trauma - ALL OF NATS Flashcards
1
Q
- How wide is the apical foramen in a mature tooth?
A
0.4mm
2
Q
- In the absence of infection, can a tooth be revascularized and at what rate?
A
Capillary buds can grow in through the foramen at 0.5mm per day, eventually revascularizing the pulp chamber
3
Q
- What is the pressure of blood flow by the time it reaches the arterioles supplying the dental pulp?
A
30mmHg
4
Q
- What happens if pulpal tissue pressure is too high?
A
If pulpal tissue pressure is greater than apical arteriolar pressure, the pulp dies
5
Q
- What is Transient Apical Breakdown (TAB)?
A
When a small, radiolucent ‘cap’ can be seen on 1/12, 2/12 periapical views due to increased cellular activity when the tooth is revascularizing & pulp sensibility goes from NEG to POSITIVE
6
Q
- What happens when there is a painful response to dentine?
A
A painful response to anything that produces fluid movement in the tubules, occurs with functioning odontoblastic processes occupying dentinal tubules.
7
Q
- What is pulp canal obliteration?
A
Following revascularisation, primitive odontoblast type cells that differentiate from revascularizing tissue lay down dentine type tissue in a disorganised way until the whole chamber is filled.
8
Q
- How does a necrotic and infected pulp result in external inflammatory root resorption?
A
Due to diffusion of bacterial products down the tubules and into the PDL, where they cause an inflammatory reaction
9
Q
- Why are radiolucencies on radiographs smaller than reality?
A
Because a lesion has to start resorbing the cortical plates before you can see it as a radiolucency
10
Q
- What happens to the PDL in intrusions?
A
Cells on both sides of the PDL get crushed
11
Q
- What happens to the PDL in avulsions?
A
Cells on the root surface become desiccated and die
12
Q
- What happens if there is a loss of PDL?
A
Ankylosis and infra occlusion
13
Q
- What are the 3 peak times of dental trauma?
A
1-2 years, 8-10 years, 4-16 years
14
Q
- What are the predisposing factors of dental trauma?
A
Boys>girls, age, season, sports, activity profile, occlusion
15
Q
- What is a dento-alveolar fracture?
A
When the alveolus surrounding teeth is fractured too and one or more adjacent teeth appear displaced together
16
Q
- What type of occlusion has increased incidence of incisal trauma?
A
Increased overjet
17
Q
- What should be provided for patient’s for prevention of trauma?
A
Mouth guards, 4mm horseshoe thermoplastic vinyl, ethylene vinyl acetate
18
Q
- What are the 3 types of mouth-guards?
A
Stock, boil and bite, custom made
19
Q
- What should be assessed for signs of head trauma?
A
History of loss of consciousness,
was the incident witnessed?,
child acting ‘out of character’,
history of vomiting, nausea?,
visual disturbances?,
amnesia?
20
Q
- What should you ask a patient during an assessment of dental trauma?
A
When did the injury occur?,
where did it occur?,
was it witnessed?,
is it the first time this trauma has occurred?,
if the tooth is avulsed, dry time?
How long in medium and what medium?,
what symptoms are they having now?,
is the pain getting worse?,
tetanus status?
21
Q
- What do you look for in Extra orally in trauma cases?
A
Abrasions, lacerations, palpate and look for skeletal fractures, asymmetry
22
Q
- What do you look for Intra orally in trauma cases?
A
Bruising,
haematoma of FOM,
lacerations,
steps in occlusion
23
Q
- Why do we want to check the roots of the primary teeth?
A
To see if root has potential to damage permanent successor,
24
Q
- Why do we want to check the roots of the permanent teeth?
A
To see if there is a chance of fracture and if root has been displaced
25
1. What type of radiographs should you take to rule of possible root fracture?
Anterior occlusal maxillary and intra-oral periapical views
26
1. What do you look for in the short term in radiographs?
Signs of displacement, signs of root fracture
27
1. What do you look for in the long term in radiographs?
Periapical area inflammation of tissues surrounding apex, be aware of TAB; root resorption, root development, pulp canal obliteration
28
1. How do you treat EO lacerations?
If minor, advise possible scar and clean; if laceration with loose tissue, tx planning with plastic surgery or oral maxfax
29
1. How do you treat IO lacerations?
Examine, if minor,
clean and advise to keep clean;
