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BDS4 Paediatrics > Trauma Guidelines Primary Dentition - International Association of Dental Traumatology 2020 > Flashcards

Trauma Guidelines Primary Dentition - International Association of Dental Traumatology 2020 Flashcards

1
Q

What are the clinical findings for an enamel only fracture

A

fracture involved enamel only

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2
Q

What are the radiographs indicated for enamel only fracture

A
  • none
  • if TTP, consider x-ray to rule out luxation or root fracture
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3
Q

What is the tx for enamel only fracture

A

smooth sharp edges
comp restoration if desirable

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4
Q

When should we follow up enamel only fracture

A

none required

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5
Q

What are the favourable outcomes of enamel only fractures

A
  • asymptomatic
  • pulp healing
  • continued root development in immature teeth
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6
Q

What are signs of pulp healing

A
  • no colour change of crowns
  • no sign of pulpal necrosis or infection
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7
Q

What are the unfavourable outcomes of enamel only fracture

A
  • symptomatic
  • crown discolouerd
  • signs of pulpal necrosis/infection
  • no further root development in immature teeth
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8
Q

What are signs of pulp necrosis/infection

A
  • sinus tract
  • gingival swelling
  • abscess
  • increased mobility
  • persistant dark grey discolouration with signs of infection
  • no further root development in immature teeth
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9
Q

What is the general aftercare for all injuries

A
  • watch out when eating, dont want to further traumatise tooth
  • encourage healing by good OH using soft brush or cotton swab and use CHX mouthwash - two times daily for a week
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10
Q

What are the clinical considerations for enamel dentine fratcure with no pulp exposure

A
  • locate missing tooth fragment
  • risk of it being imbedded or aspirated
  • fracture with no pulp exposrue
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11
Q

What radiographs do we take for enamel dentine fracture with no pulp exposure

A

baseline xray option
take xray of soft tissues if unaccounted for
if TTP, rule out luxation and root fracture

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12
Q

What is the treatment for enamel dentine fracture with no pulp exposure

A

cover exposed dentine with GI/comp
can restore lost tooth structure with comp

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13
Q

What is the follow up for enamel dentine fracture with no pulp exposure

A
  • 6-8 wks
  • only follow up with x-ray if signs of pulp necrosis and/or infection
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14
Q

What are the favourable outcomes of enamel dentine fracture with no pulp exposure

A
  • asymptomatic
  • pulp healing
  • continued root development
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15
Q

What are the unfavourable outcomes of enamel dentine fracture with no pulp exposure

A
  • symptomatic
  • crown discoloured
  • signs of pulp necrosis/infection
  • no further root development
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16
Q

What are the clinical considerations of complicated crown fracture (enamel dentine pulp)

A
  • exposed pulp
  • locate missing tooth fragment
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17
Q

What radiographs do you want for a complicated crown fracture

A
  • PA or occlusal for diagnosis and baseline
  • screen for signs of displacement and root injury
  • take x-ray soft tissue if concerned about embedding
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18
Q

What is the tx for complicated crown fracture

A
  • aim to preserve pulp
  • if not then pulpectomy (not really mentioned in IADT guidelines) or XLA
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19
Q

Why should we aim to preserve pulp in complicated fractures

A

to encourage normal root growth known as apexogenesis

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20
Q

What ways can we preserve pulp

A
  • pulp cap
  • partial pulpotomy
  • coronal pulpotomy
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21
Q

When can we do a pulp cap

A

When pulp exposure within 24h and <1mm exposure

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22
Q

How do we do a pulp cap

A

cover exposure with setting caoh
cover with gi
cover with comp

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23
Q

What is the procedure for partial pulpotomy - briefly

A
  • dam
  • remove 2mm pulp and arrest haemorrhage with saline
  • NScaoh placed
  • cover with GI
  • cover with comp
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24
Q

