immediate management of trauma Flashcards
(134 cards)
1
Q
5 steps in immediate trauma management. pt first teeth second
A
full body assessment to rule out any head or other injury
extra-oral examination
intra-oral examination
assess for aspiration
be calm, reassure and relax the pt
2
Q
what should you ask when assessing if there is a head or other injury?
A
Loss of consciousness
Was the incident witnessed
Is the child acting ‘out of character’ - really quiet
Vomiting/nausea
Visual disturbances
3
Q
if a trauma pt presents with Visual disturbances - blurred or double vision what should you do?
A
send them to A&E
4
Q
why do u palpate during extra-oral examination?
A
look for symmetry
5
Q
what are battle signs?
A
Bruising behind the ears (mastoid process), may be followed by raccoon eyes
indicates serious head injury
6
Q
if there is a mandibular deviation on opening, what does that indicate?
A
condylar fracture
7
Q
how do you assess for aspiration?
A
are all teeth/fragments accounted for
if in doubt call A&E for advice
8
Q
what information should be gathered if non-accidental injury is suspected?
A
Phone number, address, GP, GDP, school
Who lives at home
Legal guardian
Who brought them
Social worker if applicable
9
Q
what does grey mucosa indicate?
A
granulation tissue which shows its been healing for a while
need to question why it hasn’t been seen to earlier
10
Q
what to ask if a pt presents with trauma 8
A
Medical history
When, where, how?
Was it witnessed
Are all teeth/fragments accounted for
Symptoms and Pain history - now vs when it happened
Attending with?
History of previous trauma
Dental history - regular attended, dentally anxious
11
Q
Adjacent teeth move together what does this indicate?
A
alveolar fracture
12
Q
Blood clot at gingival crevice if <24hrs, what does this indicate
A
subluxation
13
Q
healing outcomes of horizontal root fracture 4
A
No healing - granulation tissue present in the fracture
Hard-tissue union
Investing of the connecting tissue - PDL invests the fracture
Investing of connective tissue and bone
14
Q
what should u advise the pt if there is a minor extra-oral laceration?
A
might scar
15
Q
what should u do if there is a extra-oral laceration requiring suturing?
A
A&E
16
Q
what should u do if there is a minor intra-oral laceration not requiring suture?
A
clean and adv to salt/water rinse
17
Q
what should u do if there is a intra-oral laceration requiring suturing?
A
clean, anaesthetise (topical & LA), suture
18
Q
define enamel infraction
A
Incomplete enamel fracture without loss of tissue structure
19
Q
clinical findings for enamel infraction
A
Responds normally
Assess for associated luxation/root fracture
20
Q
what radiographs should be taken to asses trauma?
A
parallel periapical
some cases require 2 additional views
21
Q
how is enamel infraction treated in permanent teeth?
A
- No treatment
If severe etch and seal with resin
22
Q
how is enamel infraction treated in primary teeth?
A
no treatment
23
Q
when is follow up required after enamel infraction?
A
Not required unless associated injury
24
Q
define Uncomplicated crown fracture (enamel only)
A
Loss of enamel, no exposed dentine
25
clinical findings for uncomplicated enamel fracture
- Responds normally
Assess for associated luxation/root fracture
26
what can be seen radiographically for uncomplicated enamel fracture?
