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Oral Surgery > Dentoalveolar Trauma & Management > Flashcards

Dentoalveolar Trauma & Management Flashcards

(70 cards)

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1
Q

% of all bodily injuries?

A

oral regions is 1% of the body but 5% of all bodily injuries

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2
Q

most common facial injuries?

A

dental

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3
Q

implication of the vascular supply to teeth

A

redundant nature of the vascular supply allows most dento-alveolar bony injuries to heal well despite mucosal lacerations and extensive communication

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4
Q

ages 6-50 years old how much dental traums

A

1 in 4 had evidence of dental trauma

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5
Q

incidence of trauma

A

children with primary - 11-30%

children with permanent 5-20%

boys 2x girls

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6
Q

peak incidence of trauma

A

at 2-4 years

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7
Q

second peak incidence of trauma

A

at 8-12 years

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8
Q

most commonly involved teeth

A

maxillary central incisors

maxillary lateral incisors

mandibular anterior teeth

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9
Q

what includes the physical examination THEN?

A
  1. soft tissue
  2. jaw and alveoalar bone
  3. occlusion
  4. teeth
    - infection
    - fracture
    - displacment
    - mobility
    - pulp testing
    - percussion

then go to RADIOGRAPHIC
- examine the presence of any patholgy (root fracture/ extent/ peri-apical pathoses/ size of pulp/ jaw fractures/ tooth fragments)

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10
Q

classification of dento-alveolar injury

A

ellis and davey classification

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11
Q

ellis and davey classification

A

classification of dento-alveolar injury

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12
Q

ellis and davey classification I –> IV

A

I - fracture within enamel

II- fracture of enamel- dentin

III- fracture involving the pulp

IV - fracture involving the roots

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13
Q

peri-apical radiographs help with

A

intrusion or extrusion injuries

  • influences the tx!!
  • impotrant to recognoize
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14
Q

retain or extract has a lot to do with?

A

extent of root development!

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15
Q

size of pulp chamber and root canal implication?

A

larger pulp - increase in infection area - can be bigger?

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16
Q

radiographic examination can show laceration?

A

yes – may be able to see a tooth piece in the lip

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17
Q

radiographic examination can include

A 
periapical
occlusal 
pano -- ghost images appear 
CBCT-- 
medical CT

last two are best ones to look at for trauam

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18
Q

pano implication

A

if trauam in the midline – may be ghost image - not as accurate

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19
Q

medical CT use?

A

wide spread damage to other cranial bones

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20
Q

enamel crown fracture tx and follow up

A

smooth and relieve occlusion

follow up 6 weeks to 1 year and soft diet

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21
Q

enamel and dentin crown fracture tx and follow up

A

RESTORE then smooth and relieve occlusion

follow up 6 weeks to 1 year and soft diet

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22
Q

enamel / dentin / pulp crown fracture tx and follow up

IMMATURE teeth

A

calcium hydroxide and pulp cap or pulpotomy

6 weeks to 1 year

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23
Q

enamel / dentin / pulp crown fracture tx and follow up

mature teeth

A

endodontic tx

6 weeks to 1 year

important to follow up for like presence of cysts

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24
Q

pulp capping when?

A

exposure is SMALL

patient is seen shortly after the injury

patient has no root fracture

tooth is not displaced

no large or deep restorations exist that might indicate chronic inflammation of the pulp

