4th year Flashcards
(134 cards)
1
Q
how could trauma cause localised recession?
A
non vital –> repeated abscess –> loss of bone around tooth –> localised recession
2
Q
4 risk factos for trauma?
A
- prolcined maxillary incisors
- short upper lip
- accident prone
- MH e.g. epilepsy
3
Q
how might rheumatic fever effect treatment of avulsions?
A
putting tooth back in mouth reintroduces bacteria - increased risk
4
Q
4 things to look for e/o in trauma patient?
A
- shock
- head/other injuries
- foreign bodies
- bleeding/CSF from nose
5
Q
what to look for in HT after trauma?
A
bony step deformities
6
Q
what does percussion of a tooth tell you?
A
periodontal injury
7
Q
4 tests/signs to assess in trauma
A
- mobility
- percussion
- tooth colour
- sensibility - negative may be necrosis or concussed
8
Q
routine imaging to assess anterior fractures?
A
PA + occlusal
9
Q
WHO dentoalveolar injury classification splits trauma into which 4 groups?
A
- hard tissue/pulp
- periodontal tissue
- supporting bone
- gingiva/oral mucosa
10
Q
7 types of dental hard tissue/pulp trauma?
A
- enamel infarction
- enamel fracture
- enamel-dentine fracture
- complicated crown fracture
- uncomplicated crown-root fracture
- complicated crown-root fracture
- root fracture - apical/middle/coronal
11
Q
6 types of periodontal tissue trauma classifications?
A
- concussion
- subluxation
- extrusive luxation
- lateral luxation
- intrusive laxation
- avulsion
12
Q
4 classifications for trauma to supporting bone?
A
- comminution of alveolar socket wall
- fracture of alveolar socket wall
- fracture of alveolar process
- fracture of mandible + maxilla
13
Q
3 classifications of gingiva/oral mucosa trauma?
A
- laceration
- contusion
- abrasion
14
Q
what is involved in conservative/basic management of tooth trauma?
A
soft diet 10-14 days analgesics use soft tooth brush corsodyl rinse/gel antibiotics yes/no refer to GP if tetanus unsure
15
Q
how to treat enamel fracture in primary tooth?
A
smooth sharp edges +/- composite
no review
prognosis good
16
Q
how to treat enamel dentine fracture in primary tooth?
A
identify location of fragments smooth sharp edges +/- composite (GIC if not cooperative) review 6-8 weeks radiograph if necrosis suspected prognosis depends on associated PDL
17
Q
2 options to treat complicated crown fractures in primary teeth?
A
- partial pulpotomy with non-setting CaOH2 + restoration - review 1 week, 6-8 weeks, 1yr
- extracted + review in 1 yr
radiograph if eruption of permanent delayed
18
Q
how would you treat root fracture in primary tooth that is not displaced?
A
conservatively
review 1wk, 8wk, 1 yr
radiograph if eruption of permanent delayed
19
Q
how would you treat root fracture in primary tooth that is displaced but not mobile?
A
conservatively
review 1wk, 8wk, 1 yr
radiograph if eruption of permanent delayed
20
Q
how would you treat root fracture in primary tooth that is displaced + mobile?
A
options:
- resposition + splint for 4 weeks
- extract coronal fragment + leave apical fragment to absorb
review 1wk, 8wk, 1 yr
radiograph if eruption of permanent delayed
21
Q
how to treat concussion/subluxation in primary tooth?
A
conservative
review 6-8wks
extract if symptoms develop
22
Q
how would you treat lateral luxation if no occlusal interference in primary tooth?
A
observe, spontaneous reposition usually 6month
23
Q
how would you treat lateral luxation if occlusal interface or excessive mobility In primary tooth?
A
reposition + flexible splint 4weeks
or extract if severe
24
Q
what type of PDL trauma is likely to affect permanent successor?
A
intrusion
25
how would you treat intrusion trauma in primary tooth?
leave + allow spontaneous eruption 6-12month
1 wk, 6-8wks, 1yr
26
how can radiographs be used to asses intrusion of primary tooth?
if apex displaces towards labial bone = tooth apex can be visualised + tooth appears shorter
if apex displaced into developing tooth germ = apex can not be visually + tooth elongated
27
how would you treat extrusion in primary tooth without any occlusal interference?
conservation, allow spontaneous repositioning
review 1wk, 6-8weeks, 1yr
28
how would you treat extrusion in primary tooth with an occlusal interference?