- Visible enamel loss
All fragments should be accounted for
27
treatment options for uncomplicated enamel fracture in permanent teeth 3
- Bond fragment back on
- Smooth the edges
- Composite resin placed
28
treatment options for uncomplicated enamel fracture in primary teeth
smooth sharp edges
29
when should Clinical and radiographical assessment after
uncomplicated enamel fracture be? follow up
6-8 weeks
1 year
30
define uncomplicated enamel-dentine crown fracture
Fracture confined to enamel and dentine, no exposed pulp
31
clinical findings of uncomplicated enamel-dentine crown fracture
- Responds normally
Assess for associated luxation/root fracture
32
radiographic findings for uncomplicated enamel-dentine crown fracture
- Enamel-dentine loss visible
Fragments accounted for
33
treatment options for uncomplicated enamel-dentine crown fracture in permanent teeth 3
- Bond fragment back on, soak in saline/water for 20 minutes before
- Cover with GI or bond and composite
- If within 0.5mm of pulp (pink but not bleeding), line with CaOH and cover with GI
34
treatment options for uncomplicated enamel-dentine crown fracture in primary teeth
Cover with GI or composite
35
when should Clinical and radiographical assessment after uncomplicated enamel-dentine crown fracture be? follow up
- 6-8 weeks
1 year
36
define Complicated crown fracture
Fracture confined to enamel and dentine with pulp exposure
37
clinical findings in complicated crown fracture
Exposed pulp it is sensitive to stimuli
38
radiographic findings of Complicated crown fracture
- Enamel-dentine loss visible
Missing fragments accounted for
39
treatment for complicated crown fracture in permanent teeth with immature roots and open apices
partial pulpotomy or pulp capping
- Non-setting calcium hydroxide or non-staining calcium silicate cement can be placed directly on the stump
- Bond fragment back on after pulp treatment and rehydration or Cover with GI or bond and composite
40
treatment for complicated crown fracture in permanent teeth with mature roots
partial pulpotomy
- Non-setting calcium hydroxide or non-staining calcium silicate cement can be placed directly on the stump
- Bond fragment back on after pulp treatment and rehydration or Cover with GI or bond and composite
41
treatment for complicated crown fracture in primary teeth
Partial pulpotomy, non-setting CaOH, GI, composite
42
when should follow up be after complicated crown fracture in permanent teeth?
- 6-8 weeks
- 3 months
- 6 months
- 1 year
43
when should follow up be after complicated crown fracture in primary teeth?
- 1 week
- 6-8 weeks
1 year
44
define uncomplicated crown root fracture
Fracture involving enamel, dentine and cementum. No pulp exposure
45
clinical findings of uncomplicated crown root fracture 3
- TTP
- Mobile fragment
- Sensibility positive
46
what radiographs should be taken for uncomplicated crown root fracture?
- One parallel periapical and 2 additional views of the tooth
CBCT to assess extent
47
treatment options for uncomplicated crown root fracture in permanent teeth
- Stabilise mobile fragment temporarily
- remove coronal/mobile fragment and cover dentine with GI or composite
48
4 future management options for uncomplicated crown root fracture in permanent teeth
extrusion, RCT, root submergence, XLA
49
treatment of uncomplicated crown root fractures in primary teeth
Remove loose fragment
- If restorable cover in GI
- If unrestorable XLA
50
follow up for permanent teeth after uncomplicated crown root fracture
- 6-8 weeks
- 3 months
- 6 months
- 1 year
Yearly for 5yrs
51
follow up for primary teeth after uncomplicated crown root fracture
- 1 week
- 6-8 weeks
1 year X-rays
52
define complicated crown root fracture
Fracture involving enamel, dentine, cementum and the pulp
53
clinical findings of complicated crown root fracture
- TTP
- Fragment mobile
Sensibility positive
54
what radiographs should be taken for complicated crown root fractures?
- One parallel periapical and 2 additional views of the tooth
CBCT to assess extent
55
treatment options for complicated crown root fracture in permanent teeth (mature and immature teeth)
- Stabilise mobile fragment temporarily
- Immature teeth - partial pulpotomy using non- setting CaOH or non-staining Ca silicate cement
- Mature teeth - remove pulp, cover with GI or composite
56
future management of complicated crown root fractures in permanent teeth
RCT, extrusion, root submergence, XLA
57
treatment options for complicated crown root fractures in primary teeth
Remove loose fragment
- If restorable pulpotomy or RCT
- Unrestorable XLA
58
follow up for permanent teeth after complicated crown root fracture
- 6-8 weeks
- 3 months
- 6 months
- 1 year
Yearly for 5yrs
59
follow up for primary teeth after complicated crown root fracture
- 1 week
- 6-8 weeks
1 year X-rays
60
define concussion
Bruised periodontal tissues
61
clinical findings of concussion
TTP
62
radiographic findings of concussion
No abnormalities
63
treatment for concussion of permanent teeth
- No treatment required
Monitor pulp for at least 1 year
64
treatment for concussion of primary teeth
No treatment
Observation
65
follow up after concussion in permanent teeth
- 4 weeks
1 year
66
follow up after concussion in primary teeth
- 1 week
6-8 weeks
67
define subluxation
Loosened tooth with no displacement
68
clinical findings for subluxation
- TTP
- Mobility
- Bleeding from gingival crevice
Sensibility testing may be -ve initially
69
radiographic findings for subluxation
No abnormalities
70
treatment for subluxation in permanent teeth
none
flexible splint if excessive mobility or tenderness
monitor pulp for at least a year
71
how long should a flexible splint be on for subluxation in permanent teeth
2 weeks
72
treatment for subluxation in primary teeth
No treatment
Observation
73
follow up after subluxation in permanent teeth
- 2 weeks remove splint
- 12 weeks
- 6 months
1 year
74
follow up after subluxation in primary teeth
- 1 week
6-8 weeks
75
define extrusion luxation
Displacement of tooth out of its socket in the incisal direction
76
clinical findings of extrusion luxation
- Tooth appears elongated
- Sensibility testing -ve
Increased mobility
77
radiographic findings of extrusion luxation
Increased PDL space apically
78
treatment for extrusion luxation in permanent teeth
- Push tooth back into socket
- Passive and flexible splint
- Monitor pulp
79
how long should a passive and flexible splint be worn for extrusion in permanent teeth?
