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Peds II > Trauma III > Flashcards

Trauma III Flashcards

1
Q

What is another name for concussion?

A
  • AKA contussion
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2
Q

Concussion: periodontal ligament?

A

Doesn’t break

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3
Q

Concussion: Mobility? (2)

A

no mobility or displacement

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4
Q

Intrusive luxation treatment on permanent dentition: options?

A
  1. Leave it to reerupt
  2. Orthodontic reposition
  3. surgical reposition
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5
Q

Intrusive luxation treatment on primary dentition? (3)

A
  • Let it reerupt
  • Pulpectomy
  • Extraction
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6
Q

Concussion: bleeding?

A

Usually no bleeding on the gingival margin

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7
Q

Concussion: pain?

A

Pain to percussion

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8
Q

Concussion: X-ray?

A

No findings

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9
Q

Concussion: esthetic problem?

A

No

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10
Q

Concussion: Pain problems? (2)

A

Yes.

Analgesics and soft diet?

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11
Q

Concussion: Pulpar problems? (2)

A

no

Check up

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12
Q

Concussion: Mobility problems? (2)

A

no

Check up

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13
Q

Concussion: Aftercare on permanent teeth? (3)

A

• CHECK-UPS
• SOFT DIET FOR 2 WEEKS
• GOOD ORAL HYGIENE
(CLORHEXIDINE)

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14
Q

Concussion: Aftercare on primary teeth? (4)

A 
Same as permanent dentition
• CHECK-UPS
• SOFT DIET FOR 2 WEEKS
• GOOD ORAL HYGIENE
(CLORHEXIDINE)
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15
Q

What is subluxation? (2)

A
  • Traumatic injury to the periodontal tissue

- tooth has increased mobility (i.e., is loosened) but has not been displaced from its tooth socket

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16
Q

Subluxation: periodontal ligament?

A

Breaking of a bigger number of fibers of the periodontal ligament

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17
Q

Subluxation: Mobility?

A

Yes

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18
Q

Subluxation: Displacement?

A

No

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19
Q

Subluxation: Bleeding?

A

OF the gingival margin

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20
Q

Subluxation: pulp affectation?

A

Sometimes

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21
Q

Subluxation: Aesthetic problem?

A

No

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22
Q

Subluxation: Pain? Aftercare? (3)

A

Yes
Analgesics
Soft diet

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23
Q

Subluxation: Pulpar problems? (2)

A
  • Rarely

- Check the pulp

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24
Q

Subluxation: Mobility? (3)

A

Yes

No occlusion/ferulization

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25
Q

Subluxation: treatment on permanent teeth? (2)

A
  • Same as in permanent dentition, except….

- NO FERULIZATION

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26
Q

Intrusive luxation: periodontal fibers? (2)

A
  • Very intense trauma

- Breaking of great number of periodontal fibers

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27
Q

Intrusive luxation: displacement?

A

Towards apical and is introduced in the alveolus

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28
Q

Intrusive luxation: Pulpar problems? (3)

A
  • Check evolution - pulp tx
  • 60%
  • Until 2008 it was considered very severe, with a 100% of
    cases with pulp affectation
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29
Q

Intrusive luxation: mobility? (2)

A
  • Mobility in a first moment and displacement

- The posterior blood clot immobilizes the tooth

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30
Q

Intrusive luxation: bleeding?

A

Bleeding of the gingival margin

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31
Q

Intrusive luxation: occlusion?

A

Does not alter occlusion

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32
Q

Intrusive luxation: pain? (3)

A
  • To palpation
  • to percussion
  • analgesics
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33
Q

Intrusive luxation: percussion?

A

Sounds similar to ankylosis

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34
Q

Intrusive luxation: Clinic? (3)

A

• The spontaneous re-eruption in the following 3-12 months in
70% of the cases
• Pulp necrosis in 60 % of the cases with open ápex and
almost 100% when the ápex was closed.
• The root reabsorption is smaller in those teeth that re-erupt spontaneously.

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35
Q

Intrusive luxation: aesthetic problem? (2)

A

Yes

Re-erupt

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36
Q

Intrusive luxation: mobility?

A

No

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37
Q

Intrusive luxation: Treatment types on permanent dentition? (3)

A
  1. Leave it to re-erupt
  2. Orthodontic reposition
  3. SURGICAL REPOSITION
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38
Q

Intrusive luxation: Treatment permanent dentition - re-eruption apexes? (2)

A
  • Up to 7 mm with open ápex

- 3mm with closed apex

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39
Q

Intrusive luxation: Treatment permanent dentition - re-eruption: How long do we wait? (2)

A
  • 3 months with open apex
  • 3-4 weeks with closed apex (some authors leave it for a
    longer time)
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40
Q

Intrusive luxation: Treatment permanent dentition - re-eruption: further treatments if necessary ?

