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Dental injuries in children Flashcards

(46 cards)

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1
Q

What are the most commonly affected teeth wrt dental injuries?

A

Max incisors

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2
Q

What are the most common injuries?

A

Primary dentition - luxation injuries
Permanent dentition - enamel fractures

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3
Q

What ages do peak incidences occur?

A

2-4 years - primary incisors
7-10 - perm incisors

m>f (2:1)

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4
Q

Injuries in babies

A

Highly unlikely - non accidental injury

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5
Q

Injuries in infants

A

Due to trips and falls as cognitive and motor skills develop

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6
Q

Injuries in childhood

A

Falls and accidents

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7
Q

Injuries in adolescence

A

Sporting, fights, assults

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8
Q

What are the predisposing factors towards dental injury

A

Class 2 div 1 - proclined incisors
lack of soft tissue coverage
increased overjet (3-6mm 2x freq)(>6mm = 3x freq)
medical or physical impairment (cerebral palsy, autism, epilepsy)
Accident prone children, aggressions ADHD and lack of parental supervision

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9
Q

MH questions to check

A

Bleeding disorders
Reduced immunity
Allergies
Medications
Immunisation status (check tetanus)

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10
Q

Dental history questions to ask

A

Previous injury to the dentition and management
Past dental experience
Anxiety

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11
Q

Trauma history questions

A

What happened
When did it happen
How did it happen
Where did it happen
Loss of consciousness/ head injuries/ other injuries
Immediate management

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12
Q

EOE in dental injuries

A

Observe injuries elsewhere in body
Facial asymmetry
Observe from above and behind pt
Palpation of the facial skeleton
Facial injuries: swellings, lacerations, abrasions, contusions (bruises)

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13
Q

IOE in dental injuries

A

ST:
Lips, all mucosa palate, tongue, FOM

Check irregularities in occlusion

Teeth:
Position
Mobility
Loss of tooth tissue, i.e. fracture of parts of the tooth or loss of whole tooth

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14
Q

Radiographic examinations to take

A

PA
Occlusal
DPT
ST views

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15
Q

What is included on a trauma grid?

A

Colour
Mob
TTP
Vitality
Radiograph

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16
Q

What are you checking for in TTP?

A

Damage to the PDL (pain)
Percussion tone - if there is a change, the tooth could be locked into the bone due to an intrusive injury - metallic sound on tapping

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17
Q

What we checking with mobility?

A

Pulp vascularity changes with mobility
If there is a group of teeth that are mobile = alveolar bone fracture

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18
Q

What does transillumination check for?

A

Infractions of enamel (microcracks)

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19
Q

What tissues can be damaged in a dent-alveolar injury?

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A

Hard tissues and pulp
Periodontal tissues
Supporting bone
Gingival or oral mucosa

20
Q

What are the least to most severe dental injuries

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A

Infraction, enamel fracture, enamel-dentine fracture, compl crown fracture, crown root fracture, root fracture

21
Q

What the type of injury to the periodontal tissues

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A

concussion
subluxation
extrusive luxation
lateral luxation
intrusive luxation
avulsion

22
Q

What are the types of injury to the supporting bone?

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A

Comminuition of the socket wall (crushing of the bone in intrusive/lateral luxation)

fracture of socket wall
fracture of alveolar process
fracture of mandible or maxilla

23
Q

Injuries to gingivae or oral mucosa

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A

Laceration
Contusion
Abrasion
Degloving injury

24
Q

Signs of non accidental injury

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A

Delayed presentation of dental trauma
Injuries that do not match the given history
inconsistencies in stories
Multiple injuries of different ages
Bruising of soft tissues not overlying bony prominences
injuries taking the shape of a recognisable object
Any oral injury in a newborn or pre-walking infant

25
What are the pulpal healing outcomes of fractured teeth?
Survival Obliteration Necrosis
26
How long does it take for the radiographic obliteration of pulp to occur?
3m - deposition of mineralised tissue in the pulp chamber walls Causes yellow discolouration
27
What are the factors that influence the outcome of pulp?
Initial pulp status Status of the apex - open apex, survival/obliteration Time since injury - more time passes = necrosis Concurrent injuries - PDL damage = necrosis
28
Luxation injuries of permanent teeth
Concussion and subluxation are unlikely to cause damage to pulp Extrusive luxation Palatal luxation Intrusion Avulsion
29
What is extrusive luxation
Partial displacement of tooth from socket Identify if pulp, PDL or gingivae have been injured Will pulp revascularise Is there rupture of neurovascular bundle around tooth Gingivae - will fibres reorganise
30
What is palatal luxation?
Displacement of tooth from the socket in a way other than axially Is tooth locked in new position of bone Compression zones Complicated by bony damage SPLINT
31
What is intrusive luxation?
Displacement of socket in to the alveolar bone
32
What is an avulsion?
Complete displacement of tooth from socket minimise time that tooth is out of the socket. Tissues deteriorate due to dehydration, bacteria, cleaning products
33
What are the pulpal healing outcomes of luxation injuries?
Survival Obliteration Internal resorption Necrosis
34
What are the factors that influence healing?
Status of apex - open/wide neuromuscular bundle - larger diameter = more likely to revascularise Extent of injury - damage to PDL causes root resorption Concomitant damage to the PDL
35
What is internal resorption?
Confused healing Response to pulpal inflammation - needs to be connected to an apical blood supply can look normal/pink in coronal/cervical area continuous pulp chamber and canal outline (smooth)
36
What happens during necrosis of the pulp?
Asymptomatic or signs of irreversible pulpitis/necrotic pulp. TTT, discolouration, mobility. Failure of revascularisation Inflammatory resorption - damage to PDL and root surface. Irregular loss of tooth surface structure and surrounding alveolar bone. Irregular appearance over root canal and misdiagnosed for internal resorption.
37
When does external inflammatory resorption occur?
damage to PDL and root surface toxins and bacteria progress and travel via dentine tubules to root surface
38
Which teeth have zero chance of survival if they sustain these injuries?
intrusion and avulsion of teeth with closed apex
39
What is surface resorption?
Short resorpative phase repair related and traumata related transient apical breakdown at root and adjacent bone discolouration - no sensitivity widening of PDL space and lamina dura Apical radiolucency due to an inflammatory change rather than bacteria. Non infective pressure resorption of underlying cementum and dentine. self limiting and transient BUT pulp is vital.
40
What is inflammatory resorption?
Post avulsion/luxation Influenced by pulp vitality Infection, necrosis related surface resorption pathognomic pulpal necrosis more likely with a mature apex
41
What is replacement resorption?
When ankylosis occurs related to death of the PDL Progressive
42
What is replacement resorption?
When ankylosis occurs related to death of the PDL Progressive Cells attach to root surface before cementum can - resorption Necrotic pulp Loss of vitality Endo may or may not stop resorption - no successful tx
43
What is apexogenesis?
stimulation of the pulp tissue to encourage completion of root development in a previously healthy pulp after pulpal exposure
44
What is the goal of apexogenesis?
maintain pulp vitality support root development
45
Which teeth should apexogenesis be used for?
Maintain pulp vitality Support root development
46
Immature non vital tooth
Extirpate Apexification - establish calcific apical barrier - MTA plug at apex instead of biodentine Goal - to facillitate endo obturation

Paediatrics (13 decks)

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