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BDS3 paeds > Trauma IV > Flashcards

Trauma IV Flashcards

1
Q

aetiology of primary tooth trauma

A

Falls
Bumping into objects
Non-accidental

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2
Q

epidemiology of primary tooth trauma

A

Maxillary centrals most commonly affected

Prevalence 17-54%

Male = Female

Luxation commonest

2-4 years peak incidence

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3
Q

prevalence of types of injury

A 
Enamel crack
ED# 		7-13%
EDP#		
CR#		        2%
Root#		2-4%
Luxation	        62-69%
Avulsion 	        7-13%
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4
Q

pt management of primary tooth morphology

A 
Reassure
History
Examination
Diagnosis
Emergency treatment 
Advise parent of sequelae to permanent teeth 
Further treatment and review
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5
Q

trauma history

A

This injury

  • When
  • Where
  • How
  • Any other symptoms
  • Lost teeth/fragments

Medical history

  • R.Fever
  • Congenital heart defects
  • Immunosuppression

Dental history

  • previous trauma
  • Treatment experience
  • Parent and child attitude
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6
Q

trauma examination

extraoral

A

Laceration

Haematomas

Haemorrhage/CSF

Subconjunctival haemorrhage

Bony step deformities

Mouth opening

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7
Q

trauma examination

intraoral

A

soft tissue

alveolar bone

occlusion

teeth

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8
Q

detailed intraoral examination for primary tooth trauma

A

Soft tissue damage
- penetrating wounds, foreign bodies.

Tooth mobility
- may indicate: displacement; root#; bone#.

Transillumination
- may show: fracture lines in teeth, pulpal degeneration, caries

Tactile test with probe
- look for: horizontal #’s; vertical #’s; pulpal involvement

Percussion
- duller note may indicate root#

Occlusion
- traumatic occlusion demands urgent treatment

Radiographs
- intra-oral or ant occlusal, lateral pre-maxilla, OPT, soft tissue.

Classify the trauma
- trauma stamp

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9
Q

issue with sensibility tests in children

A

common to be incorrect in children as they want to please you

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10
Q

classifications for primary tooth trauma

A

Enamel - E# - uncomplicated

Enamel-dentine - ED# - uncomplicated

Enamel-dentine-pulp - EDP# - complicated

Crown-root (pulp involved)
Root #

Alveolar #

Concussion / Subluxation

Luxation - lateral, intrusive, extrusive

Avulsion

Crown Fractures

  • Enamel only
  • Enamel + dentine
  • Enamel, dentine + pulp
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11
Q

immediate home manage of all primary tooth trauma injuries

A

Soft diet for 10-14 days (normal diet just cut everything small and chew with molars)

Brush teeth with soft toothbrush after every meal

Topical chlorhexidine by parent twice daily for one week (cotton wool rolls for swabbing)

After initial treatment review 1, 3 ,6 monthly taking radiographs if possible 6 monthly

Intrusion requires more frequent review (see guidelines).

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12
Q

treatment of primary tooth trauma injuries

enamel only

A

smooth sharp edges

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13
Q

treatment of primary tooth trauma injuries

enamel only or enamel-dentine fractures

A

restore/bandage with composite or compomer (do not use GI)

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14
Q

treatment of primary tooth trauma injuries

enamel-dentine-pulp fractures

A

endodontic therapy or extraction

be careful not to encroach on dental follicle - 2mm away - do not take EWL X-rays in children

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15
Q

treatment of primary tooth trauma injuries

crown and root fractures

A

exact coronal fragment

don’t be overzealous to remove any root fragments that aren’t obvious
- these should be left to resorb physiologically