if lacerations require closure, clean, anaesthetise, suture, ensure haemostasis
30
1. What is the most common type of injury to primary teeth?
Intrusion
31
1. What do you generally never do to treat primary teeth trauma? (acc. to clem)
Replant,
RCT,
(splint),
pulpotomy,
reposition
32
1. What colour may primary teeth go if it is pulp canal obliteration and what should you tell the parents?
Orange,
tooth is vital
33
1. What is the purpose of a splint?
To stabilise teeth that have undergone injuries to the PDL
34
1. What happens if a permanent tooth with an open apex is extruded?
Revascularisation can be confirmed radiographically by evidence of PCO and return of positive pulp response to sensibility testing
35
1. What happens if a permanent tooth with a closed apex is extruded?
Continued lack of pulp response = evidence of pulp necrosis together with periapical rarefaction and sometimes crown discolouration
36
1. In an extrusion of primary tooth, what does treatment depend on?
Degree of displacement, mobility, root formation and ability for child to cope with emergency situation
37
1. Why is 4 weeks using a flexible splint indication for a lateral luxation of a permanent tooth?
Due to the associated bone fracture
38
1. Why is it important to monitor pulpal condition after lateral luxation of permanent tooth?
See if pulp becomes necrotic, RCT indicated to prevent infection
39
1. What needs to be recorded in the intrusion of permanent teeth and why?
Level of intrusion as this will serve as a baseline for monitoring eruption
40
1. What happens in spontaneous eruption of intrusion of permanent teeth?
Recommended for immature tooth with incomplete root formation that experiences minor/moderate intrusion and mature tooth with minor intrusion.
Active repositioning should be considered if no movement within first few weeks
41
1. Why should you choose orthodontic repositioning for intrusion of permanent teeth?
It allows bone to remodel and is less traumatic for the patient
42
1. What advice should you give over the phone if avulsion happens?
DO NOT REPLANT THE PRIMARY TOOTH!
For permanent: remain calm, pick up tooth by crown (NOT ROOT),
gently wash with tap water for 10s, if confident, encourage to replant and hold in place by biting on handkerchief, if not, place in storage solution i.e. milk/saline/pt. saliva, not water if possible, seek immediate dental tx
43
1. What is the goal in avulsion despite delayed replantation?
Restoring tooth for aesthetic, functional and psychological reasons, maintain alveolar bone contour
44
1. What can be used to slow down osseous replacement of tooth?
Treatment of root surface with fluoride prior to replantation (2% sodium fluoride solution for 20mins)
45
1. What topical antibiotics can be considered during avulsion of permanent tooth with open apex with an EO dry time of \<60mins?
Minocycline or doxycycline 1mg/20ml saline for 5 minutes soak
46
1. In enamel-dentin-pulp fracture of permanent teeth, what do you cap the cut pulpal surface with?
Calcium hydroxide
47
1. Why use calcium hydroxide when undertaking partial pulpotomy?
It promotes remineralisation. At pH11, it kills the pulpal cells in contact with it but also is very bactericidal allowing pulp healing.
48
1. What kind of radiographic exposure is optimal for locating root fracture in apical and mid 1/3?
Occlusal
49
1. What kind of radiographic exposure is needed for locating fractures in cervical 1/3 of root?
Bisecting angle exposure or 90 degree angulation exposure
50
1. What do you look for in primary teeth with pulpal necrosis?
Persistent grey colour that does not fade, no reduction in size of pulp cavity, radiographic signs of periapical inflammation, signs of infection, abscesses (abc’s), sinus tract, radiograph radiolucency
51
1. What do you do with primary teeth with pulpal necrosis?
XLA if radiographic signs of inflammation/clinical signs of infection
52
1. What do you look for in teeth with pulpal obliteration?
Tooth may become yellow/opaque, radiographically, pulp chamber will shrink
53
1. What is root dilaceration?
Deviation of root shape from normal long axis formation
54
1. What do you look for radiographically for a tooth with root dilaceration?
Root malformation, change in angulation
55
1. How do you treat root dilaceration?
Depends on severity of dilaceration, ortho or XLA
56
1. Why do immature teeth have a better prognosis than mature teeth with pulpal necrosis?
Due to the wide apical opening where slight movements can occur without disruption of the apical neurovascular bundle, like revascularisation
57
1. According to clem, how many clinical signs of pulpal necrosis should be present before starting RCT?
At least 2
58
1. What do you look for in permanent teeth with pulpal necrosis?
No response to sensibility testing, greyish discolouration, radiographic and clinical signs of periradicular inflammation/infection
59
What shouldn’t you use to dress a tooth with pulpal necrosis if you’re starting RCT within 2 weeks of re-implanting? Why?