2 weeks
80
treatment for extrusion luxation in primary teeth
- If not interfering with occlusion leave
- If excessively mobile or extruded >3mm XLA
81
follow up for permanent teeth after extrusion luxation
- 2 weeks remove splint
- 4 weeks
- 8 weeks
- 12 weeks
- 6 months
- 1 year
Yearly for 5 years
82
follow up for primary teeth after extrusion luxation
- 1 week
- 6-8 weeks
Follow up each year if unfavourable outcome likely
83
define lateral luxation
Displacement of the tooth in any lateral direction usually resulting in alveolar fracture or bone compression
84
clinical findings of lateral luxation
- Immobile
- High percussive sound
Sensibility tests likely -ve
85
radiographic findings of lateral luxation
Widened PDL space best seen on occlusal exposure
86
treatment of permanent tooth after lateral luxation
- Reposition tooth under LA
- Passive and flexible splint
- Monitor pulp
- Endodontic evaluation after 2 weeks
- RCT if necrosis
87
how long should a passive and flexible splint be worn for lateral luxation
4 weeks
88
treatment of primary tooth after lateral luxation
Minimal/no occlusal interference leave
Severe displacement:
a. XLA if risk of tooth ingestion/aspiration
b. Reposition and splint for 4 weeks if unstable
89
follow up for permanent teeth after lateral luxation
- 2 weeks endo evaluation
- 4 weeks splint removal
- 8 weeks
- 12 weeks
- 6 months
- 1 year
- Yearly for 5 years
90
follow up for primary teeth after lateral luxation
- 1 week
- 6-8 weeks
- 1 year
Follow up each year if unfavourable outcome likely
91
define intrusion luxation
Displacement of tooth in apical direction
92
clinical findings of intrusion luxation
- Immobile
- High metallic percussive sound
Sensibility test -ve
93
radiographic findings of intrusion luxation
- No PDL space
ECJ more apical than non-injured teeth
94
treatment of intrusion luxation in immature permanent teeth
- Allow re-eruption with no intervention
- If no re-eruption after 4 weeks orthodontically reposition tooth
- RCT if necrosis
95
treatment of intrusion luxation in mature permanent teeth if <3mm intruded
allow re-eruption with no intervention. If no re-eruption within 8 weeks reposition surgically and splint or orthodontically
96
treatment of intrusion luxation in mature permanent teeth if 3-7mm intruded
reposition surgically or orthodontically
97
treatment of intrusion luxation in mature permanent teeth If >7mm intruded
reposition surgically
98
what is almost always done for treatment of mature permanent teeth following intrusion luxation
RCT at 2 weeks as almost always necrotic
99
treatment of intrusion luxation in primary tooth
Leave to spontaneously reposition takes 6 months to 1 year
100
follow up following intrusion luxation in permanent teeth
- 2 weeks
- 4 weeks splint removal
- 8 weeks
- 12 weeks
- 6 months
- 1 year
Yearly for 5 years
101
follow up after intrusion luxation in primary teeth
- 1 week
- 6-8 weeks
- 1 year
Follow up at 6 years of age to monitor permanent tooth eruption
102
define avulsion
Tooth completely out
103
treatment of avulsion in permanent teeth (mature, immature)
- First aid - clean with milk/saline/spit and replant immediately or store in milk/spit/saline and go to A&E
- If mispositioned reposition
- Passive and flexible splint
- RCT after 2 weeks if mature. If immature only initiate endo if necrosis and infection occur
104
following avulsion of a permanent tooth, if mispositioned within how long should it be repositioned?
