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Paediatric dentistry > trauma guide > Flashcards

trauma guide Flashcards

1
Q

subluxation in primary tooth

clinical findings
radiographic recommendations
treatment
follow up

A

clin: tooth is tender to touch, increased mob, not been displaced, gingival crevice bleeding
xray: PA and baseline establishment
treatment: no treatment, observation, cleaning (with soft brush and alcohol free 0.1-0.2% chlorhexidine gluconate mouth rinse applied topically 2 times a day for a week), soft diet, analgesic
follow up:
1 week, 6-8 week
xray when signs of pathosis

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2
Q

concussion in primary tooth

clinical findings
radiographic recommendations
treatment
follow up

A

clin: tooth is tender not been displaced, normal mobility
xray: none
treatment: no treatment, observation, cleaning (with soft brush and alcohol free 0.1-0.2% chlorhexidine gluconate mouth rinse applied topically 2 times a day for a week), soft diet

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3
Q

favourable outcome

A

asymptomatic
pulp healing with normal colour of crown, transient discolouration
no sign of pulp necrosis
continued root development in immature teeth
no disturbance to development/eruption of the permanent successor

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4
Q

unfavourable

A 
symptomatic
pulp necrosis and infection
radiographic signs
further root development of immature teeth
negative impact on successor
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5
Q

lateral luxation in primary teeth

clinical findings
radiographic recommendations
treatment
follow up

A

clinical: tooth displaced palatally/lingually/labial
xray: PA for baseline (PDL space increased)
treatment:
if no occlusal interference & stable & displacement mild, tooth should be allowed to spontaneously reposition (physiologic) (happens in 6 months)
immediate repositioning: splint for 4 weeks using flexible splint attached to adjacent uninjured teeth
extract if (w LA): tooth pushed into tooth bud
occlusal interference,
excess mobility
follow up:
if left alone: 1 wk, 6-8 wk, 6 mo, 1y
if repositioned: 1 wk, 4 wk for splint removal, 8 wk, 6 mo, 1 yr
radiographic follow up when theres pathosis

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6
Q

extrusive luxation in primary teeth

when to extract

A

if to mobile or extruded >3mm

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7
Q

intrusion/intrusive luxation in primary teeth

clinical findings
radiographic recommendations
treatment
follow up

A

clinical findings: displaced through lateral bone plate, impinged on perm too bud, could completely disappear into socket
ask for history to ensure that its true intrusion
xray: PA for baseline, if apex is labial, tooth will appear short, if tooth towards perm tooth, apex cannot be visualised, tooth appear elongated (higher risk of injury to tooth germ)
treatment: tooth allowed to reposition (6mo-1y), observation, cleaning (with soft brush and alcohol-free 0.1-0.2% chlorhexidine gluconate mouth rinse applied topically 2 times a day for a week), soft diet
follow up: 1wl, 6-8 wk, 6mo, 1y
at 6y for severe intrusion to monitor eruption of perm

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8
Q

follow ups for luxation injuries

A

1w, 6-8w, 6mo, 1y

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9
Q 
avulsion in primary teeth
clinical findings
radiographic recommendations
treatment
follow up
A

DO NOT reimplant due to perm tooth
locate the missing tooth
clinical findings: if not found, send to A&E
xray: PA to find it or baseline for assessment of perm tooth
treatment: soft diet, CHX cleaning
follow up: 6-8 wk, follow up at 6 y to monitor the eruption, only xray if pathological, bad if perm doesnt erupt

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10
Q

root fracture in primary teeth

clinical findings
radiographic recommendations
treatment
follow up

A 
clinical finding: 
radio: PA at baseline
treatment: 
if stable: leave and monitor
if not: extract coronal segment and leave apical segment (roots close to perm)
reposition and splint for 4 weeks
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11
Q

crown fractures in primary teeth: depends on pulp exposure

clinical findings
radiographic recommendations
treatment
follow up

A

enamel and enamel dentine
treatment: leave, smoothen sharp edges, composite restoration strip crown

pulp exposure
treatment: pulpotomy/pulpectomy extraction

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12
Q

crown-root fracture in primary teeth: depending on pulp exposure

clinical findings
radiographic recommendations
treatment
follow up

A

without pulp involvement: fragment removal, cover dentine w GIC
extract

with pulp:
fragment removal, RCT
extraction

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13
Q

alveolar fracture in primary teeth

clinical findings
radiographic recommendations
treatment
follow up

A

treatment: give LA/sedation, manual reposition, stabilise with flexible splint for 4 weeks, monitor teeth in fracture line

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14
Q

do you do sensitivity tests in children?

A

not reliable in children

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15
Q

what is the OHE instructions for parents

A

support tooth in brushing, cotton ball cleaning w chlorhex

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16
Q

what happens when theres a grey tooth discolouration

A

haemorrage one or 2 weeks before, if it gradually disappears/lightens, we dont treat. only treat when theres other signs and symptoms

17
Q

Lateral luxation in perm tooth

Clinical findings
X-ray
Treatment and
Follow-up

A

Tooth-is displaced, usually assoc fracture of alveolar bone percussion likely give high metallic sound.

