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Paeds for FINALS > Trauma to the permanent dentition: luxation injuries > Flashcards

Trauma to the permanent dentition: luxation injuries Flashcards

1
Q

Define concussion (3)

A

Injury to supporting tissues
No loosening or displacement of tooth
TTP

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2
Q

Define subluxation (3)

A

Injury to tooth supporting tissues WITH abnormal loosening of tooth
No displacement

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3
Q

What should you look for as evidence of a concussion or subluxation injury?

A

Bleeding at the gingival margin

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4
Q

What is lateral luxation? (4)

A

Bodily movement of tooth within socket
Not usually mobile
Rupture of neurovascular bundle
Crushing of PDL cells in palatal cervical region

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5
Q

What is extrusion? (3)

A

Axial displacement partially out of socket
Mobile
Appears elongated

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6
Q

What is intrusion? (3)

A

Tooth forced upwards into socket (in developing dentition - may be difficult to tell if teeth were partially erupting anyway)
Complex and severe injury
Crushing of PDL cells and neurovascular bundle

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7
Q

What is avulsion? (3)

A

Tooth completely lost from socket
Ischaemic injury to pulp
PDL cell death

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8
Q

Prognosis of pulp in luxation injuries dependent on (3)

A

Type of injury
Age of pt (ie stage of apical development)
Concomitant injury (fracture)

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9
Q

Types of pulpal healing (3)

A

Complete healing
Pulp canal obliteration
Pulp necrosis - inflammatory resorption

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10
Q

Sequelae of pulp canal obliteration (2)

A

Necrotic pulp –> inflammatory resorption/????

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11
Q

Types of resorption (3)

A

Inflammatory
Replacement
Internal

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12
Q

What is inflammatory (external resorption) (3)

A

Continuation of surface resorption due to toxins from necrotic pulp
Progressive until bacteria removed (i.e. pulp extirpation)
Will be filled in with cementum or bone on healing

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13
Q

Inflammatory (internal) resorption treatment (1)

A

Extirpation and dressing with calcium hydroxide

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14
Q

Features of inflammatory (internal) resorption (4)

A

Infrequent complication
Necrotic pulp
Ballooning of canal
Rapid progression

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15
Q

What is replacement resorption? (3)

A

Extensive PDL damage
Osteoclasts are in direct contact with dentine
Normal bone turnover leads to progressive replacement resorption - progressive

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16
Q

General advice for management of luxation injuries (5)

A 
Soft diet for 7 days
Analgesics as necessary
Good oral hygiene
Chlorhexidine mouthwash or gel
Review splint at 48 hours
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17
Q

Concussion treatment (2)

A

No treatment required

Monitor at 4 weeks, 6-8 weeks, 1 year

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18
Q

Subluxation treatment (2)

A

A flexible splint can be placed for up to 2 weeks (if necessary)
Monitor for 4 weeks, 6-8 weeks, 1 year

19
Q

Extrusion treatment (4)

A

Reposition by gently repositioning with or without LA
Avoid high speed suction
Flexible splint for 2 weeks
Monitor a 2, 4, 6-8 weeks, 6 months, 1 year, yearly for 5 years

20
Q

Treatment of lateral luxation (3)

A

Reposition, disengaging tooth from any bony lock (usually with LA)
Flexible splint for 4 weeks
Monitor at 2, 4, 6-8 weeks, 6 months, 1 year, yearly for 5 years

21
Q

Treatment options for intrusion (3)

A

Leave - may spontaneously erupt
Orthodontically extrude
Surgically extrude

22
Q

Treatment for intrusion for teeth with immature apex (2)

A

Allow spontaneous repositioning to take place
-if no movement noted within a few weeks, recommend rapid ortho repositioning
If intruded >7mm reposition surgically or orthodontically

23
Q

Treatment for intrusion for teeth with mature apex (5)

A

Allow re-eruption if tooth intruded <3mm, if no movement after 2-4 weeks reposition surgically or orthodontically
If intruded 3-7mm surgical or ortho repositioning
If intruded >7mm, reposition surgically
Splint for 4-8 weeks once surgically repositioned
Commence RCT within 3-4 weeks

24
Q

Telephone advice for avulsion (4)

A

Find tooth
Hold tooth by crown (white part) NOT root (yellow, pointy part)
If dirty, rinse with cold water (10s - care not to drop down plughole)
Put in milk/ saliva
OR
Place tooth back in socket
Get child to bite on rolled up tissue to hold in place

25
Q

Unfavourable healing for avulsion (3)