>3mm extrusion or excessiv mobility = extract
29
how would you treat avulsion injury in primary tooth?
do not reimplant
review 6-8wks
follow up to monitor eruption of permanents
30
what type of injury causes comminution of alveolar socket wall
crushing
31
how to treat alveolar fracture?
reposition segment
splint for 4 weeks
review 1wk, 4wk, 8wk, 1yr
radiographs 4wk + 8wk
or extract
32
what is a laceration injury?
tear
33
what is a contusion injury?
bruise
34
what causes an abrasion injury
superficial wound caused by rubbing/scraping
35
6 complications to primary teeth after primary tooth trauma
1. necrosis = discolouration
2. infection
3. premature loss
4. pulpal obliteration = creamy
5. resorption
6. arrested development
36
8 complications to permanent teeth after primary tooth trauma
1. enamel hypoplasia/hypominerlisation
2. pulp necrosis/infection
3. irregular/delayed/failed eruption
4. arrested development
5. crown/root dilaceration
6. root duplication
7. odontome like formation
8. sequestration of tooth germ
37
what is crown/root dilaceration?
abrupt deviation of long axis of crown/root caused by trauma
38
management of crown/root dilaceration
1. aim to maintain vitality
2. seal hypoplastic areas
3. temporise with composite
4. if vitality lost RCT +/-MTA
5. definitive restoration for veneer/crown
6. possible ortho
39
what is an IMCA?
independent mental capacity advocate
40
what is domiciliary care?
treating in the home
41
6 important questions to ask pt with trauma?
1. how/when/where
2. loss of consciousness?
3. other injuries?
4. bite disturbances/traumatic occlusion
5. are teeth in same position?
6. NAI - does injury match history
42
what is assessed using the trauma stamp?
```
mobility
displacemnets
TTP
colour (check palatal not labial)
sinus
thermal - ethyl chloride
radiographs + photographs
```
43
treatment of enamel dentine fracture in permanent tooth?
locate fragments
composite bandage
definite restoration 3-4wks later
6-8wks + 1yr radiographs + sensibility tests
44
treatment of complicated crown fracture in permanent tooth depends on what 2 factors?
size of exposure + time since exposure
45
if a pulp exposure is <2mm <24hr in permanent tooth, how do you treat? only if vital
direct pulp cap with CaOh2 + composite
46
if a pulp exposure >2mm or >24hrs in permanent tooth, how do you treat? only if vital
pulpotomy - partial of full coronal with CaOH2
composite
monitor 1,3,6 months
47
what do you use to disinfect tooth before pulp cap/pulpotomy?
clean with saline + disinfect with sodium hypochlorite
48
what is cvek pulpotomy?
partial coronal (2-3mm)
49
when would you have to do a pulpectomy after pulpotomy
if can't stop bleeding or if no bleeding
50
what is HERS and why do you need to protect it when RCT?
hertwigs epithelial root sheath
| maps out shape + length of root
51
what are the 2 options for RCT with open apex?
1. specification - change non-setting CaOH2 every 3 month + check for barrier
2. obturate with thermoplastic GP +/- MTA - average 9-12months for closure
52
how thick does MTA need to be apically?
4-6mm
53
what sort of post crown would you use in children
fiberoptic post crown - bonded composite down 4-5mm in canal + fibre post
54
5 treatment options for uncomplicated root fracture?
1. fragment removal + gingival reattachemetn
2. fragment removal + surgical exposure of sub gingival fracture
3. fragment removal + orthodontic extrusion
4. fragment removal + surgical extrusion
5. extraction
55
difference between uncomplicated + complicated root fracture treatment?
same but complicated also needs endo (pulp cap, pulptotomy, extirpation)
56
will root fractures be TTP?
yes
57
how do you classify root fractures?
apical, middle, coronal
58
signs of root fracture
coronal segment mobile
TTP
possible colour change
59
what imaging to use for root fracture
PA + occlusal
60
how to treat a non-mobile root fracture?
conservative + monitor
61
how to treat a mobile root fracture? permanent
flexible splint for 4 weeks
62
how to treat displaced root fracture? permanent
reposition coronal portion
| flexible splint 4 weeks
63
in a coronal root fracture how long might you need to use a splint for?
