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BDS3 paeds > Trauma I > Flashcards

Trauma I Flashcards

1
Q

accidental damage to permanent teeth occurence

A

25% all school children experience dental trauma

33% adults - permanent dentition mostly before 19yrs

Boys:girls approximately 3:1

70% not treated

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2
Q

what is the most common injury in primary dentition

A

luxation

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3
Q

what is the most common injury in permanent dentition

A

crown fractures

  • enamel dentine fracture
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4
Q

peak period for trauma to permanent teeth

A

7-10 years

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5
Q

what makes trauma to permanent teeth more likely

A

large overjet (likely not fixed by ortho yet)

OJ > 9mm doubles the incidence of trauma

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6
Q

causes of trauma (4)

A

Falls
- 50%

Bike, skateboard, RTA.
- 17-35%

Sport
- 14 – 25%

Fights
- 3%

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7
Q

what should you take in dental history of trauma child

A

How did it happen
When did it happen exactly
Where are the lost teeth/fragments
Any other symptoms

Take a dental and medical history
- Important to identify if any aspects of MH may influence treatment options

Be aware if :
- Rheumatic Fever
- Congenital heart defects
- Immunosuppression
These conditions are not contraindications to treatment but appropriate additional treatment may need to be given.
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8
Q

what types of MH may influence dental Tx for trauma child pt

A 
Be aware if :
- Rheumatic Fever
- Congenital heart defects
- Immunosuppression
These conditions are not contraindications to treatment but appropriate additional treatment may need to be given.
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9
Q

order of EO and IO examination for child trauma pt

A

rule out facial/jaw fracture

Extra oral

  • Laceration
  • Haematomas
  • Haemorrhage / CSF
  • Subconjunctival haemorrhage
  • Bony step deformities
  • Mouth opening

Intraoral

  • Soft tissue
  • Alveolar bone
  • Occlusion
  • Teeth
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10
Q

what may be in the wound of child dental trauma

A

foreign bodies

Check for soft tissue damage

  • Penetrating wounds, foreign bodies
  • Soft tissue radiograph to check lacerations
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11
Q

tooth mobility tested with

A

probe

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12
Q

tooth mobility may indicate (2)

A
  • displacement of tooth
  • root or bone fracture (horizontal or vertical - transillumination can help)

potential pulpal involvement

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13
Q

5 stages in detailed intra oral exam of child pt with trauma

A

Sensibility tests

  • Thermal: ethyl chloride (ECL) or warm Gutta-Percha
  • Electrical: electric pulp tester (EPT).

Percussion
- duller note may indicate root#

Occlusion
- traumatic occlusion demands urgent treatment

Radiographs
- intra-oral, occlusal, OPT, soft tissue.

Classify the trauma

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14
Q

percussion of traumatised tooth

A

duller note = indicate root fracture

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15
Q

sensibility tests assess

A

nerve response

vitality – blood – Laser Dopler

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16
Q

types of sensibility tests (2)

A
  • Thermal: ethyl chloride (ECL) or warm Gutta-Percha

- Electrical: electric pulp tester (EPT).

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17
Q

what type of occlusion needs urgent treatment

A

traumatic occlusion

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18
Q

trauma sticker

A

Label FDI notation at top

+/- for:

  • sinus,
  • TTP,
  • ECL,
  • P.NOTE,
  • radiograph (see below)

Color describe

Mobility grade

EPT score after test

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19
Q

how to carry out a sensibility test

A

Compare injured tooth with the adjacent non-injured tooth.
- Always test adjacent teeth and opposing teeth in addition to those obviously injured. These teeth must have received either direct or indirect concussive injuries.

This applies to both sensibility tests AND when viewing root surfaces on radiographs

Continue sensibility tests for at least 2 years after an injury

Never make clinical judgements on sensibility tests alone

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20
Q

classification of crown and root fracture

A

enamel fracture

enamel dentine fracture

enamel dentine pulp fracture

uncomplicated crown root fracture

root fracture (apical, middle or cervical third)

complicated crown root fracture

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21
Q

uncomplicated fracture means

A

the pulp is not involved

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22
Q

complicated fracture means

A

pulp is the involved

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23
Q

prognosis of traumatised tooth depends on (5)

A

Stage of root development - positive and negative impacts

Type of injury

If PDL is damaged to

Time between injury and treatment

Presence of infection

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24
Q

general aims and principles of treatment

emergency Tx
5

A

Aim to retain vitality of any damaged or displaced tooth by protecting exposed dentine by an adhesive ‘dentine bandage’