CaOH, it may contribute to replacement resorption
60
1. What is the method for apical barrier formation of a tooth with an open apex?
Access canal, rubber dam, extirpate pulp, irrigate with NaOCl, find WL, shape + irrigate, dry canal, place non-setting CaOH as dressing, r/v at next appt, no infection → continue, clean out CaOH, irrigate (NaOCl + citric acid) + clean, MTA carrier 3mm short of apex and gently place + condense, introduce MTA to 2mm, verify radiographically, seal damp cotton pellet in contact with MTA (5mm plug) and dress tooth, see pt 48hrs later, remove cotton pellet, clean and fill, root fill and restore
61
1. Which portion of the tooth remains vital in root fractures?
Portion apical to the root fracture
62
1. How do you treat an apical ⅓ and mid ⅓ root fracture?
Treat up to the point of root fracture - MTA apical barrier, GP, resin-mod GI liner, composite
63
1. How do you treat a coronal ⅓ root fracture?
3 options: splinting coronal segment, XLA of coronal and apical portion, XLA of coronal portion
64
1. Which way do odontoblasts move when layering reactionary dentine after traumatic injury?
Away from the canal walls
65
1. What is inflammatory resorption caused by?
Multi nuclear giant cells
66
1. What type of trauma is external root resorption associated with?
Intrusions and teeth replanted following avulsions
67
1. How is external inflammatory resorption initiated?
By PDL damage and propagated by infected necrotic pulpal products diffusing down the dentinal tubules
68
1. How would you treat a restorable tooth with external root resorption?
RCT + monitor - pulp extirpation, debridement, fill with non-setting CaOH until infection controlled then permanent root filling
69
1. Clinically, what can internal inflammatory resorption present as?
Pink spot discolouration
70
1. When does replacement resorption usually occur?
After large luxation or avulsion injuries, usually when avulsed tooth is replanted too late or intruded tooth where PDL of socket and root surface is crushed
71
1. What characteristic would a tooth with replacement resorption have?
Metallic tone on percussion, “cracked plate”
72
1. How could you treat a patient with a tooth with replacement resorption where the gingival margin discrepancy exceeds 1-2mm?
May be necessary to decoronate the tooth below the alveolar bone and remove any root filling material present
73
1. How do you review trauma?
Reproducible, standardised testing; clear, relevant and concise notes; pt history, clinical examination, special tests
74
1. What do you assess in the clinical examination of trauma?
Colour assessment,
transillumination,
palpation,
sinuses,
percussion,
mobility
75
1. What are the 9 commonly used tests for pulpal/tooth vitality?
Colour,
EPT,
thermal test,
transillumination,
TTP,
mobility,
sinus/alveolar tenderness,
history and radiographic examination
76
1. What types of signs of infection can you look for to assess pulpal vitality?
Sinus tracts, suppuration, swelling
77
1. Why might pulpal necrosis presentation appear brownish?
Due to haemosiderin from oxidising haemoglobin
78
1. What is a good way to detect craze lines enamel infraction?
Transillumination
79
1. What do you put in the trauma referral letter?
When the trauma occurred,
where they were first seen,
trauma diagnosis,
what tx has been undertaken to date,
radiographs taken; avulsion case: EO time, storage medium; Name, contact number, date, MH, dental anxiety/cooperation level, PDH
80
1. What can cause discolouration of a tooth?
Pulpal necrosis, discolouration following RCT, localised discolouration of permanent tooth following primary tooth trauma, discolouration of restoration following trauma tx
81
1. How do you prevent discolouration following RCT?
Make sure GP has been trimmed off to finish below gingival level, canal is then sealed with thin layer of resin modified GI, ensure composite used to fill access cavity is well condensed and colour matched
82
1. What options do you have if RCT is finished and the tooth is still discoloured?
Crown +/- post core,
ceramic veneer,
internal/external bleaching,
composite camouflage
83
1. How can you aesthetically manage a discoloured tooth?
Accept it bro, free hand composite veneer, lab processed porcelain veneer, crown, combined with existing endo treatment - non vital bleaching if 18+
84
1. Why shouldn’t you use ferric sulphate to achieve haemostasis in permanent teeth?
It prevents tertiary dentine from laying down
85
1. Why do you not give doxycycline or tetracycline as topical abx in kids below 12?
Discoloration
86
1. What systematic abx do you use?
FL - penicillin
Doxycycline \> tetracycline; tetracycline - caution of crown discolouration
87