When is partial pulpotomy indicated

A

exposure >1mm
>24h

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25
Q

When is coronal pulpotomy indicated

A
  • pulp hyperaemic or necrotic
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26
Q

What is the procedure for full pulpotomy

A

remove all coronal pulp
place nscaoh
seal with GIC lining

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27
Q

How is a pulpectomy done on a primary tooth

A
  • file 2mm short of WL
  • no radiograph with file inside done for WL
  • CaOh and iodoform paste so tooth can resorb away
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28
Q

When is the follow up for complicated crown fracture

A

1 wk, 6-8 wks, 1y
x-ray 1 yr following pulpotomy

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29
Q

What is an unfavourable outcome for complicated crown fracture

A
  • symptoamtic
  • crown discoloured
  • signs of pulp nercosis
  • no further root development in immature teeth
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30
Q

What is a favourable outcome for complicated crown fracture

A
  • asymptomatic
  • pulp healing
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31
Q

What are signs of continued root development

A

increase in root length
thicker dentine walls
no PAP
no root resorption

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32
Q

What are the clinical findings for uncomplicated crown roto fracture

A
  • fracture involves enamel dentine and root
  • pulp not exposed
  • may notice loose but still attached fragments
  • TTP
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33
Q

What x-rays do you want for crown-root fracture

A

PA or occlusal

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34
Q

What is the tx options for uncomplicated crown root fracture

A
  • no tx and rapid referral
  • extract coronal fragment and restore if possible with GIC
  • if unrestorable, remove loose fragments without damaging the permanent and then leave firm root in situ
  • XLA
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35
Q

What is the follow up for crown root fracture - uncomplicated

A

fragment removal
* 1 wk, 6-8 wk, 1yr
extraction
* 1 yr

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36
Q

What are favourable outcomes for uncomplicated crown root fracture

A
  • asymptomatic
  • pulp healing
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37
Q

What are unfavourable outcomes for crown root fracture

A
  • symptomatic
  • crown discoloured
  • signs of pulp necrosis/infection
  • no further root development of immature teeth
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38
Q

What are the clinical findings for complicated crown root fracture

A
  • involves enamel, dentine and the root
  • pulp exposed
  • may notice loose but still attached fragments
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39
Q

What x-rays for complicated crown root fracture

A

PA/occlusal

40
Q

What is the tx for complicated crown root fracture

A
  • fragment removal
  • only if remaining tissue large enough to allow restoration adn perform pulpotomy/RCT
  • XLA otherwise
41
Q

What is the follow up for complicated crown root fracture

A
  • fragment removal - 1wk, 6-8wk, 1yr. xray after 1 year only
  • XLA: clinical review 1 yr
42
Q

What are favourable outcomes of complicated crown root fracture

A
  • asymptomatic
  • pulp healing
  • continued root development in immature teeth
43
Q

What are unfavourable outcomes in complicated crown root fracture

A
  • symptomatic
  • crown discoloured
  • signs of pulp necrosis
  • no further root development
44
Q

What are the clinical findings for root fracture

A
  • depends on fracture location
  • coronal fragment may be mobile and displaced
  • occlusal interference may be present
  • tooth may be TTp
45
Q

What radiographs should you take for root fracture

A

PA or occlusal
fracture usually in mid or apical 1/3

46
Q

What are the tx options for treatment of root fracture

A
  • no tx
  • repositioning
  • xla of loose coronal fragment only
47
Q

When is it suitable to carry out no tx for root fracture

A
  • not displaced
  • displcaed but not excessively mobile
  • can expect spontaneous repositioning
48
Q

When repositioning coronal root fracture, how long should a flexible splint be placed for

A

4 wks

49
Q

What is the follow up for root fracture

A

1wk, 6-8 wk, 1 yr then every year until permanent tooth eruption (if no tx provided)

