Trauma Flashcards
What does the trauma stamp/ sticker encompass? (8)
- Sinus
- Colour
- TTP
- Mobility
- Thermal (E. Cl)
- Electrical (EPT)
- P. note
- Radiograph
What is a mobile tooth indicative of?
- Displacement
- Root fracture
- Bone fracture
What conditions seen in a MH may require appropriate additional treatment following trauma?
- Rheumatic fever
- Congenital heart defects
- Immunosuppression
How long must sensibility tests be carried out following trauma?
2 years
What type of tooth fractures are there?
- Enamel only
- Enamel-dentine
- Enamel-dentine-pulp
- Uncomplicated crown-root
- Complicated crown-root
- Root (apical, middle, coronal 1/3)
What does the prognosis of a tooth following trauma depend on?
- Stage of root development
- Type of injury
- Damage to PDL
- Time (between injury and tx)
- Infection
What are the aims and principles of EMERGENCY treatment?
- Retain VITALITY = protect exposed dentine (dentine bandage)
- TREAT exposed PULP
- REDUCTION and IMMOBILISATION (of displaced teeth)
- TETANUS prophylaxis
- AB cover?
What are the aims and principles of INTERMEDIATE treatment?
- +/- PULP TX
2. RESTORE (min. invasive i.e. acid etch rests)
What are the aims and principles of PERMANENT treatment?
- APEXIGENESIS (vital pulpotomy -> encourage apex formation)
- APEXIFICATION (calcium barrier at apex)
- ROOT FILLING +/- root extrusion
- Gingival and alveolar collar modification if required
- Coronal restoration
How is an enamel only fracture managed?
- Account for fragment
- Bond fragment to tooth
- Or smooth sharp edges
- Take 2 PA XR (rule out fracture/ luxation)
- Follow up
- -> 6-8 weeks
- -> 1 year
How is an enamel-dentine fracture managed?
- Account for fragment
- Bond fragment to tooth
- Or comp bandage
- Take 2 PA XR (rule out fracture/ luxation)
- -> If lacerations: XR to check any embedded frags
- Sensibility testing and evaluate tooth maturity
- Definitive rest
- Follow up
- -> 6-8 weeks
- -> 1 year
What is checked radiographically following trauma?
- Root development (width and length of canal)
- Compare with other side
- Resorption (internal/external)
- PAP
How is an enamel-dentine-pulp fracture managed?
- Pulp cap
- Partial pulpotomy
- Full coronal pulpotomy
=> Dependent on size of exposure, time since injury and associated PDL injuries
How is an displaced root fracture managed?
- LA not usually required
- Clean area with water/ saline/ CHX
- Reposition with digit pressure
- SPLINT
- -> apical or middle 1/3 = flexible 4 WEEKS
- -> coronal 1/3 = flexible 4 MONTHS
- ADVICE = soft diet for 1 week and good OH
- Review
- -> 6-8 weeks
- -> 1yr
- -> 5yr w radiographs
Following root fracture management, how is the tooth managed if it becomes non-vital?
APICAL and MIDDLE 1/3 #
- Extirpate to # line
- Dress nsCaOH then MTA coronal to # line
- Root fill (GP) to # line
==> distal root fragment will be resorbed, remain with PDL or become infected (AB/apicectomy)
What are the splinting times for each type of trauma:
- Subluxation
- Extrusion
- Avulsion
- Luxation
- Root fracture
- Intrusion
- Dento-alveolar fracture
FLEXIBLE 2 WEEKS
- Subluxation
- Extrusion
- Avulsion (open/ closed apex EADT <60mins)
FLEXIBLE 4 WEEKS
- Luxation
- Intrusion
- Apical/middle 1/3 root #
- Dento-alveolar
- Avulsion (open/ closed apex EADT >60mins)
FLEXIBLE 4 MONTHS
- Coronal 1/3 root #
What type of dental trauma to the PDL are there?
- Concussion
- Subluxation
- Extrusion
- Lateral luxation
- Intrusion
- Avulsion
- Dento-alveolar #
What the 5 year prognosis for pulpal survival in OPEN APEX PDL traumas?
- Concussion 100%
- Subluxation 100%
- Extrusion 95%
- Lateral luxation 95%
- Intrusion 40%
- Avulsion 30%
What the 5 year prognosis for pulpal survival in CLOSED APEX PDL traumas?
- Concussion 95%
- Subluxation 85%
- Extrusion 45%
- Lateral luxation 25%
- Intrusion 0%
- Avulsion 0%
What the 5 year prognosis for root resorption in OPEN APEX PDL traumas?
- Concussion 1%
- Subluxation 1%
- Extrusion 5%
- Lateral luxation 3%
- Intrusion 67%
- Avulsion frequent
What the 5 year prognosis for root resorption in CLOSED APEX PDL traumas?
- Concussion 3%
- Subluxation 3%
- Extrusion 7%
- Lateral luxation 38%
- Intrusion 100%
- Avulsion frequent
What is the definition of a dental concussion injury?
- Injury to tooth-supporting structures
- With no increased in mobility or displacement
- TTP
What is the definition of a dental subluxation injury?