Treat exposed pulp tissue

Reduction and immobilisation of displaced teeth

Tetanus prophylaxis

Antibiotics - Depends on location trauma

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25
Q

general aims and principles of treatment

immediate Tx
2

A

+/- Pulp treatment

Restoration
- Minimally invasive e.g. acid etch restoration

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26
Q

general aims and principles of treatment

permanent Tx
5

A

Apexigenesis
- normal biological process of apex growing and closing - worked

Apexification
- intervene to provide an apex as developmental process halter

Root filling +/- root extrusion

Gingival and alveolar collar modification if required

Coronal restoration

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27
Q

apexigenesis

A

normal biological process of apex growing and closing - worked

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28
Q

apexification

A

intervene to provide an apex as developmental process halter

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29
Q

how to manage an enamel fracture (2 options)

A

Either

  • Bond fragment to tooth or
  • Simply grind sharp edges

Take 2 periapical radiographs to rule out root fracture or luxation

Follow up
- 6-8weeks and at 1 year

Prognosis – 0% risk of pulp necrosis

30
Q

follow up for enamel fracture

A

6-8weeks and at 1 year

31
Q

prognosis of enamel fracture

A

0% risk of pulp necrosis

32
Q

how to manage an enamel dentine fracture

2 options

A

Either
- Bond fragment to tooth or
- Place composite bandage
Line the restoration if the fracture is close to the pulp

then definitive restoration

33
Q

how to manage an enamel dentine fracture

first step

A

Account for fragment – know where it is, bond on/composite bandage/ composite

34
Q

Special tests for enamel dentine fracture

A

Take 2 periapical
radiographs to rule our root fracture or luxation

Radiograph any lip or cheek lacerations to rule out embedded fragment

Sensibility testing and evaluate tooth maturity

35
Q

when is follow up for enamel dentine fracture

A

Follow up – 6-8 weeks and at 1 year

36
Q

prognosis of restored crown after ED fracture

A

5% chance pulp necrosis at 10 years

37
Q

what to check on radiographs for in follow up fo ED fracture

A

root development - width of canal and length

comparison with other side

internal + external inflammatory resorption

periapical pathology

38
Q

effect on concussion on pulpal survival in ED fracture

open apex

A

95%

39
Q

effect on concussion on pulpal survival in ED fracture

closed apex

A

85%

40
Q

effect on subluxation on pulpal survival in ED fracture

open apex

A

80%

41
Q

effect on subluxation on pulpal survival in ED fracture

closed apex

A

50%

42
Q

effect on extrusion on pulpal survival in ED fracture

open apex

A

60%

43
Q

effect on extrusion on pulpal survival in ED fracture

closed apex

A

20%

44
Q

effect on lateral luxation on pulpal survival in ED fracture

open apex

A

65%

45
Q

effect on lateral luxation on pulpal survival in ED fracture

closed apex

A

15%

46
Q

effect on intrusion on pulpal survival in ED fracture

open apex

A

0%

47
Q

effect on intrusion on pulpal survival in ED fracture

closed apex

A

0%

48
Q

mature Vs immature tooth chance of pulpal survival after trauma

A

Chances of pulp survival better in immature tooth – open, lots of access to nerves and blood vessels compared to single point entry for closed apex

49
Q

3 things to evaluate after enamel-dentine-pulp exposure

A

size of pulp exposure

time since injury

associated PDL injuries

50
Q

treatment options for enamel-dentine-pulp exposure (3)

A

pulp cap
- less than 24hr

partial pulpotomy (Cvek Pulpotomy) 
- more than 24hr old

full coronal pulpotomy

  • damage to pulp is and length exposed
  • last resort
51
Q

what is the aim of treatment for enamel-dentine-pulp exposure

A

to preserve pulp vitality

52
Q

treatment of choice in open and closed apices with EDP exposure

A

preserve pulp vitality by pulp capping or partial pulpotomy
- in order to secure further root development.

This treatment is also the treatment of choice in patients with closed apices.

Calcium hydroxide compounds and MTA (white) are suitable materials for such procedures.