1wk, 4wk, 8wk, 1y if coronal fragment repositioned

1 yr if XLA

50
Q

What are favourable outcomes for root fracture

A
  • asymptomatic
  • pulp healing
  • realignment of root - fractured tooth
  • no mobility
  • resorption of apical fragment
51
Q

What are unfavourable outcomes of root fracture

A
  • symptomatic
  • crown discoloured
  • signs of pulp necrosis/infection
  • no further root development
  • no improvement in position of root fractured tooth
52
Q

What are the clinical findings of alveolar fracture

A
  • fracture involves alveolar bone
  • mobility and dislocation of segment with several teeth moving together
  • occlusal interference
  • TTP
53
Q

What x-rays should you get for an alveolar fracture

A
  • PA/occlusal
  • lateral x-ray may give information on relationship between permanent tooth and primary
  • further imaging may be required to see extent of the fracture
54
Q

What is the tx for alveolar fracture

A
  • reposition
  • flexible splint 4 wks to adjacent uninjured teeth
55
Q

When is the clinical follow up for alveolar fracture

A
  • 1wk, 4wk, 8wk, 1yr
  • radiographs at 4 wks and 1 yr to assess impact on teeth
  • follow up at 6 YO to monitor eruption
  • fracture lines located at primary tooth apex –> can cause abscess
56
Q

What are unfavourable outcomes for an alveolar fracture

A
  • symptomatic
  • crown discoloured
  • signs of pulp necrosis/infection
  • no further root development
  • no improvement in position of displcaed segment and original occlusion not restored
  • disturbed permanent successor
57
Q

What are favourable outcomes for alveolar fracture

A
  • asymptomatic
  • pulp healing
  • pdl healing
  • continued root development
  • realignment of segment with original occlusion
  • no disturbance to permanent tooth development or eruption
58
Q

What are the clinical findings of a concussion injury

A
  • tooth TTP
  • no displacement
  • no gingival bleeding
59
Q

What x-rays should be taken for concussion

A

none

60
Q

What is the tx for concussion

A

observe

61
Q

What is the follow up for concussion

A
  • 1wk and 6-8wks
  • xray only when signs of pathology
62
Q

What are favourable outcomes of concussion injury

A
  • asymptomatic
  • pulp healing - normal colour of crown or transient red/gray/yellow colour and pulp obliteration
  • continued root development
  • continued development and eruption of permanent tooth
63
Q

What is pulp obliteration

A

pulpal response to trauma
rapid deposition of mineralized tissue in root canal space

64
Q

What are unfavourable outcomes for concussion

A
  • symptomatic
  • signs of pulp necrosis
  • no further root development
  • negative impact on permanent successor
65
Q

What are the clinical findings of subluxation

A

TTP
no displacement
gingival bleeding

66
Q

What xray should we take for subluxation and what would you expect to see

A

PA or occlusal
would expect to see normal or widened PDL space

67
Q

What is the tx for subluxation

A

no tx
observe

68
Q

What is the follow up for subluxation

A
  • 1wk and 6-8 wks
  • xray only when signs of pathology
69
Q

What are favourable outcomes for subluxation

A
  • asymptomatic
  • pulp healing - normal colour of crown or transient red/yellow discolouration and pulp obliteration
  • continued root development
  • continued development and eruption of permanent tooth
70
Q

What are unfavourable outcomes for subluxation

A
  • symptomatic
  • signs of pulp necrosis
  • no further root development
  • negative impact on permanent successor
71
Q

What are the clinical findings of extrusive luxation

A
  • partial displacement of tooth out of its socket
  • tooth appears elongated
  • occlusal interference possible
72
Q

What xray for extrusive luxation

A

PA/occlusal
slight/substantial widening to PDL space

73
Q

What is the tx for extrusive lxuation

A

if no occlusal interference - no tx, allow spontaneous repositioning

if excessive mobility or extruded >3mm - extract under LA

74
Q

What is the follow up for extrusive luxation

A

1wk, 6-8 wk, 1y
where concerned about outcome, review every year until eruption of permanent
xray only when indicated

