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CSA SR > trauma to incisors > Flashcards

trauma to incisors Flashcards

1
Q

how many 15 year olds suffer from dentoalveolar trauma

A

4%

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2
Q

what type of trauma is common

A

dentoalveolar trauma

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3
Q

how do we manage trauma cases

A

can be complex and long term

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4
Q

what do children with trauma suffer from

A

it influences oral health related quality of life

children with traumatised incisors can be subject to negative social judgments and teasing

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5
Q

what guidelines do we follow

A

the international association of dental traumatology

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6
Q

how do we help with dental trauma

A

keep calm and be reassuring- through a systematic approach
ask parents and child
head injury/loss of consciousness- straight to A&E

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7
Q

what should we fill out if a patient was to come to us for trauma

A

trauma history and diagnosis form

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8
Q

what do we record on the trauma history form

A 
date of injury
location
cause
KO
symptoms of head injury 
other injuries
where is the tooth fragments 
PMH 
PSH/PDH
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9
Q

what do we look at in an extra oral exam

A

gentle palpation
maxilla and mandible
soft tissue lacerations

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10
Q

what do we look for IO

A

soft tissue and also any lacerations
hard tissue
traumatised temp-TTP,MOBILILTY,DISPLACEMENT,DISCOLOURATION check all teeth
check occlusion

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11
Q

why do we carry out speciality tests

A

help with accurate diagnosis
act as baseline for followup
can be an indicator from prognosis

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12
Q

what should we also use in special tests

A

OPT if concern of facial fracture

soft tissue if concern of tooth fragment

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13
Q

what do we need to consider as well as our radiograph

A

root development stage

assess presence of root fracture

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14
Q

what do we use for special tests

A

ethyl chloride
EPT
transillumination
test normal teeth as well as damaged teeth

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15
Q

why can sensitivity tests not be accurate

A

due to the fact its subjective and children will be anxious and in pain

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16
Q

if we do a VT on an immature tooth why might it not be accurate

A

poorly myelinated nerve fibre

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17
Q

what are the two types of injuries

A

fractures
luxation
but a tooth can have both types

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18
Q

what are the most minimal enamel fracture

A

simple

infraction-no loss of enamel but crack extends into the ADJ

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19
Q

what are the treatment options for enamel fracture

A
  • None and monitor
  • Desensitising agents
  • Unfilled resin
  • Composite build-up
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20
Q

how do we repair infractions

A

unfilled resin or a small composite build up

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21
Q

what were enamel dentine fractures previously called

A

uncomplicated fractures

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22
Q

what is the treatment for enamel-dentine fracture

A

composite buildup

or reattach fracture- long term issues as it can dry out the tooth

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23
Q

what were enamel dentine pulp fractures called

A

complicated enamel dentine fracture

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24
Q

what do we need to consider with complicated enamel dentine fracture

A

time since damage
degree of contamination
degree of damage

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25
Q

what are the treatment options for enamel dentine pulp fracture

A

Cvek’s (Partial) Pulpotomy

• Pulpectomy (extirpation, complete removal of the pulp) •Pulp cap(?)

26
Q

what is Cvek’s (Partial) Pulpotomy

A

removing the top part of the pulp to remove the infected part - eg 2mm
looking for fresh red pulp which stops bleeding with pressure with a pellet

27
Q

what is a pulp cap

A

placing CAOH over the exposed site- not really done anymore

28
Q

how do we group root fractures

A

location(cervical,mid, apical)
horizontal/vertical
single and multiple

29
Q

what are the diagnosis of a root fracture

A

mobility might be increased
can have an extrusion of a crown
radiographs from two angles

30
Q

what is the treatment of root fractures

A 
reposition if displaced 
check position radiographically 
stabilise the tooth with a flexible splint for 4 wks- if near the cervical areas of the tooth 
monitor healing for a year 
if pulp necrosis then RCT
31
Q

what is a crown root fracture

A

Fracture line extends

- Below gingival crevice - Below alveolar bone

32
Q

why can crown root fractures be complex

A

fragment might be attached
can have multiple fracture lines
difficult to treat and restore-MDT management