53
Q

direct pup cap when

A

tiny exposure (1mm)

24hr window

54
Q

direct pulp cap procedure

A

Trauma sticker and radiographic assessment
- Should be non-TTP and positive to sensibility tests

LA and rubber dam

Clean area with water then disinfect area with sodium hypochlorite

Apply calcium hydroxide (Dycal) or MTA White to pulp exposre

Restore tooth with quality composite restoration

Review 6-8 weeks then 1 year

55
Q

partial pulpotomy (Cvek pulpotomy) when

A

larger exposure (>1mm)

24+ hours since trauma

56
Q

partial pulpotomy (Cvek pulpotomy) procedure

A

Trauma sticker and radiographic assessment

LA and rubber dam

Clean area with water then disinfect area with sodium hypochlorite

Remove 2mm of pulp with high speed round diamond bur

Place saline soaked CW pellet over exposure until haemostasis achieved
- If no bleeding or can’t arrest bleeding (hyperaemic) proceed to full coronal pulpotomy

Apply CaOH then vitrebond (or white MTA) then restore with quality composure resin

should get continued root development from wide open apex

57
Q

full coronal pulpotomy procedure

A

Begin with partial pulpotomy
- Assess for haemostasis after application of saline soaked cotton-wool
(Last resort)

If hyperaemic or necrotic, then proceed to remove ALL of the coronal pulp

Place calcium hydroxide in pulp chamber

Seal with GIC lining and quality coronal restoration

58
Q

when do you resort full coronal pulpotomy

A

when assessing haemostasis at partial
- saline soaked cotton wool

hyperaemic or necrotic (no bleeding), then proceed to remove ALL of the coronal pulp

59
Q

partial (Cvek) Vs full coronal pulpotomy

A

partial - 97% success

full coronal - 75% success

60
Q

aim of pulpotomy

A

to keep vital pulp tissue within the canal to allow normal root growth (apexogenesis) both in the length of the root and the thickness of the dentine.

61
Q

follow up for pulpotomy

A

6-8 weeks and 12 months

clinical and radiographic review

62
Q

root treatment for immature incisors

tooth non-vital then

A

full pulpectomy needed

63
Q

root treatment for immature incisors

tooth non-vital but
apex of tooth is open

A

clinical problem is the need to have an apical stop to allow obturation with GP

64
Q

how to achieve apical stop in open apex tooth needing pulpectomy (3 options)

A

CaOH placed in canal aiming to induce hard-tissue barrier to form (apexification)
- Not great, takes 9 months to form properly but CaOH denatures dentine after 4 weeks

or MTA/BioDentine/bioceramic placed at apex of canal to create cement barrier

Or Regenerative Endodontic Technique to encourage hard tissue formation at apex
- Stem cells activate and differentiate into odontoblasts, then make dentine (sometimes bone so still in early stage)

65
Q

best material for achieve apical stop in open apex tooth

A

MTA/BioDentine/bioceramic placed at apex of canal to create cement barrie

66
Q

pulpectomy - open apex

A
  • Rubber dam
  • Access
  • Haemorrhage control - LA / sterile water
  • Diagnostic radiograph for WL
  • File 2mm short of estimated WL
  • Dry canal, Non-setting Ca(OH)2 , CW in pulp chamber

Extirpate pulp and place MTA plug and heated GP obturation (5-6mm of MTA)
- cylinder of GP to fill wide canal

Glass-ionomer temporary cement in access cavity and evaluate MTA fill level with radiograph

67
Q

how is MTA placed

A

use carriers

68
Q

final coronal restoration of pulpectomy

A

Once obturation complete

Consider bonded composite short way down canal as well as in access cavity

Bonded core

Try to avoid post crown

69
Q

crown-root fracture with no pulp exposure

extends beyond gum – past gingival level and crestal bone

treatment options (7)

A

fragment removal only and restore

Fragment removal and gingivectomy
- Indicated in crown-root fractures with palatal
subgingival extension

Orthodontic extrusion of apical portion

  1. Extrusion
  2. Endodontic
  3. Post crown

Surgical extrusion
- Removing all PDL and lowering tooth into place – severe. If pulp alive unlike

Orthodontic extrusion of apical portion

Decoronation
- Preserve bone for future implant

Extraction

May need to do temporary treatment as need more information before can proceed

70
Q

when is fragment removal and ginivectomy indicated in crown-root fractures

A

Indicated in crown-root fractures with palatal

subgingival extension

71
Q

purpose of decoronation

A

perserve boen for future implant

72
Q

post crown

A

not wanted in crown-root fracture Tx but sometimes needed

BDS3 paeds (15 decks)

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