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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
what are the treatment options for enamel dentine pulp fracture
Cvek’s (Partial) Pulpotomy | • Pulpectomy (extirpation, complete removal of the pulp) •Pulp cap(?)
26
what is Cvek’s (Partial) Pulpotomy
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
what is a pulp cap
placing CAOH over the exposed site- not really done anymore
28
how do we group root fractures
location(cervical,mid, apical) horizontal/vertical single and multiple
29
what are the diagnosis of a root fracture
mobility might be increased can have an extrusion of a crown radiographs from two angles
30
what is the treatment of root fractures
``` 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
what is a crown root fracture
Fracture line extends | - Below gingival crevice - Below alveolar bone
32
why can crown root fractures be complex
fragment might be attached can have multiple fracture lines difficult to treat and restore-MDT management
33
how can we treat crown root fractures
``` fragment removal and gingivectomy orthodontic extrusion of apical fragment surgical extrusion root submergence extraction ```
34
what types of luxation do we have
``` concussion subluxation extrusion lateral luxation intrusion avulsion alveolar fracture ```
35
what is a concussion luxation
``` haemorrhage and oedema in PDL no tearing tender no mobility no displacement ```
36
what is the treatment of the concussion laxation
non required soft diet avoid contact sports monitor as IADT guidline
37
what is subluxation
``` tearing of PDL blood in the ginigival sulcus tender may have increased mobility no displacement ```
38
what is the treatment for subluxation
usually none can split for comfort if mobile soft diet no contact sports monitor
39
what is extrusion
tearing of PDL rupture of NVB(neuromuscular bundle) tooth moves axially out of the socket
40
what does extrusion look like clinically
``` looks dropped bleeding tender mobility displacement radiographically ```
41
what is the treatment for extrusion
reposition the tooth stabilise for 2 weeks using a flexible splint instructions monitor
42
what is a lateral luxation
simultaneous rupture and compression of the NVB tooth moves laterally fracture of alveolar socket
43
what does lateral luxation look like clinically
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
what is the treatment for lateral luxation
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
what is intrusion
crushing of the NVB and PDL | tooth displaced axially
46
what do we see clinically on intrusion teeth
``` Clinical crown not fully visible • Often immobile • Sometimes has ankylotic sound • Gingival haemorrhage • Radiographically – loss of PDL space apically • Check – partially erupted teeth? ```
47
what is avulsion
tooth knocked out the mouth
48
how do we deal with avulsion
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
what is the treatment of avulsion
open or closed apex total EO time- if more than 30/60 mins less positive outcome EO dry time
50
what is guaranteed with avulsion
unfavourable healing
51
what is included in unfavorable healing
pulp necrosis | PDL death leading to ankylosis
52
what are the steps of replacement resorption
death PDL bone in direct contact with tooth ankylosis and replacement resorption
53
what do we need to prescribe when dealing with patients who suffer from avulsion
systemic antibiotics: tetracycline first choice- doxycycline 2x/day for 7 days at app for dose for patient age and weight tetanus coverage?
54
what do we need to consider when prescribing tetracycline
risk of discolouration- many countries tetracycline not recommended for patient under 12
55
what is the appropriate instead of tetracycline in children
phenoxymethyl penicillin
56
what instructions do we give patients who have had a reimplanted tooth
soft food for two weeks no contact sport brush with soft toothbrush use chlorhexidine mouth rinse 2x a day for 1 week
57
what do we do if there is a closed apex avulsion
begin RCT 7-10 DAYS with splint on
58
what do we do if there is a OPEN apex avulsion
BEGIN act 7-10 DAYS if out of the mouth for 60 mins | close monitoring if less than 60 mins
59
describe an alveolar fracture
``` fracture of the alveolar plate segmental mobility of full section several teeth might move together gingival tearing may not respond to VT ```
60
what is the treatment of an alveolar fracture
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
what are the guidelines for avulsion
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
explain the severity of fractures
``` enamel fracture enamel dentine fracture enamel dentine pulp fracture crown root fracture crown root fracture(complicated) ```

CSA (51 decks)

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