X-ray: 1 parallel PA, 2 angled PA, 1 occlusal

Treatment: give LA then reposition for 4 weeks with splint, monitor pulp status
Fix aesthetics with partial dentures
Initiate rct early to prevent resorption

Prognosis depends on status of tooth: tooth w incomplete
Apex may have spontaneous
Revascularisation but apex complete tooth likely necrosis

Clinical & xray follow up: 2wk, 4wk, 8wk, 12wk, 6mo, 1yr, yearly for 5 years

18
Q

Complications to look out for after trauma

A

Loss of vitality
Internal external root resorption
Pulpal necrosis & obliteration
Ankylosis/ replacement resorption

19
Q

List order of how severe trauma can be

prognosis

A

1 intrusion
2 lateral luxation / extrusion
3 concussion/ subluxation
If you have combination shit then even worse

20
Q 
Intrusive luxation in perm tooth
Clinical finding
x-ray
treatment
follow up
A

Clinical finding: tooth displaced, immobile, percussion gives high metallic sound

xray: 1 parallel PA, 2 angled PA, 1 occlusal

Treatment:
in developing tooth, allow reeruption, if no re eruption in 4 weeks use ortho to pull it down
If pulp become necrotic then rct

In fully formed roots: if tooth intruded less than 3mm, allow reeruption. 3-7mm reposition surgical (prefered) or ortho. beyond 7mm reposition surgically
rct in 2 weeks cos tooth almost sure die
can use steroids in canal to reduce inflammation, if not use anitbiotics and CaOH

follow up: 2wk, 4wk, 8 wk, 12wk, 6 mo, 1y, yearly for 5 years

21
Q

why do teeth kenna pulp canal obliteration

A

common in teeth with wide open apex trying to heal by laying down dentine, cause pulpal strangulation, lose vitality

22
Q

extrusive luxation in perm tooth

Clinical finding
x-ray
treatment
follow up

A

clinical: elongated, mobile,

23
Q 
root fracture for perm tooth
clinical
x-ray
treatment
follow up
A

clinical descriptions:
coronal segment mobile, TTP, bleeding from sulcus

xray: 1 parallel PA, 2 angled PA, 1 occlusal, CBCT can be considered
treatment: coronal fragment should be repositioned as soon as possible, take PA, splint for 4 wks-4mo (cervical), monitor healing for a year, if necrosis happens, treat the necrotic part only (not the whole canal), but a bit hard to determine length.

follow up: 4 weeks, 6-8 weeks, 4 mo, 6mo, 1y, yearly for 5 years
dont RCT just because no pulp response. give it time

coronal 1/3 poorest prognosis, greater chance for oral bacteria and more movement

24
Q

how to describe root fractures

A

single or multiple,
horizontal or vertical,
level
degree of separation

25
Q

complicated fracture for perm tooth

clinical finding
xray
treatment
follow up

A

clinical finding: pulp sensitivity usually positive, pls find the fragment thanks later they aspirate need go A&E

xray: 1+2+occlusal maybe CBCT

treatment: if no pulp exposure, spint and stick back w GIC
if pulp exposed, partial pulpot for developing tooth and and full pulpot for fully formed root.
in the future can ortho, surgical, RCT etc

follow up: 1wk, 6-8wk, 3 mo, 6 mo, 1y, yearly at least 5 years

26
Q

whats transient apical breakdown

A

in moderate injury to pulp or PDL, sometimes repair can happen and apex looks radiolucent cos increased blood supply to allow healing. can loss of sensitivity shortly also. DONT ANYHOW RCT just because sensibility test gg. monitor da radiographs

27
Q

alveolar fracture in perm tooth

clinical finding
xray
treatment
follow up

A

clinical findings: mobility, usually multiple teeth

xray: 1+2+occlusal maybe CBCT
treatment: reposition with passive splint, suture any lacerations

follow up: 4 wk, 6-8 wk, 4mo, 6mo, 1y, yearly for 5 years

28
Q

types of resorptions

A

replacement resorption: root resorpt replaced by bone
inflammatory resorption: infected pulp tissue act as constant stimulus for inflammation (need to do RCT early)
surface resorption: mild, limited to surface of cementum or dentine

29
Q

tooth avulsion in perm teeth w closed apex

clinical finding
xray
treatment
follow up

A

clinical:
at site of accident: pick up the crown, rinse w saline or milk, try to stick back, but if cannot, put in milk

if patient comes in with tooth replanted: check if is correct, if not correct can change up to 48hr, give LA (no vasoconstrictor), reposition
if in saline or milk, wash gently, irrigate socket, put back, verify

systemic antibiotics, check tetanus
splint for 2 weeks. if got alveolar fracture then 4 weeks

if put back in 15min, PDL likely alive
if in medium for up to 1 hour, compromised but still can try
if more than 1 hour, GG will ankylosis but just at least got some aesthetics and function

endo within 2 weeks

30
Q

tooth avulsion in perm teeth w open apex whats the difference?

clinical finding
xray
treatment
follow up

A

revascularisation can lead to further root development. if unlucky it never happen, inflammatory resorption and necrosis then do root canal.

expect pulp canal obliteration

31
Q

what antibiotics to give when tooth is avulsed

A

amox, penicillin, tetracycline, doxycycline (not for patients under 12 later intrinsic discolouration)

32
Q

types of intracanal medicament and and guidelines

A

CaOH for a month

corticosteroid/antibiotic mixture then need 6 weeks

33
Q

4 post emergency advice

A
  1. avoid contact sports
  2. maintain soft diet for up to 2 weeks
  3. brush w soft tooth brush after every meal
  4. CHX 0.12% mouth rinse 2 weeks
34
Q

open apex vs closed apex difference between recalls

A

open apex more frequent, need to see at 2 months cos later ankylosis need to discover early

Paediatric dentistry (12 decks)

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