33
Q

how can we treat crown root fractures

A 
fragment removal and gingivectomy
orthodontic extrusion of apical fragment 
surgical 
extrusion 
root submergence 
extraction
34
Q

what types of luxation do we have

A 
concussion
subluxation 
extrusion
lateral luxation 
intrusion 
avulsion
alveolar fracture
35
Q

what is a concussion luxation

A 
haemorrhage and oedema in PDL 
no tearing 
tender
no mobility
no displacement
36
Q

what is the treatment of the concussion laxation

A

non required
soft diet
avoid contact sports
monitor as IADT guidline

37
Q

what is subluxation

A 
tearing of PDL 
blood in the ginigival sulcus 
tender
may have increased mobility 
no displacement
38
Q

what is the treatment for subluxation

A

usually none
can split for comfort if mobile
soft diet no contact sports
monitor

39
Q

what is extrusion

A

tearing of PDL
rupture of NVB(neuromuscular bundle)
tooth moves axially out of the socket

40
Q

what does extrusion look like clinically

A 
looks dropped
bleeding
tender
mobility 
displacement 
radiographically
41
Q

what is the treatment for extrusion

A

reposition the tooth
stabilise for 2 weeks using a flexible splint
instructions
monitor

42
Q

what is a lateral luxation

A

simultaneous rupture and compression of the NVB
tooth moves laterally
fracture of alveolar socket

43
Q

what does lateral luxation look like clinically

A

immobile due to locking in bone
sometimes ankylotic sound
gingival haemorrhage
crown may be labially or palatally displaced
gingival haemorrhage
radiographically- widened PDL space best seen on occlusal film check for occlusal interference

44
Q

what is the treatment for lateral luxation

A

Reposition the tooth digitally or with
forceps to disengage it from its bony lock and gently reposition it into its original location.
• Stabilize the tooth for 4 weeks using a flexible splint.
• Monitor the pulpal condition.

45
Q

what is intrusion

A

crushing of the NVB and PDL

tooth displaced axially

46
Q

what do we see clinically on intrusion teeth

A 
Clinical crown not fully visible
• Often immobile
• Sometimes has ankylotic sound
• Gingival haemorrhage
• Radiographically – loss of PDL space apically
• Check – partially erupted teeth?
47
Q

what is avulsion

A

tooth knocked out the mouth

48
Q

how do we deal with avulsion

A

check age and MH- we only reimplant adult teeth, baby teeth should not be reimplaced
keep the patient calm
pick the tooth up by the crown and avoid touching the root
if dirty- wash gently for 10 seconds
try to replace the tooth and bite on a handkerchief
if not possible then store in a medium eg such as milk or a pot of saliva
seek emergency treatment

49
Q

what is the treatment of avulsion

A

open or closed apex
total EO time- if more than 30/60 mins less positive outcome
EO dry time

50
Q

what is guaranteed with avulsion

A

unfavourable healing

51
Q

what is included in unfavorable healing

A

pulp necrosis

PDL death leading to ankylosis

52
Q

what are the steps of replacement resorption

A

death PDL
bone in direct contact with tooth
ankylosis and replacement resorption

53
Q

what do we need to prescribe when dealing with patients who suffer from avulsion

A

systemic antibiotics:
tetracycline first choice- doxycycline 2x/day for 7 days at app for dose for patient age and weight
tetanus coverage?

54
Q

what do we need to consider when prescribing tetracycline

A

risk of discolouration- many countries tetracycline not recommended for patient under 12

55
Q

what is the appropriate instead of tetracycline in children

A

phenoxymethyl penicillin

56
Q

what instructions do we give patients who have had a reimplanted tooth

A

soft food for two weeks
no contact sport
brush with soft toothbrush
use chlorhexidine mouth rinse 2x a day for 1 week

57
Q

what do we do if there is a closed apex avulsion

A

begin RCT 7-10 DAYS with splint on

58
Q

what do we do if there is a OPEN apex avulsion

A

BEGIN act 7-10 DAYS if out of the mouth for 60 mins

close monitoring if less than 60 mins

59
Q

describe an alveolar fracture

A 
fracture of the alveolar plate
segmental mobility of full section 
several teeth might move together
gingival tearing 
may not respond to VT
60
Q

what is the treatment of an alveolar fracture

A

Reposition any displaced segment and then splint.
• Suture gingival laceration, if present.
• Stabilize the segment for 4 weeks.
• If severe fracture, may need to refer to
Maxillofacial department

61
Q

what are the guidelines for avulsion

A

4 weeks – Splint removal (2 weeks for <60 mins), clinical and radiographic examination.
• 6-8 weeks – Clinical and radiographic examination.
• 4 months – Clinical and radiographic examination.
• 6 months – Clinical and radiographic examination.
• 1 year – Clinical and radiographic examination.
• 5 years – Clinical and radiographic examination.

62
Q

explain the severity of fractures

A 
enamel fracture 
enamel dentine fracture 
enamel dentine pulp fracture 
crown root fracture 
crown root fracture(complicated)

CSA SR (52 decks)

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