A
  • Root canal treatments

- Apexification

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41
Q

Intrusive luxation: Treatment permanent dentition - Orthodontic reposition: apexes?

A
  • More than 7 mm with open apex

- 3mm with closed apex

42
Q

Intrusive luxation: Treatment permanent dentition - Orthodontic reposition? (3)

A
  • If the tooth does not re-erupt after the convenient time
  • There are more complications
  • Root canal treatment or apexification if necessary
43
Q

Intrusive luxation: Treatment permanent dentition - Surgical reposition apexes?

A

• More than 7 mm with open ápex

- 3mm with closed apex

44
Q

Intrusive luxation: Treatment permanent dentition - Surgical reposition? (2)

A
  • it has better results if we do it shortly after the trauma

* Root canal treatment or apexification if necessary

45
Q

INTRUSIVE LUXATION: PULP TREATMENT ON PERMANENT DENTITION - closed apex? (2)

A
  • Root canal in almost 100% of cases.

- Place calcium hydroxide inside canal for 3-4 weeks and then obturate with guttaperhca

46
Q

INTRUSIVE LUXATION: PULP TREATMENT ON PERMANENT DENTITION - open apex? (2)

A
  • Pulp treatment not always necessary

- If necessary apexification or revascularization

47
Q

INTRUSIVE LUXATION. TREATMENT ON PRIMARY DENTITION ? (3)

A 
• Let it re-erupt: wait 1-3 months
• If it shows signs of pulp
necrosis (very frequent) we
may try to do pulpectomy or do
extraction.
• If the tooth is in contact with
the permanent tooth germ, we
will extract
48
Q

Extrusive luxation: periodontal fibers?

A

Breaking of many periodontal fibers (less than in the intrusive
luxation)

49
Q

Extrusive luxation: displacement? (2)

A
  • Towards occlusal and comes
    partially out of the alveolus
  • Mobility and displacement in a first moment (24hrs) then the tooth may have more mobility (because of interference with the occlusion) or stop moving (blood clot)
50
Q

Extrusive luxation: pulp? (2)

A

• Pulp affectation on a high % of cases

- Check pulp vitality - pulp tx

51
Q

Extrusive luxation: clinic? (4)

A

• Smaller % of teeth with pulp affectation if apex is open.
100% if apex is closed
• It alters the occlusion (it may make impossible to close the
mouth)
• Pain to palpation and percussion. Bleeding
• X-ray: Periodontal ligament is widened

52
Q

Extrusive luxation: Pain? (2)

A

Yes

analgesics

53
Q

Extrusive luxation: Mobility problems? (2)

A

Yes

Reduce luation and splint

54
Q

Extrusive luxation: Aesthetic problems ? (2)

A

Yes

Reposition

55
Q

Extrusive luxation: treatment on permanent teeth? (5)

A

1º.- Soft reduction of the luxation with the fingers (on the first day)

2º.- Splint 1- 2 weeks

• If there are signs of necrosis

- Open apex: apexification or revascularization
- Closed apex: Root canal treatment
56
Q

Extrusive luxation: treatment on primary teeth? (2)

A

• If < 3mm: It repositions spontaneously
• If > 3mm: Make extraction (it interferes with the occlusion and
gives great pain to the child)

57
Q

Lateral luxation: Displacement?

A

Displaced to a side, generally towards palatal

58
Q

Lateral luxation: peridontal fibers?

A

Breaking of big number of fibers (similar to the

extrusive luxation)

59
Q

Lateral luxation: pulp?

A
  • Affectation in many cases

- Check pulp - pulp tx

60
Q

Lateral luxation: alveolar bone?

A

Sometimes there is a fracture

61
Q

Lateral luxation: clinic? (3)

A

• Clínic: alteration of the occlusion, pain to percussion and palapation
• X-RAY : reduction of the periodontal ligament on one side
and widening on the opposite
• Percussion : sound similar to ankylosis

62
Q

Lateral luxation: aesthetic problem? (2)

A

Yes

Reposition

63
Q

Lateral luxation: Pain? (2)

A

Yes

Analgesics

64
Q

Lateral luxation: mobility? (2)

A

Yes

Reduce and splint

65
Q

Lateral luxation: Permanent teeth treatment? (3)

A 
• 1º.Reduction in 2 times
(entrampment or click
phenomenon)
• 2º.- Splint 4 weeks
• 3º.- Control of the pulp vitality
66
Q

Lateral luxation: Primary teeth treatment? (3)

A

• If there is no interference with the occlusion, it will reposition
itself spontaneously
• If the displacement is mild, softly reposition
• If the displacement is severe or the root may be in contact
with the permanent tooth germ (Crown towards labial),
extraction

67
Q

Avulsion: periodontal ligament?