75
Q

What are favourable outcomes for extrusive luxation

A
  • asymptomatic
  • pulp healing
  • continued root development
  • continued development/eruption of permanent tooth
  • realignment of extruded tooth
  • no occlusal interference
76
Q

What are unfavourable outcomes for extrusive luxation

A
  • symptoamtic
  • signs of pulp necrosis
  • no further root development
  • negative impact on permanent sucessor
  • occlusal interference
  • no improvement in position
77
Q

What are the clinical findings for lateral luxation

A
  • tooth displaced palatal/labially
  • immobile
  • occlusal interference
  • high metallic sound on TTP
78
Q

What xray should you take for lateral luxation and what would you expect to see

A
  • pa/occlusal
  • increased widening to PDL space apically
  • best seen on occlusal
79
Q

What is the tx for lateral luxation if there is no oclcusal interference

A
  • no tx - spontaneous repositioning, occurs within 6mo
80
Q

What is the tx for lateral luxation if there is excessive displacement

A

options are
* extract under LA
* reposition under LA - 4wk flexible splint

81
Q

When should you follow up a lateral luxation

A

1wk, 6-8wk, 6 mo, 1 yr
also at 4 wk if repositioned - splint removal
where concerned about outcome, review every year until eruption of permanent
xray only when indicated

82
Q

What are favourable outcomes for lateral luxation

A
  • asymptomatic
  • pulp healing
  • continued root development
  • continued development/eruption of permanent tooth
  • realignmnet of tooth
  • no occlusal interference
  • PDL healing
83
Q

What are unfavourable outcomes of lateral luxation

A
  • symptomatic
  • signs of pulp necrosis
  • no further root development
  • negative impact on permanent sucecssor
  • occlusal interference
  • no improvement in position
  • ankylosis
84
Q

What are the clinical findings of intrusion

A
  • tooth usually displaced through labial bone plate or permanent tooth bud
  • tooth almost/completey disappeared into socket
  • high metallic sound
  • non mobile
85
Q

What xray would you take for intrusion and what would you see

A
  • PA/occlusal
  • if apex displaced labially, apical tip can be seen and tooth appears shorter
  • if apex displaced towards tooth germ, apical tip cannot be seen and tooth germ appears elongated
86
Q

What is the tx for intrusion

A
  • it is assoicated with damage to the permanent tooth
  • for that reason, allow for spontaneous repositioning which can take up to a year
  • refer
87
Q

When is the follow up for intrusion

A

1wk, 6-8wks, 6 months, 1yr
follow up at 6yo for severe intursion to monitor for eruption of permanent tooth

88
Q

What are favourable outcomes for intrusion

A
  • asymptomatic
  • pulp healing
  • continued root development
  • continued development/eruption of permanent tooth
  • realignment of tooth
  • PDL healing
89
Q

What are the unfavourable outcomes for intrusion

A
  • symptomatic
  • signs of pulp necrosis
  • no further root development
  • negative impact on permanent succesor
  • occlusal interference
  • no improvement in position
  • ankylosis
90
Q

What are the clinical findings for avulsion

A
  • tooth out of socket
  • account for tooth
91
Q

What radiograph for avulsion

A

PA/occlusal to rule out intrusion

92
Q

What is the tx for avulsion

A

nil
do not replant

93
Q

What is the follow up for avulsion

A

6-8wks
6 yo to monitor eruption of permanent

94
Q

What is the favourable outcome for avulsion

A

no disruption to permanent

95
Q

What is an unfavourable outcome for avulsion

A

disruption to permanent

96
Q

What age is the highest risk for injury to cause damage to permanent

A

<3YO

97
Q

What are the possible complications that parents should look out for post injury

A
  • swelling
  • dark discolouration of crown
  • increased mobility
  • fistula

BDS4 Paediatrics (4 decks)

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