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16
Q

treatment of primary tooth trauma injuries

alveolar bone fractures

A

reposition segment
- splint to adjacent teeth 3-4 weeks

teeth may need to be extracted after alveolar stability has been achieved

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17
Q

treatment of primary tooth trauma injuries

concussion and subluxation

A

observation

18
Q

treatment of primary tooth trauma injuries

lateral luxation

A

radiograph - increased pl space apically

no occlusal interference - allow to position spontaneously

occlusion interference - extract

19
Q

treatment of primary tooth trauma injuries

localisation of intrusion injury with one film

A

not parallax as only using one radiograph

there are 2 types of film you can use to help localise - PA or lateral premaxilla (extra oral film)

being able to assess the danger to the permanent tooth allows better counselling re prognosis

20
Q

treatment of primary tooth trauma injuries

localisation in intrusion injury with one PA

A

take a periapical radiograph
- if the apical tip appears shorter than that of the contralateral tooth then it has been displaced towards or through the buccal plate - preferable direction (away from developing tooth germ)

  • if the apical tip is indistinct and the tooth appears elongated in comparison to the contralateral tooth then the apex is displaced towards the permanent tooth germ
21
Q

treatment of primary tooth trauma injuries

localisation premaxilla

A

identifies direction of displacement as providing a lateral view

22
Q

treatment of primary tooth trauma injuries

intrusion

A

monitor re-eruption of tooth

if no re-eruption after 6 months consider extraction to avoid problems in eruption of permanent tooth

23
Q

treatment of primary tooth trauma injuries

extrusion

A

extract

guidelines consider reposition but change of damage to permanent tooth is high

24
Q

treatment of primary tooth trauma injuries

avulsion

A

radiograph to confirm avulsion

do not replant - damage to permanent

25
Q

3 possible long term effects to primary teeth after trauma

A

discolouration

discolouration and infection

delayed exfoliation

26
Q

discolouration and/or infection Tx

vital tooth

A

no Tx

27
Q

discolouration and/or infection Tx

non vital tooth

A

sinus or PAP on radiograph: RCT or extraction

no sinus or PAP then leave and review

28
Q

discolouration and/or infection Tx

opaque

A

no treatment

29
Q

immediate discoloration

A

pinkish colour

may maintain vitality

30
Q

intermediate change in colour

A

tooth is non-vital

brown, black, grey
- weeks after

31
Q

delayed exfoliation of primary teeth

A

primary teeth may not resorb normally after trauma

extraction is necessary or permanent successor will erupt ectopically

32
Q

injuries to permanent teeth relates to what

A

age of trauma of primary teeth

0-2 years 63%
3-4 years 58%
5-6 years 24%
7-8 years 25%

33
Q

long term effects on permanent teeth

A

Enamel defects- 44% (under 2 years)

Abnormal tooth/root morphology 8%

  • Crown or root dilaceration
  • Crown or root duplication

Delayed eruption 1%

Ectopic tooth position

Arrest in tooth formation

Complete failure of tooth to form

Odontoma formation

34
Q

2 enamel defects (can occur to permanent teeth after primary tooth trauma)

A

hypomineralisation

hypoplasia

35
Q

hypomineralisaton

A

white/yellow spot (Normal thickness of enamel)

Treatment Options

  • Leave
  • Mask with composite
  • Localised removal and restore with composite
  • External bleaching
36
Q

hypoplasia

A

yellow/brown areas. (Less than normal enamel thickness)

Treatment Options
- restore with composite
(porcelain veneer when -gingival level stabilised, at least 16 years).

37
Q

treatment complications after primary tooth trauma (5)

A
  • crown dilaceration
  • root dilaceration/angulation/duplication
  • arrest of root development
  • odontome
  • undeveloped tooth germ
38
Q

crown dilaceration Tx

A

surgical exposure

ortho realignement

improve appearance

39
Q

root dilaceration/angulation/duplication Tx

A

combined surgical and ortho

40
Q

odontome Tx

A

surgical removal

41
Q

undeveloped tooth germ Tx

A

may sequestrate spontaneously or require removal

42
Q

delayed eruption

A

Premature loss of a primary tooth can result in delayed eruption of about 1 yr due to thickened mucosa.

Take radiograph if greater than 6 month delay compared to contralateral

Surgical exposure and ortho may be required if abnormal morphology

BDS3 paeds (15 decks)

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