A
  • Fibers broken and tooth comes completely out of alveolus
68
Q

Avulsion: Pulp? (2)

A
  • Open apex the pulp may regenerate

* Closed apex, there is always pulp affectation

69
Q

Avulsion: conflicts?

A

Multiple and combined traumas are staring to be very

frequent (due to car accidents) = conflicts for deciding best treatment

70
Q

Avulsion: Factors that condition the treatment? (2)

A
  • Time passed since trauma

- Storage media

71
Q

Avulsion: Time passed since trauma? (5)

A 
*Always less than 2 hours
• <60 minutes ……………100% success
• 60 min- 120 minutes …………..Possible necrosis of periodontal ligament
• >2 hours…………... 100% failure
**Immediate reimplant Best prognosis
72
Q

Avulsion: Storage media? (2)

A
  • The best: Hanks balanced saline solution. It avoids necorsis in 90% of the cases
  • Others : milk (keep fibroblast vitality 3h, better skim cow milk), saliva (2 hours, has bacterias)
73
Q

Avulsion: Factors that condition the treatment? (2)

A

• Only 24% of the teeth are carried in a correct storage
media and for the correct time
• Rescue –Box make batter the prognosis

74
Q

Avulsion emergency treatment on the phone? (5)

A

• Clean the tooth with tap water for 10 seconds
• Take the tooth by the crown and reimplant it (encourage
the person to do it)
• Once the tooth is reimplanted the child will bite a tissue or
gauze
• If it is not posible to reimplant it, introduce it in Hanks
balanced saline solution, milk or saliva (never water)
• Go to the dental clinic as fast as possible

75
Q

Avulsion: general treatment in every case? (2)

A
  1. Systemic antibiotic ( amoxycillin)

2. Antitetanic vaccine

76
Q

Avulsion: In every case…

A

The tooth is reimplanted at the clinic

77
Q

Avulsion: what not to do with tooth reimplantation?

A

Do not remove and reimplant back again if it comes already

reimplanted

78
Q

Avulsion: Reimplantation steps? (6)

A
  1. Local anesthesia.
  2. Suture the soft tissues if necessary and remove the blood clot from the
    alveolus
  3. Clean the alveolus softly with saline solution and clorhexidine
  4. Pick the tooth by the crown (do not scrpae the root
  5. Splint for 1-2 week
  6. Pulp treatment on teeth with closed apex (if it is done on the first 14
    days the risk of root reabsorption). If the apex is open, see evolution.
79
Q

Avulsions: Drugs that can improve prognosis? (3)

A
  • Doxicycline/minocycline
  • 2% Sodium fuoride solution
  • Emdogain
80
Q

Avulsions: Doxicycline/minocycline (3)

A
  • Introduce the tooth for 5 minute in a solution of
    1mg of antibiotic/20ml saline solution
  • helps pulp revascularization
  • Used in teeth with open apex reimplanted in <
    60 minutes
81
Q

Avulsions: 2% Sodium fuoride solution (3)

A
  • For 20 minutes on the surface of the tooth
  • Slow down the osseus replacement of the tooth
  • Used in teeth with closed apex reimplanted after >60 minutes
82
Q

Avulsions: Emdogain? (3)

A
  • inside the alveolus
  • Controversial results
  • not accepted 100%
83
Q

Avulsions: To determine the treatment plan, we take into account? (4)

A
  1. If the tooth has open or closed apex
  2. If it has been reimplanted at the place of the accident
  3. If it is not reimplanted immediatly, which storage media
    was used.
  4. If the storage media was not good, how much time
    does it pass until it is reimplanted (> or < 60 minutes)
84
Q

Avulsion: Clinical situationa - tooth with closed apex? (3)

A

1.1 Already reimplanted
1.2 With dry period < 60 minutes and/or good storage media (Hanks balanced saline solution, milk or saliva)
1.3 With dry period >60 minutes or other situations that suggest
cell necrosis

85
Q

Avulsion: Clinical situationa - tooth with open apex? (3)