4 months
64
what type of root fracture has worst + best prognosis?
apical best
| coronal worst
65
when to review root fractures?
4 weeks
6-8weeks
4months
6months
66
what sort of tissue forms in good healing of root fracture?
calcified tissue + Connective tissue
not granulation tissue
67
how would you treat pulp necrosis in root fracture?
extirpate to fracture line
Caoh2 then MTA/biotine just coronal to fracture line
obturate to fracture line
hard tissue closure of root canal at fracture line 6-12 months
68
5 factors affecting prognosis of fractures?
1. age of child
2. degree of displacement
3. associated injuries
4. time between injury + treatment
5. presence of infection
69
what is subluxation?
injury causing abnormal loosening but without tooth displacement
70
management for subluxation + concussion
permanent
occlusal relief
soft diet
possible flexible splint for 2 weeks
71
what does lateral luxation mean has happened to the alveolar plate?
fractured
72
how to manage lateral excursion? permanent
reposition + flexible splint 4 weeks
73
how to monitor concussion/subluxation/extrusion/lateral luxation/intrusion
clinical tests - sensibility
radiographs - for root development, check for internal + external inflammatory resorption
at time of injury
1, 3, 6, months
74
how to manage extrusion of permanent tooth?
reposition
| flexible splint for 2 weeks
75
how to treat intrusion of permanent tooth?
flexible splint 4 weeks to stabilise
| endo start within 10days if complete apex
76
when does root closure occur?
up to 3 years after eruption
77
guidelines for repositioning closed apice teeth after intrusion
<3mm spontaneous - then Orthodontics
3-6mm ortho
>6mm surgical + 4/52 splint
78
guidelines for repositioning open apex teeth after intrusion
<6mm ortho
| >6mm surgical + 4/52 splint
79
what may prolonged splinting lead to?
ankylosing
80
what should you rinse avulsed tooth in?
saline/milk/saliva
| DO NOT TOUCH ROOT
81
what is EADT?
extra alveolar dry time - how long out of mouth
60min threshold - when PDL cells turn from viable to non-viable
82
3 factors for avulsed tooth healing
EADT
type of storage
stage of root formation - open root best
83
how to deal with tooth EADT <60mins
rinse with saline
replant with fingers
flexible splint 2 weeks
if closed apex = RCT:
extirpate prior to splint removal
Caoh2 4 weeks
obturate +/- MTA
84
if a tooth has an open apex + EADT < 45 mins what might be possible
revascularization
begin after 4 days
if no evidence in 2 week, extirpate before splint removal
85
how to deal with tooth closed apex + EASDT >60mins
replacement resorption will occur, maintain for space + bone
extirpate within 2 weeks
dress CaOh2 4 weeks
obturate
encourage ankylosis - scape off PDL splint 2-3months
86
how to deal with tooth open apex + EADT >60mins
do not reimplant
| decorate + retain - best for ankylosed teeth
87
3 presentations of replacement resorption?
1. radiographic absence of PDL space/lamina dura
2. replacement of root structure by bone
3. metallic sounds to percussion
88
what initiates replacement resorption?
severe damage to PDL
normal repair does not occur, bone directly fused to dentine
89
what is replacement resorption?
ankylosis
progressive
tooth gradually resorbed as it is now part of bony remodelling - grown around
90
how to treat a dentoalveolar fracture
reposition
flexible but rigid splint for 4 weeks
antibiotics
91
4 type of resorption which are complications of PDL injuries?
external resorption
external inflammatory resorption
internal inflammatory resorption
replacement resorption
92
what is transient external resorption?
damage to PDL which heals, non-progressive
93
what is external inflammatory resorption?
damage to PDL + propagated by diffusion of necrotic pulp tissue via dentinal tubes
progressive
94
what sort of resorption does orthodontics cause?
external transient
95
how would you diagnose external inflammatory resorption?
root surface indistinct but tramlines of canal still intact
96
how would you treat external inflammatory resorption?
extirpate
NS CAOH2
treat until non-progressive then obturate
if progressive - iodoform or CaOH2 every 6 months + plan for pros replacement
97
how would you treat replacement resorption?
poor prognosis
not influenced by endo
composite additions if possible or decoronation to maintain bone or extraction
98
what is internal inflammatory resorption?