- Injury to tooth-supporting structures
- With increased mobility but no displacement
- Bleeding from ginigival sulcus and TTP
When should a CONCUSSION injury be reviewed clinically and radiographically?
- 1 month
- 2 months
- 1 year
When should a SUBLUXATON injury be reviewed clinically and radiographically?
- 2 weeks
- 1 month
- 2 months
- 1 year
What is the definition of a dental extrusion injury?
- Injury to tooth
- Displacement of tooth out of its socket
What is the definition of a dental lateral luxation injury?
- Injury to tooth
- Displacement of tooth other than axially
When should an EXTRUSION injury be reviewed clinically and radiographically?
- 1 month
- 2 months
- 6 months
- Yearly for 5 years
When should an LATERAL LUXATION injury be reviewed clinically and radiographically?
- 1 month
- 2 months
- 6 months
- Yearly for 5 years
How is an extrusion injury managed?
- Reposition under LA (buccal and palatal)
- 2 weeks splint
–> If late presentation (teeth are firm) use URA
How is a lateral luxaton injury managed?
- Reposition under LA (buccal and palatal)
- 4 weeks splint
–> If late presentation (teeth are firm) use URA
What is the definition of a dental intrusion injury?
- Injury to tooth
- Displacement of tooth into alveolar bone
When should an INTRUSION injury be reviewed clinically and radiographically?
- 2 weeks
- 1 month
- 2 months
- 6 months
- Yearly for 5 years
How is an intrusion injury managed?
OPEN APEX
<7mm = spontaneous repositioning
>7mm = ortho/ surgical
CLOSED APEX
<3mm = spontaneous repositioning
3-7mm = ortho/ surgical
>7mm = srugical
- 4 week splint
==> temp restoration with CaOH recommended
What is the definition of a dental avulsion injury?
- Injury to tooth
- tooth is displaced completely out of its socket
What advice is given (e.g. over the phone) in regards to an avulsed tooth?
- Find the tooth
- Hold by the crown
- Plug the sink and run under cold water
- Put tooth back in its place and child to bit on tissue
- OR store tooth in milk/ saline/ saliva
- Attend dentist immediately
What is the management for avulsed teeth?
Reimplant under LA
<60mins EADT; OPEN APEX
- Reimplant & NO RCT
- Closely monitor for non-vitality –> pulpectomy
- 2 week splint
<60mins EADT; CLOSED APEX
- Reimplant & extirpate pulp
- Antibiotic-steroid paste into canals (leave in for 2 months)
- After 2 months replace with nsCaOH
- GP obturation within 3 months
- 2 week splint
> 60mins EADT; OPEN APEX
- Reimplant & NO RCT
- Closely monitor for non-vitality –> pulpectomy
- 4 week splint
> 60mins EADT; CLOSED APEX
- E/O RCT –> reimplant
- If no E/O RCT –> extirpate at 1 week, place nsCaOH for 1 month –> GP obturation after
- 4 week splint
==> Consider AB cover and check tetanus status
What are the aims of reimplantation?
<60mins EADT = PDL healing
> 60mins EADT = ankylosis
When should an AVULSION injury be reviewed clinically and radiographically?
OPEN APEX
- 2 weeks
- 1 month
- 2 months
- 3 months
- 6 months
- Yearly
CLOSED APEX
- 3 months
- 6 months
- 12 months
- Yearly
How is a dento-alveolar fracture managed?
- LA
- Reposition
- AB
- 4 weeks splint
When should a dento-alveolar fracture be reviewed clinically and radiographically?
- 2 months
- 4 months
- 6 months
- 1 year
- Yearly for 5 years
What advice is given following dental injuries?
- SOFT diet for 1 weeks
- Avoid contact sports while splint in place
- Careful OH (soft toothbrush) with 0.1% CHX mw use (between meals) = brush after meals
What is the process of internal (inflammation) resorption and how is it managed?
Initiated by necrotic pulp
- Extirpate pulp
- Mechanical and chemical irrigation
- nsCaOH
- Change nsCaOH every 4-6 weeks (to try halt resorption)
- No progressive resorption for 6 weeks –> obturate GP
- If continues, plan for prosthesis
What are the types of resorption?
- External surface (ortho, ectopic teeth)
- Internal inflammation
- External inflammation
- Replacement resorption
What is the process of external (inflammation) resorption and how is it managed?
Initially damage to PDL but maintained by necrotic pulp
- Extirpate pulp
- Mechanical and chemical irrigation
- nsCaOH
- Change nsCaOH every 4-6 weeks (to try halt resorption)
- No progressive resorption for 6 weeks –> obturate GP
- If continues, plan for prosthesis
Describe the procedure for a partial (Cvek) pulpotomy
- LA and isolation (dam)
- Access (diamond fissure bur) + clean with water then sodium hypochlorite
- Amputation 2mm of coronal pulp (highspeed –> saline soaked CW pellet)
- Assess radicular pulp stumps
- -> arrested bleeding = continue pulpotomy
- -> abnormal bleeding = full coronal
- -> full coronal, abnormal bleeding = pulpectomy - Dress and restore (CaOH then RMGI (Vitrepex)/ MTA (white) –> comp)