A

2.1 Already reimplanted
2.2 With dry period < 60 minutes and/or good storage media ( Hanks balanced saline solution, milk or saliva)
2.3 With dry period >60 minutes or other situations that suggest
cell necrosis

86
Q

Avulsion: tooth with closed apex already reimplanted? (4)

A
  1. Do not extract the tooth
  2. Verify that it has been correctly reimplanted
  3. Flexible splint for 1-2 weeks
  4. Root canal treatment in 7-10 days (before removing the splint): Apply calcium hidroxyde or antibiotics + corticoids for 1 month and then obturate with gutapercha.
87
Q

Avulsion: Tooth with closed apex and dry period < 60 minutes and/or good storage media ( Hanks balanced saline solution, milk or saliva)? (3)

A
  1. Reimplant softly picking the tooth from the crown and verify it is in a correct position
  2. Flexible splint for 1-2 weeks
  3. Root canal treatment in 7-10 days (before removing the
    splint) : Apply calcium hidroxyde or antibiotics + corticoids for 1 month and then obturate with gutapercha.
88
Q

Avulsion: Tooth with closed apex and dry period >60 minutes or other
situations that suggest cell necrosis? (4)

A
  • Periodontal ligament will be necrotic and can not be expected to heal.
  • The goal in delayed replantation is, in addition to restoring the tooth for
    esthetic, functional and psychological reasons, to maintain alveolar bone
    contour.
  • However, the expected eventual outcome is ankylosis and resorption of the root and the tooth will be lost eventually.
  • Use sodium fluoride to delay the resorption of the root
89
Q

Avulsion: Tooth with closed apex and dry period >60 minutes or other
situations that suggest cell necrosis treatment? (4)

A
  1. Submerge the tooth in sodium fluoride 2% for 20 minutes
  2. Reimplant softly
  3. Splint for 4 weeks
  4. Root canal treatment may be done prior reimplantation or
    after 7-10 days
90
Q

Avulsion: Tooth with open apex already reimplanted (4)

A
  1. Do not extract the tooth
  2. Verify that it has been correctly reimplanted
  3. Flexible splint for 1-2 weeks
  4. Usually the tooth suffers revascularization. If it suffers
    necrosis, then we will di pulp treatment
91
Q 
Avulsion: Tooth with open apex and dry period < 60 minutes and/or good
storage media ( Hanks balanced saline solution, milk or saliva) properties?
A

It has been proven that introducing the tooth in a solution of doxicycline/minocycline for 5 minutes increaees the chances of
revascularization to happen.

92
Q 
Avulsion: Tooth with open apex and dry period < 60 minutes and/or good
storage media ( Hanks balanced saline solution, milk or saliva) treatment? (4)
A
  1. Introduce the tooth in the solution for 5 minutes
  2. Reimplant
  3. Flexible splint for 1-2 weeks
  4. Check pulp evolution
93
Q

Avulsion: Tooth with open apex and dry period >60 minutes

or other situations that suggest cell necrosis? (4)

A
  1. Submerge the tooth in sodium fluoride 2% for 20
    minutes
  2. Reimplant softly
  3. Splint for 4 weeks
  4. Root canal treatment may be done prior reimplantation
    or after 7-10 days
94
Q

Avulsion: Immediate reimplantation closed apex? (4)

A
  • Do not reimplant again
  • Splint 1-2 weeks
  • Root canal treatment
  • Good prognosis
95
Q

Immediate reimplantation open apex? (4)

A 
• Do not reimplant again
• Splint 1-2 weeks
• Revascularization
(natural or induced)
• Good prognosis
96
Q

Avulsion: Dry period < 60 minutes and/or good storage media closed apex? (2)

A
  • Reimplant

* Same as immediate reimplantation

97
Q

Avulsion: Dry period < 60 minutes and/or good storage media open apex? (3)

A

• Put the tooth in ATB
solution
• Reimplant
• Same as immediate reimplantation

98
Q

Avulsion: dry period >60 minutes or other

situations that suggest cell necrosis open and closed apex? (5)

A
  • Introduce the tooth in sodium fluoride
  • Reimplant
  • Splint 4 weeks
  • Root cana treatment
  • Bad prognosis
99
Q

Avulsions check ups? (3)

A

• Following Andreassen guidelines
• FAVORABLE : asymptomatic, no mobility , normal xray
• DESFAVORABLE : symptomatic mobility , X-ray: root
resorption

100
Q

Avulsions treatment on primary teeth? (2)

A

• We never reimplant
• If it happens in very small
children, there may be a delay in the eruption of the permanent
tooth

Peds II (11 decks)

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