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5th yr- Finals- CSA revision > Trauma to Permanent Incisors > Flashcards

Trauma to Permanent Incisors Flashcards

1
Q

When taking a history of a patient suffering from Dentoalveolar trauma what should you be trying to find out?

A
  1. Date of injury
  2. Location of injury
  3. Cause of injury
  4. Did the pt faint or any signs of head injury-> A&E
  5. Other injuries
  6. Where is the tooth/ tooth fragment
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2
Q

What would you carry out in your extra oral examination of a Dentoalveolar trauma patient?

A
  1. Gentle palpations
  2. Look for maxilla and mandible to see if theres signs of a facial bone fracture
  3. Look for soft tissue lacerations
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3
Q

Give some symptoms of facial bone fracture

A
  1. Pain on palpations
  2. Occlusion may be deranged
  3. Patient can’t open or close their mouth
  4. May be Abel to see zygoma abnormalities
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4
Q

What would you carry out in your intra oral examination of a Dentoalveolar trauma patient?

A
  1. Systematically look at their soft and hard tissues
  2. Look for soft tissue lacerations
  3. Look for traumatised teeth: TTP, mobility, discolouration, displaceme
  4. Check all teeth for other diseases eg caries
  5. Check ALL anterior teeth
  6. Check occlusion
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5
Q

Which radiographs should we take when treating a patient with incisor trauma

A
  1. Upper standerd occlusal and peri apicals
  2. OPTs if you’re concerned with facial fracture
  3. Soft tissue radiograph if concern of tooth fragment
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6
Q

Why is it important to take radiographs when treating a trauma case

A
  1. Helps to form a diagnosis
  2. Can assess root development stage
  3. Can assess presence of root fracture
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7
Q

Why is it important to do a sensitivity test?

A

To assess baseline responsiveness

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8
Q

Name the 3 types of dental incisor trauma

A
  1. Fractures
  2. Luxation
  3. Both
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9
Q

Name the 6 types of dental fractures

A
  1. Enamel fracture
  2. Enamel dentine fracture
  3. Enamel dentine pulp fracture
  4. Crown root fracture (uncomplicated)
  5. Crown root fracture (complicated)
  6. Root fracture
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10
Q

Name the 2 types of enamel fractures

A
  1. Simple
  2. Infraction
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11
Q

What is a simple enamel fracture

A

Simple clean break that minimally gets into the enamel (2-3mm)

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12
Q

What is an infraction enamel fracture

A

when there’s no loss of enamel but a crack that extends to the ADJ

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13
Q

How do we treat enamel fractures

A
  1. No tx and just monitor
  2. Desensitising agents
  3. Comp build up
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14
Q

What is another name for enamel dentine fractures

A

Uncomplicated fractures (pulp isn’t involved )

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15
Q

How can we treat enamel dentine fractures

A
  1. Comp build up
  2. Reattach fragment
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16
Q

What are enamel dentin pulp fractures also called?

A

Complicated enamel dentine fractures

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17
Q

What do we need to consider when dealign with an enamel dentine pulp fracture

A
  1. Time since fracture occured
  2. Degree of contamination
  3. Degree of damage
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18
Q

What are the treatment options for a complicated enamel dentine fracture

A
  1. Cveck’s partial pulpotomy
  2. Pulpectomy
  3. pulp cap
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19
Q

What is the aim of a Cvek’s partial pulptomy

A

Preserve the vitality of the pulp by removing the top layer of potentially infected pulp tissue

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20
Q

What are you looking for when you first remove pulp tissue during Cvek’s (Partial) Pulpotomy?

