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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
Q

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

A

Pulp likely become necrotic

RCT initiated to prevent infection related resorption

26
Q

Management of intrusion?

A

Leave - may spontaneously erupt
Can consider: ortho/ surgical extrusion
Follow up 2,4,8,12 weeks, 6 months, year, yearly 5 years

27
Q

Management of intrusion if incomplete root formation?

A

Allow spontaneous reposition regardless degree intrusion
No eruption 4 weeks - reposition ortho
Monitor pulp status - sign loss vitality = RCT

28
Q

Management of intrusion if have complete root formation?

A

If intruded less 3mm - allow re-eruption –> no movement 8 weeks extrude surgical/ortho

If 3-7mm surgical or ortho

+7mm surgical

29
Q

What must do after extruding tooth surgically

A

Splint 4-8 weeks

RCT within 2 weeks of position

30
Q

What to do if called advice on avulsion?

A 
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
Q

What are different ways PDL cells can be affected after avulsion?

A

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
Q

Adv of reimplanting tooth?

A 
Aeshteitc
Space maintenance
Bone preservation
Prevent restorative tx
Physological benefit
33
Q

What consider prior implantation tooth?

A

Prognosis
MH
Behaviour
Pt/ parent wish

34
Q

Disadv re-implant tooth?

A

Infra-occlusion
Multiple visits
Tooth eventually be lost

35
Q

Contraindications of reimplanting tooth?

A 
Immunosupression
Severe cardiac disease
Caries/ perio 
Children severe learning diff
Severe incision crowding
Supplementary teeth
36
Q

Management of avulsed tooth in practice

A 
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
Q

Tip for making RCT avulsed tooth easier?

A

Measure prior re-implant

38
Q

When are ab recommended?

A

Post avulsion

If: contamination, multiple injured teeth, medical condition suscpetible infection

39
Q

What ab prescribe?

A

Older 12 yrs: doxycycline 200mg 2x day 1st day, 100mg 2x day 10 days

5-12years: amoxicillin 500mg 3x 5-7 days

40
Q

When should RCT be provided in avulsion?

A

All teeth w/ mature apex

41
Q

Ideal time RCT avulsed tooth

A

0-10 days - before splint removal

42
Q

What changes is carry out RCT in first 7 days post avulsion?

A

Use corticosteroid/ ab paste instead calcium hydroxide - leave 6 weeks

If later dress CaOH 1 month

43
Q

Ideal time provide definitive obturation?

A

1 MONTH

44
Q

When can RCT be avoided in avulsion?

A

Opec apex - unless clinical/radiographic sign necrosis

45
Q

What is review regimen for avulsed tooth?

A

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
Q

What causes replacement resorption?

A

Death PDL

Bone direct contact w/ tooth= ankylosis/ replacement resorption

47
Q

What injuries should be splinted for 2 weeks?

A

Avulsion
Subluxation
Extrusion

48
Q

What injuries should be splinted 4 weeks?

A

Lateral luxation
Dento-alveolar fracture
Middle/apical third root fracture

49
Q

What injuries should be splinted for 4 months?

A

Cervical third root fracture

50
Q

What is aim of direct splint?

A

Use physiological splint to encourage healing and reduce risk analysis

51
Q

What is direct splint?

A

Flexible orthodontic wire w/ composite

Can use passive ortho brackets/ flexible wire

52
Q

What is example of indirect splint

A

Essix type retainer w/ temporary cement

53
Q

When should indirect splint be used?

A

Can’t obtain moisture control for direct/ not enough teeth

54
Q

Issue indirect splint?

A

Teeth may come out in alginate
Poor OHI
Can’t RCT with splint

55
Q

How provide direct splint?

A

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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