A

Extra aveolar time >90mins
Extra alveolar dry time >30 mins
90% chance of ankylosis if replanted after these times - in reality, anything more than 5 mins will result in PDL cell death

26
Q

Replacement resorption pathway - avulsion (3)

A

Death PDL
Bone in direct contact with tooth
Ankylosis and replacement resorption -leading to infraocclusion

27
Q

Replant or not? Consider… (5)

A 
Prognosis
Medical status
Behavioural aspects
Burden of care
Child/ parent wishes
28
Q

Advantages of replanting avulsed teeth (5)

A 
Aesthetics
Space maintenance (avoidance of denture)
Maintain options (bone preservation, transplants)
Prevent restorative treatment
Psychological benefit
29
Q

Disadvantages of replanting avulsed teeth (4)

A

Infra-occlusion
Loss of gingival contour and bone
Multiple visits (burden to family and child)
Tooth will be lost eventually

30
Q

Key findings of socio-economic burden of permanent incisor replantation on children and parents (6)

A

9.1 treatment visits in 1st year post injury (1.2 emergencies)
7.2 hrs direct tx time
Direct tx cost £900
Loss of work time for 86% parents
School missed for 1-2 weeks after injury
18% replanted teeth were extracted within 1st year

31
Q

Stat: if you knew what you know now, would prefer to have incisor replanted or left out? (2)

A

Parents: 19% would not
Children: 33% would not

32
Q

Potential contraindications of avusion (5)

A

Immunosuppression
Severe cardiac disease
Caries/ perio disease
Children with severe learning difficulties who would not be able to manage ongoing tx
Severe incisor crowding, supplemental incisor

33
Q

Management of avulsions: before replanting (7)

A

-store tooth in saline/ milk
-LA if required
-gently irrigate socket to remove clot
-handle tooth by crown not root
-if contaminated remove debris with saline
-if stubborn debris, gently dab with saline soaked gauze
Tip> measure tooth length prior to replanting to conform WL for future RCT

34
Q

Management of avulsions: replanting (6)

A

Replant with gentle p
If won’t replant fully, STOP
Reposition any bony fractures with blunt instrument (flat plastic) if required
Flexible splint for 7-14 days
Systemic Abx
Extirpate pulp in mature tooth between 0-10 days

35
Q

Systemic Abx avulsions (3)

A

Recommended where contamination, multiple injured teeth, med conditions rendering child susceptible to infection
>12yrs: doxycycline 2x for 1 day, then 100mg 2x/ day for 10 days
<12yrs: amoxicillin 500mg 3x/ day for 5-7 days

36
Q

Endo for avulsed teeth (6)

A

RCT is mandatory for teeth with mature apex
Ideal time 0-10 days (before splint removal, so tooth stable during tx)
If extirpated prior to 7 days, use odontopaste instead of CaOH
Dress with non setting CaOH for 1 month
Definitive obturation at 1 month
In teeth with open apices, RCT can be avoided unless clinical and rad evidence of pulpal necrosis

37
Q

Extra oral endo (4)

A

Only usually in older pts, where growth complete and excessive extra-oral dry time - ankylosis expected

  • with conventional access cavity
  • replant
  • flexible splint for 7-10 days
38
Q

Follow up regime after avulsion (10)

A 
Frequent clinical and rad examination
1/2 days (splint check)
0-10 days (RCT if required)
2 weeks (splint removal)
4 weeks (definitive RCT if required)
6-8 weeks
3 months
6 months
1 year
Yearly
39
Q

Duration of splinting: what is splinted for 2 weeks? (3)

A

Subluxation
Extrusion
Avulsion

40
Q

Duration of splinting: what is splinted for 4 weeks? (3)

A

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

41
Q

Duration of splinting: what is splinted for 4 months? (1)

A

Cervical third root fracture (poor prognosis)

42
Q

Types of splint (2)

A

Direct (physiological better as encourages healing and reduces risk of ankylosis)
Indirect

43
Q

Direct splints (4)

A

Physiological
-titanium splint (best but spenny)
-flexible ortho brackets and flexible wire
Composite/ GIC ‘bandage’ (only in emergency)
Surgical wiring (only by max fax)

44
Q

Indirect splints and disadvantages (6)

A 
Essix type retainer, use of temp cement
-only if unable to get moisture control for direct splint or insufficient teeth to splint to
> costs (lab costs)
Teeth may come out in impression
Not good for OH
Can't access for RCT

Paeds for FINALS (2 decks)

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