A

Looking for fresh red pulp tissue that bleeds but the bleeding is easily stopped with a cotton roll
If bleeding doesn’t stop go another 2mm

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21
Q

What is a pulp cap

A

When you place calcium hydroxide over the exposed site

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22
Q

Which tx has a higher success rate Cveks pulpotomy or direct pulp cap

A

Cveks pulpotomy

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23
Q

How do we classify root fractures

A
  1. Location (cervical, mid or apical)
  2. Horizontal vs vertical
  3. Single vs multiple
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24
Q

Why is the location of a root fracture significant

A

It dictates the prognosis and management of the fracture

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25
Q

A root fracture where on the tooth has the most positive prognosis

A

Fractures closer to the apex

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26
Q

Why do root fractures near the apex have a better prognosis

A
  1. As the fracture line is further away from the oral mucosa so less chances of contamination
  2. Root fractures close to the gingiva have a mobile crown which is harder to splint and heal
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27
Q

How can we diagnose a root fracture

A
  1. Check mobility
  2. Assess for crown fragment extrusion
  3. Take 2 radiographs
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28
Q

How can we treat root fractures

A
  1. Reposition coronal segment of Toth
  2. Check position of the root fracture radiographically
  3. Stabilise the tooth with a flexible splint for 4 weeks
  4. Monitor healing for at least a year
  5. If pulpal necrosis occurs RCT vs XLA
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29
Q

What are crown root fractures

A

Fracture lines that start at the crown and extends beyond the gingiva or alveolar bone

30
Q

Is prognosis good or bad for crown root fractures and why?

A

Poor as difficult to restore the tooth ue to poor visualisation and moisture control

31
Q

How can we treat a crown root frcarure

A
  1. Fragment removal and gingivectomy
  2. Orthodontic extrusion of apical fragment
  3. Surgical extrusion
  4. Root submergence
  5. Extraction
32
Q

What is luxaiton

A

Damage to the periodontal structures surrounding the tooth

33
Q

Name the 7 types of luxation injuries

A
  1. Concussion
  2. Subluxation
  3. Extrusion
  4. Lateral luxation
  5. Intrusion
  6. Avulsion
  7. Alveolar fracture
34
Q

What is a concussion luxation injury

A

Where theres Haemorrhage and oedema in periodontal ligament
But:
No PDL tearing
Mild tenderness
No mobility
No displacement

35
Q

How do we treat a concussion luxation injury

A

No tx required just monitor and soft diet avoiding contact sports

36
Q

What is a subluxation Luxation?

A

Tearing of the periodontal ligament

37
Q

How do we diagnose a subluxation injury

A
  1. Blood in the gingival sulcus
  2. Mild tenderness
  3. Ma y have increased mobility
  4. No displacement
38
Q

How do we treat a subluxation injury

A

Usually no tx but we can splint for the pts comfort
soft diet no contact spots
monitor

39
Q

What is an extrusion injury

A
  1. Tearing of periodontal ligament
  2. Rupture of neurovascular bundle
  3. Tooth moves axially out of the socket
40
Q

How do we diagnose an extrusion injury

A
  1. Clinically the crown looks dropped
  2. Bleeding
  3. Tenderness
  4. Increased mobilty
    5.check for increased periodontal space apically using a radiograph
41
Q

What are the treatment options for an extrusion injury

A
  1. Reposition the tooth
  2. Stabalise the tooth for 2 weeks using a flexible splint
  3. Instructions to eat soft food and avoid contact sport
  4. Monitor
42
Q

What is a lateral luxation injury

A
  1. Simultaneous rupture and compression of the neurovascular bundle
    2 .Tooth moves laterally
  2. Fracture of alveolar socket
43
Q

How can we diagnose a lateral luxation injury

A
  1. often tooth is immobile as Locked into bone
  2. Ankylotic sound
  3. Gingival haemorrhage
  4. Crown may be labially or palatally displaced
  5. Check for widened PDL space best seen on an occlusal film radiograph
    Check for occlusal interference
44
Q

How can we treat a lateral luxation injury

A
  1. Reposition the tooth digitally or with forceps to disengage it from its bony lock and gently reposition it into its original location
    2, Stabilize the tooth for 4 weeks using a flexible splint
  2. Monitor the pulpal condition
45
Q

What is an intrusion injury

A

Crushing of the neurovascular bundle and periodontal fibres
tooth displaced axially into bone

46
Q

How can we diagnose intrusion

A
  1. Clinical crown not fully visible
  2. Often tooth is immobile
  3. Ankylotic sound
  4. Gingival haemorrhage
  5. PDL space widening on radiograph
47
Q

What could an intruded tooth also be

A

A partially erupting tooth

48
Q

What determines the treatment options for an intrusion injury

A
  1. Check if theres an open or closed apex
  2. Patient age needs to be considered
  3. Intrusion severity
49
Q

How would you treat a permeant tooth suffering from intrusion?

