might we need to do to encourage eruption of adult tooth when there was premature loss of primary tooth?

A

Incision in gum to allow tooth to come through

71
Q

When would we take a radiograph if tooth isn’t erupting?

A

6 months after contralateral tooth has erupted

always palpate for tooth also

3. Paediatrics (10 decks)

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