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25
crown root fracture with pulp involvment tx and follow up
expose fracture site -- gingivectomy - ortho extrusion - endodontic tx 6 wweeks to 1 year and suggest soft diet
26
crown root fracture with NO pulp involvment tx and follow up
explore the fracture site by gingovectomy orthodontic extruion 6 weeks to 1 year and soft diets Difference here is no endo tx needed
27
vertical root fracture treatment
advise extraction
28
horizontal apical or middle root fracture tx and follow up
reposition and stabalize 4 and 8 weeks then 6 monthts to a year for every five years
29
horizontal apical third root fracture
extract
30
main pulpal responses to trauma
1. hyperemia - acute inflammation 2. pulpal hemorrhage 3. pulpal necrosis 4. calcific metamorphosis 5. internal resorption -- considered a FAILURE - vs anklylosis- he said considered a success if that results?
31
reaction of teth to trauma
surface resorption inflammatory resorption replacement resorption
32
tx to concussion
no -- just observation only as there is NO evidence of mobility - no displacement - no fracture may be tenderness to percussion
33
subluxation is? tx?
loosening the force is absorbed by the tooth without apparent loss of tooth structure may need occlusal adjustment , observation with vitality testing like take out of occlusion
34
intrusive luxation is? tx? for immature
displacement of the tooth into its alveolus immature apex -- incomplete root development --> allow the tooth to re-erupt - 6-12 months - monitor for necrosis - if pulpal necorissi - endo treatment with calcium hydroxide mature root development - has mature apex / complete root development - so reposition ro original position and splint - ortho extrusion if needed - look at other card with more info
35
intrusive luxation is? tx? for mature
reposition to original position and splint ortho exxtrusion (96% incidence of pulpal necrosis) calcium hydroxide endo treatemtn within 8-12 months likley 52% of incidence of inflammatory replacement resorption
36
hanks balanced salt solution?
can maintian PDL osmolarity , pH and cell metabolite natural pH of 7.2, osmolality of 32 mosm ot is a collective group of salts rich in bicarbonate ions, formulated by microbiologists - used as a buffer system in cell culture media and aid in maintaining the optimum physiologic pH - roughly 7-7.4 for cellular growth
37
extrusive luxation
tooth is displaced coronally tooth should be repositioned and splinted for 2 weeks 64% incidence of pulpal necrosis 7% incidence of external resorption
38
lateral luxation
can occur in a buccal, lingual, mesial or distal direction results in fracture of the alveolar bone the tooth should be manually repositioned and non-rigidly splinted for 4-8 weeks
39
lateral luxation follow up
monitor the need for endo tx. if tooth is displaced more than 5mm endodontic treatemtnis indicated
40
most common for alvulsed teeth
ages 7-10 years maxillary central incisor is most common most important factor for long term prognosis -- amount of vital periodontal fibers remaining of the tooth surface prior to replantation
41
most important factor for long term prognosis for alvusion
amount of vital periodontal fibers remaining of the tooth surface prior to replantation
42
factors to consider before replanting avulsed teeth | per Andreason and hjortig hansen
1. tooth should be free of advanced periodontal disease 2. alveolar socket shuold be reasonably intact 3. no orthodotnic contraindication 4. extra alveolar period should be considered 5. stage of root development
43
details of periodontla ligament cells
healing takes 3-4 weeks pdl cells are necrotic in teeth that have been extra-oral for 120 minutes or more hank's balanced solutoin can maintain pdl osmolarity and pH and cell metabolite
44
whole milk?
can be used for transport medium if needed - short term storage use up to 6 hours - better than saliva (not as good as hanks) - avulsed needs to be placed in it within 15 minutes - but DOES NOT PREVENT CELL DEATH
45
TX FOR ALVUSION within 2 hours with open apex
within 2 hours - replant as soon as possible - do NOT remove PDL transport in Hanks solution or whole milk place in 1mg / 20ml doxycycline solution for five minutes -- higher rate of pulpal revascularization do NOT remove blood clot from socket monitor for endo tx semi rigid splint for 10-14days take tooth OUT of occlusion
46
importance of history for dealing with dental trauma
unaccounted for AVULSED TEETH or tooth fragments -- SUSPICION OF ASPIRATION need to aucultation of the chest to rule out wheezing or labored breathing
47
Andreasen classification?
also accepted for classification of dentoalveolar injury accepted like the ellis and davey classification of dento-alveolar injuries
48
infraction
no fracture of enamel - like doesnt completely break the enamel
49
general under problems and consequences
1. malocclusion 2. loss of space 3. altered etehtics 4. dysfunctino
50
treatment of alvusion
within 2 HOURS / open apex semi rigid splint for 10-14 days take tooth out of occlusion
51
pdl cells are necrotic when?
in teeth that have been extra-oral for 120 minutes or more
52
doxycycline solution used?
In tx for AVULSION place in 1mg / 20ml doxycycline solution for five minutes -- higher rate of pulpal revascularization
53
prophylaxis for alvusion?
tetanus prophylaxis could be considered
54
post op for avulsion
antibiotic coverage for 7-10 days soft diet chlorohexidine mouth rinse 2x day oral hygeine instructions
55
tx of alvusion if it has been MORE than 2 hours
open apex or closed - necrotic pdl should be removed - scraped off - soaked in sodium hypochlorite for 30 minutes endo tx -- cleaning and shaping (extra orally - in hand)
56
risks associated with avulsion
ankylosis increases with prolonged splinting external resorption increases with rigid splints
57
implication of rigid splints and prolonged splinting
prolonged -- ankylosis can develop rigid -- external resorption can occur
58
stabalization period using splint for mobile teeth
7-10 days
59
stabalization period using splint for tooth displacement
2-3 weeksk
60
stabalization period using splint for root fracture
2-4 months
61
stabalization period using splint for avulsed (mature)
7-10 days
62
stabalization period using splint for avulsed (immature)
3-4 weeks
63
dentoalveolar fracture
fracture of the alvolar bone involving one or more teeth
64
tx of dentoalveolar fracture
reduction ofo the alveolar segment (closed or open) stabalization with splint (4-6 weeks) closure of mucosal laceration check occlusion
65
post op tx for detoalveolar fracture
antibiotics for 7-10 days chlorohexidine 2 times day / one week soft diet follow up
66
luxation in primary?
reposition or remove
67
extrusion in primary?
reposition or remove
68
intrusion in primary?
remove if contacting permanent tooth or re -eruption has not started in 408 weeks remove if infection is also present allow to erupt if not contacting permanent tooth
69
root fracture in primary if apical third? | middle or cervical third?
apical third -- observation middle or cervical third - removal without damaging permanent
70
long term follow up?
YES -- required -- since some complications can occur months or years later

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