PAEDS - trauma handbook

Question 1

how would you manage a traumatised permanent incisor where there is an enamel/ dentine fracture and a pulpal exposure?

Answer 1

pulpotomy
known as the Cvek technique or partial pulpotomy

Question 2

what is the purpose of performing a pulpotomy on a tooth with exposed pulp?

Answer 2

remove infected and inflamed pulp tissue
maintain the tooth’s vitality and allow the root to continue development in the case of immature teeth

Question 3

when treating a tooth with pulpal exposure, what is the remaining healthy pulpal tissue treated with?

Answer 3

healthy pulpal tissue surface treated with non-setting calcium hydroxide or non-staining calcium silicate

Question 4

if the patient is in the mixed dentition phase, with spacing or teeth close to exfoliation, what may be difficult prior to pulpotomy? and how do you resolve this?

Answer 4

placing rubber dam or wedging material
split dam - interproximal dam between adjacent holes
can use caulking agent or alternative in con junction

Question 5

what is used to amputate the pulp when performing a pulpotomy? and how much pulp would normally be removed?

Answer 5

round diamond bur in a high speed air rotor with water spray
1-2mm pulp removed

Question 6

how do you know how much pulp to remove when performing a pulpotomy?

Answer 6

remove until you see bleeding healthy pulp

Question 7

how is bleeding arrested when performing a pulptomy?

Answer 7

cotton wool pledget soaked in sterile water/ saline

alternative: adrenaline free LA

Question 8

what is the exposed pulp dressed with during a pulptomy?

Answer 8

non-setting calcium hydroxide
or
white MTA
or
non-staining calcium silicate cement

Question 9

how does calcium silicate and calcium hydroxide work?

Answer 9

promote calcific repair and milk antibacterial properties

Question 10

what are examples of calcium silicates?

Answer 10

biodentine
white MTA

Question 11

what is the calcium hydroxide covered with when performing a pulpotomy? what does this function as? where should it be placed?

Answer 11

RMGI cement
limited to dentine
acts as a lining in preparation to composite (larger bonding area)

Question 12

what must you do to the RMGI cement during a pulpotomy?

Answer 12

light cure

Question 13

what is a composite bandage?

Answer 13

temporary dressing placed on a tooth immediately after an enamel dentine fracture or an enamel dentine pulp fracture that has undergone a pulpotomy

Question 14

what is the purpose of a dentine bandage?

Answer 14

seal over any exposed dentine tubules (and pulp cap if present) minimising the risk of microbial invasion and preventing see

Question 15

what material is not suitable for composite bandage ?

Answer 15

GI - not robust enough

Question 16

what are the 4 reasons for the use of a composite bandage being used in the short term?

Answer 16

pt may be distressed and in pain
difficult after trauma to achieve a dry field
operator may have limited time
restoring tooth short of occlusion is advantageous if there has been periodontal injury

Question 17

why is it important when restoring the tooth definitively to preserve as much of the composite bandage as possible?

Answer 17

reduces further insult to the pulp increasing its prognosis

Question 18

what should the composite bandage cover?

Answer 18

pulp cap and all exposed dentine

Question 19

what are the 8 tests to assess pulp vitality?

Answer 19

colour
EPT
thermal test
transillumination
TTP
mobility
sinus/ alveolar tenderness
history
radiographic exam

Question 20

what is pulp vitality determined by?

Answer 20

presence of an intact blood supply - NOT intact nerve supply

Question 21

what signs should be present to indicate endodontics in a tooth?

Answer 21

2 signs of pulpal necrosis

Question 22

what should be asked in a history when reviewing trauma?

Answer 22

pain?
swelling?
bad taste?
specific tooth?
what makes it sore?
sore to touch/ move?
darkening?
mobility?

Question 23

why does decolouration not mean the pulp is irreversibly necrotic?

Answer 23

products of pulpal necrosis may permeate tubules and stain surrounding dentine.
initially pinkish which may turn brownish due to haemosiderin from oxidising haemoglobin

Question 24

what is transillumination useful for?

Answer 24

detecting craze lines, enamel infraction and assessing colour of the tooth

Question 25

what direction should the light be in when investigating a tooth with transillumination?

Answer 25

perpendicular to the long axis of the tooth

Question 26

what does percussion examine?

Answer 26

percussion note and whether the tooth is tender

Question 27

what has happened if there is increased mobility of a tooth weeks after trauma?

Answer 27

pathognomic of periapical infection

Question 28

what is Millers classification?

Answer 28

mobility

class 1: <1mm (horizontal)
class 2: >1mm (horizontal)
class 3: >1mm (horizontal and vertical)

Question 29

what does pulp testing with EPT or ethyl chloride test?

Answer 29

pulpal sensory nerve supply - NOT true pulp vitality

Question 30

what type of teeth are not likely to respond to pulp testing?

Answer 30

vital teeth that have been traumatised
vital teeth with incomplete root development

Question 31

what are radiographic signs that a traumatised tooth is non vital when reviewing?

Answer 31

the root development is lagging behind an undamaged contralateral tooth