A
  1. Spontaneous repositioning
  2. Orthodontic repositioning
  3. Surgical repositioning
50
Q

When would we Spontaneously reposition a tooth suffering from intrusion?

A
  1. Open apex up to 7mm
    2, Closed apex up to 3mm
51
Q

When would we surgically reposition a tooth suffering from intrusion?

A
  1. Open apex more than 7mm
    2, Closed apex more than 3mm
51
Q

When would we orthodontically reposition a tooth suffering from intrusion?

A
  1. Open apex more than 7mm
    2, Closed apex 2-7mm
52
Q

What is avulsion

A

Tooth out of mouth

53
Q

When dealing with a case of avulsion what should you do?

A

a1. Check the age and medical history of the patient
2. Keep the patient calm
3. Find the tooth and pick it BY THE CROWN
4. If the tooth is dirty since under cold running water

54
Q

If a patient calls saying they have knocked their tooth out what should you do?

A
  1. Keep the patient calm
  2. Tell the patient to hold the tooth by the CROWN not root
  3. If the tooth is dirty wash it gently under cold running water
  4. Try to encourage the patient. parent to replant the tooth
  5. If the tooth can’t be re implanted then place the tooth in a suitable storage medium eg milk
  6. Seal emergency dental treatment immediately
55
Q

What is the treatment of avulsion dependent on?

A
  1. Open vs closed apex
  2. Total extra oral time
  3. Extra oral dry time
56
Q

After how much dry time is the likelihood of the tooth healing 0%

A

30 minutes

57
Q

After how much wet time is the likelihood of the tooth healing 0%

A

60 mins

58
Q

When is unfavourable healing guaranteed?

A
  1. When extra alveolar time is one 60 mins
  2. When time in an extra alveolar medium exceeds 60 mins
  3. When extra alveolar dry time is over 30 mins
59
Q

What can unfavourable healing lead to

A

Pulpal necrosis

60
Q

What causes replacement resorption

A
  1. Death of the periodontal ligament
  2. This leads to bone directly contacting with the tooth
  3. Which leads to infra occlusion and repalcemtn resorption
61
Q

Is replacement resorption good or bad? why

A

BAD as the bone has fused to the tooth making it ankylosed

62
Q

Which has a better prognosis open or closed apex

A

Open

63
Q

Broadly describe how you’d manage avulsion ?

A
  1. Give LA
  2. Rinse out the socket and the tooth
  3. Digitally re implant the tooth
  4. Check clinically and radiographically that the oath is in the right tplace
  5. Apply a physiological splint (soft wire) to the tooth with composite for 2-4 weeks
    6, Give systemic antibiotics
64
Q

What instructions do we give to patients after we have re implanted their tooth

A
  1. Soft food for 2 week
  2. No contact spirt
  3. Brush teeth with a soft tooth brush after meals
  4. Use chlorhexidine (0.1 %) mouth rinse twice a day for 1 week.
65
Q

What are the chances of the pulp surviving in an avulsed tooth with a closed apex?

A

0%

66
Q

What are the chances of the pulp surviving in an avulsed tooth with an open apex?

A

30%

67
Q

How do we go about treating an avulsed tooth with a closed apex?

A

Begin Endodontics treatment 7-10 days with the splint still on

68
Q

How do we go about treating an avulsed tooth with an open apex?

A

Begin endodontic treatment 7-10 days if the tooth was out the mouth for more than an hour
If under an hour then just monitor the tooth

69
Q

What is an alveolar fracture

A

fracture of the alveolar plate

70
Q

How can we diagnose an alveolar fracture

A
  1. Segmental mobility of full section of bone
  2. Several teeth may move together at the same time
  3. Displacement +/ occlusal interference
  4. Gingival tearing and bleeding
  5. Teeth may or may not respond to vitality test
71
Q

What is the treatment for an alveolar fracture

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

5th yr- Finals- CSA revision (19 decks)

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