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5th ACS - Paeds > Trauma III - Luxation Permanent > Flashcards

Trauma III - Luxation Permanent Flashcards

1
Q

What is concussion?

A

Injury to supporting structures of tooth w/o abnormal loosening or displacement

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2
Q

What may pt complain about with concussion?

A

Tender to pressure

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3
Q

What is subluxation?

A

Injury to supporting tissue with abnormal loosening but without displacement

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4
Q

What is lateral luxation?

A

Bodily movement of tooth within the socket

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5
Q

Issue during lateral luxation?

A

Can rupture neurovasular bundle

Crush PDL cells

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6
Q

What is extrusion?

A

Axial displacement of tooth out of socket

Appear elongated

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7
Q

What is intrusion?

A

Tooth forced upwards into socket

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8
Q

Issue w/ intrusion?

A

Crush PDL/neurovascular bundle

Damage successor if into follicle

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9
Q

What is avulsion?

A

Tooth lost from socket

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10
Q

What affects prognosis if pulpal involvement?

A

Type of injury

Age pt - mature/immature apex

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11
Q

What are diff types of healing pulp can display?

A

Complete healing
Canal obliteration
Pulp necrosis
Resorption

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12
Q

3 types of resorption?

A

Inflammatory/ external
Replacement
Internal

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13
Q

What is inflammatory resorption?

A

External resorption

Continuation surface resorption due toxin from necrotic pulp

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14
Q

Can external resorption be stopped?

A

Progressive until bacterial removed (e.g extirpation)

Can be filled cementum/ bone on healing

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15
Q

What is replacement resoprtion?

A

Ankylosis-related

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16
Q

What is replacement resorption related to?

A

Extensive PDL damage - osteoclasts direct contract w/ dentine
Cause progressive replacement resorption

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17
Q

What is internal resorption related to?

A

Infection - necrotic pulp

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18
Q

How does internal resorption appear on radiograph?

A

Ballooning of canal w/ rapid progression

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19
Q

What is supportive advice?

A 
Soft diet 7 days
Analgesia
OHI
CHX if too sore brush
Review
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20
Q

Tx for concussion?

A

Supportive advice

Monitor 4 weeks/ 1 year

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21
Q

Tx for subluxation?

A

Normally supportive and review
Flexible splint 2 weeks (if needed)
Monitor 2 weeks/ 3 months/ 6 months/ 1 year

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22
Q

Tx of extrusion?

A

Reposition
Flexible splint 2 weeks - +4 weeks marginal bone breakdown
Monitor 2,4,8,,12 weeks, 6 months, 1 year, years for 5 years

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23
Q

Management of lateral luxation?

A

Reposition
Flexible splint 4 weeks + 4 marginal bone breakdown
Monitor 2,4,8,12 weeks, 6 months, 1 year, yearly 5 years

24
Q

What consider if lateral luxation on tooth w/ incomplete root formation?

A

Spontaneous revascularisation may occur

If pulp become necrotic - RCT

25
What consider if lateral luxation on tooth w/ complete root formation?
Pulp likely become necrotic | RCT initiated to prevent infection related resorption
26
Management of intrusion?
Leave - may spontaneously erupt Can consider: ortho/ surgical extrusion Follow up 2,4,8,12 weeks, 6 months, year, yearly 5 years
27
Management of intrusion if incomplete root formation?
Allow spontaneous reposition regardless degree intrusion No eruption 4 weeks - reposition ortho Monitor pulp status - sign loss vitality = RCT
28
Management of intrusion if have complete root formation?
If intruded less 3mm - allow re-eruption --> no movement 8 weeks extrude surgical/ortho If 3-7mm surgical or ortho +7mm surgical
29
What must do after extruding tooth surgically
Splint 4-8 weeks | RCT within 2 weeks of position
30
What to do if called advice on avulsion?
``` Find tooth Hold by crown - the white part, not yellow pointy end If dirty, rinse with cold water 10 sec Put tooth milk/saliva Place tooth in socket correct way Get child note on rolled up tissue ```
31
What are different ways PDL cells can be affected after avulsion?
PDL likely viable - reimplanted within 15 mins PDL likely viable but compromised - extra-oral dry time less 60 min PDL non-viable - EO dry time >60 mins
32
Adv of reimplanting tooth?
``` Aeshteitc Space maintenance Bone preservation Prevent restorative tx Physological benefit ```
33
What consider prior implantation tooth?
Prognosis MH Behaviour Pt/ parent wish
34
Disadv re-implant tooth?
Infra-occlusion Multiple visits Tooth eventually be lost
35
Contraindications of reimplanting tooth?
``` Immunosupression Severe cardiac disease Caries/ perio Children severe learning diff Severe incision crowding Supplementary teeth ```
36
Management of avulsed tooth in practice
``` Store tooth saliva/ milk Provide LA Gently irrigate socket to clean/ remove clot Handle tooth by crown - remove debris w/ saline Reposition any bony fragments Reimplant w/ gentle pressure Flexible splint 7-14 days Systemic abs Extirpate pulp in 2 weeks ```
37
Tip for making RCT avulsed tooth easier?
Measure prior re-implant
38
When are ab recommended?
Post avulsion | If: contamination, multiple injured teeth, medical condition suscpetible infection
39
What ab prescribe?
Older 12 yrs: doxycycline 200mg 2x day 1st day, 100mg 2x day 10 days 5-12years: amoxicillin 500mg 3x 5-7 days
40
When should RCT be provided in avulsion?
All teeth w/ mature apex
41
Ideal time RCT avulsed tooth
0-10 days - before splint removal
42
What changes is carry out RCT in first 7 days post avulsion?
Use corticosteroid/ ab paste instead calcium hydroxide - leave 6 weeks If later dress CaOH 1 month
43
Ideal time provide definitive obturation?
1 MONTH
44
When can RCT be avoided in avulsion?
Opec apex - unless clinical/radiographic sign necrosis
45
What is review regimen for avulsed tooth?
1-2 day =splint check 0-10 days = RCT 2 weeks = remove splint 4 weeks = definitive RCT Review 12 weeks, 6 months, 1 year, yearly 5 years
46
What causes replacement resorption?
Death PDL | Bone direct contact w/ tooth= ankylosis/ replacement resorption
47
What injuries should be splinted for 2 weeks?
Avulsion Subluxation Extrusion
48
What injuries should be splinted 4 weeks?
Lateral luxation Dento-alveolar fracture Middle/apical third root fracture
49
What injuries should be splinted for 4 months?
Cervical third root fracture
50
What is aim of direct splint?
Use physiological splint to encourage healing and reduce risk analysis
51
What is direct splint?
Flexible orthodontic wire w/ composite Can use passive ortho brackets/ flexible wire
52
What is example of indirect splint
Essix type retainer w/ temporary cement
53
When should indirect splint be used?
Can't obtain moisture control for direct/ not enough teeth
54
Issue indirect splint?
Teeth may come out in alginate Poor OHI Can't RCT with splint
55
How provide direct splint?
Reposition tooth Control bleeding Bend wire into passive arch Extend one stable tooth either side injured tooth Spot etch mid-crown and apply composite button Place wire on uncured composite towards incisor third of tooth Cure Place second button on wire Check no roughness/ sharp edge wire

5th ACS - Paeds (4 decks)

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