initiated by pulp turning non-vital
| progressive
99
how would you diagnose internal inflammatory resorption?
tramlines of root canal indistinct + root surface intact
100
how would you treat internal inflammatory resorption?
extirpate
NS CAOH2
treat until non-progressive then obturate
if progressive - iodoform or CaOH2 every 6 months + plan for pros replacement
101
apart from resorption what is another complication of PDL damage?
pulp canal obliteration
102
what is pup canal obliteration?
progressive - hard tissue formation within pulp cavity following trauma - gradual narrowing of pulp chamber/canal
103
how would you treat pulp canal obliteration?
conservatively - no prophylactic obturation as pulp only becomes necrotic in small number
104
how to treat arrested root development following trauma?
treat like open apex to form calcific barrier
CAOH2/MTA/biodentine
105
6 signs of oral malignancy
1. unexplained swelling
2. unusual bone loss/bony expansion
3. abnormal tooth mobility
4. abnormal eruption patterns associated with bone loss
5. non-healing ulcer
6. spontaneous bleeding from gingivae
106
3 orally relevent side effects of chemotherapy/BMT?
anaemia
thrombocytoenia
leukopenia
107
what the local and systemic ways of stopping bleeding for patient with thrombocytopenia?
local - pressure/surgicel/tranexamic acid
| systemic - platelet infusion
108
oral manifestation of acute myeloid leukaemia?
gingival swelling
109
ulceration + mucositis may develop how many days after chemo + radiotherapy?
```
chemo = 3-10
radio = 12-15
```
110
long term dental complications of malignancies in children?
```
microdontia
root stunting
hypodontia
hypoplasia
delay exfoliation
malalightpment of permanent teeth
facial growth
```
111
how does radiotherapy effect salivary flow?
decreased
starts 14hrs post treatment
can last 2 years post treatment
112
dental complications of chemo/radio
```
mucosistis
ulceration
immunosuppression - more infection
xerstomia - taste changes, dysphagia
increased bleeding
```
113
oral signs of graft versus host disease ? following BMT
ulcers + white patches - commonly FOM
114
what epilepsy drug can cause gingival overgrowth?
phenytoin
115
cystic fibrosis is a disorder of which glands?
exocrine glands
116
2 main groups of congenital heart disease
acyanotic
| cyanotic shunt
117
consequences of infra occluded primary tooth
tipping of adjacent teeth
| over eruption of opposing tooth
118
which primary teeth do you balance
always Cs, sometimes Ds, never Es
119
which teeth do you not compensate
primary teeth
120
what is balancing + compensation
```
compensation = extracting tooth in opposing arch
balancing = extorting other side to stop midline shift
```
121
when not to balance primary first molars?
spaced dentition
cooperative patient - balance if midline shift occuds
balance if under GA
122
5 reasons for 6s impacting Es
1. crowding
2. large 6
3. familia tenancy
4. small maxilla
5. hall crown technique - increases medial-distal length of E
123
management options for impacted 6s on Es
1. await spontaneous disimpaction - high caries risk
2. insert separator to attempt disimpaction
3. reduction of distal surface of E
4. extraction of E - most common
124
3 reasons 6s were be classed as low prognosis
1. moderate/severely hypominerlaised with post eruptive breakdown/sensitivity/pain
2. caries extending 2/3 into dentine
3. 2 surface restoration in place
125
in child - if poor prognosis 6s, class 1 with no crowding - what would your treatment be?
extract 6 + compensate with maxillary if needed
126
in child - if poor prognosis 6s, class 1 with crowding or class 2 with no crowding- what would your treatment be?
delay extraction until Orthodontics
use space to correct crowding/overjet
127
in child - if poor prognosis 6s, class 3 or class 2 with crowding- what would your treatment be?
seek specialist advice
128
ideal time to extract mandibular 6s
9.5 years - when 7s bifurcating
129
when should you palpate for canines?
9years onwards
130
when must you extract Cs?
before age of 11
131
radiographic appearance of dentinal dysplasia type 1
'rootless teeth'
132
characteristics of dentinal dysplasia type 2
primary teeth look like DI
permanent teeth normal
thistle shaped pulp chambers + pulp stones
133
which dentinogenesis imperfecta is associated with odontogenic imperfecta
1
134
which drugs should be avoided in renal disease
paracetamol
penicillin
tetracycline