48hrs
105
how long should a passive and flexible splint be worn following avulsion
2 weeks
106
treatment of avulsion in primary teeth
Leave it
107
follow up after avulsion in permanent mature teeth
- 2 weeks remove splint
- 4 weeks
- 3 months
- 6 months
- 1 year
Yearly for 5 years
108
follow up after avulsion in permanent immature teeth
- 2 weeks splint removal
- 1 month
- 2 months
- 3 months
- 6 months
- 1 year
Yearly for 5 years
109
follow up after avulsion in primary teeth
- 6-8 weeks
- Follow up at 6 years of age to monitor permanent tooth eruption
110
define root fracture
Root fracture involving dentine, pulp and cementum
111
3 types of root fracture
horizontal, oblique or both
112
clinical findings of root fracture
- Coronal segment may be mobile
- TTP maybe
- Bleeding from gingival sulcus
Sensibility -ve initially -> transient or permanent damage
113
what radiographs are taken for root fracture?
- One parallel periapical and 2 additional views of the tooth
- CBCT if above are insufficient
114
treatment of root fracture in permanent teeth (not cervical fracture)
- If coronal segment is displaced reposition and check radiographically
- Stabilise mobile coronal segment with a passive and flexible splint for 4 weeks, longer if cervically
115
how long should a passive and flexible splint be worn for root fracture?
4 weeks
116
treatment of root fracture in permanent teeth if cervical fracture
mature teeth with cervical fracture above the alveolar crest
Cervical fractures can heal so don’t remove the coronal fragment
Mature teeth with cervical fracture above alveolar crest, remove coronal fragment then RCT and post-retained crown
117
treatment of root fracture in primary teeth if the coronal segment isn't displaced
no treatment
118
treatment of root fracture in primary teeth if coronal fragment is displaced and not excessively mobile
leave to spontaneously reposition
119
treatment of root fracture in primary teeth If coronal fragment is displaced excessively, mobile or interferes with occlusion
- Extract the loose coronal fragment
- Reposition fragment and stabilise with splint
120
how long should a splint be worn following mid root and apical 1/2 fractures in permanent teeth?
4 weeks
121
how long should a splint be worn following cervical 1/3 fractures in permanent teeth
4 months
122
how long should a splint be worn following root fracture in primary tooth where the coronal fragment is repositioned and splinted?
4 weeks
123
follow up for permanent teeth following root fracture
- 4 weeks - remove splint for mid root and apical third fractures
- 6-8 weeks
- 4 months - remove splint for cervical third fractures
- 6 months
- 1 year
Yearly for 5 years
124
follow up for primary teeth following root fracture where there is no coronal displacement
* 1 week
* 6-8 weeks
* 1 year
Each year till eruption if unfavourable outcome is likely
125
follow up for primary teeth following root fracture where the coronal fragment is repositioned and splinted
* 1 week
* 4 week remove splint
* 8 week
* 1 year
126
follow up for primary teeth following root fracture where the coronal fragment is extracted
1 year
127
define alveolar facture
Fracture involves alveolar bone and may extend to adjacent bones
128
clinical signs of alveolar fracture
- Fracture extends from buccal to palatal/lingual
- Segment mobility with multiple teeth together
- Occlusal disturbances
Teeth in fractured segment -ve sensibility
129
what radiographs are taken for alveolar fracture?
- One parallel periapical and 2 additional views of the tooth
CBCT if above are insufficient
130
treatment of alveolar fracture in permanent teeth
- Reposition displacement
- Stabilise the segment with a passive flexible splint on teeth for 4 weeks
- Monitor pulp condition of teeth involved to determine if RCT is required
131
how long is a passive flexible splint worn following alveolar fracture?
4 weeks
132
treatment of alveolar fracture in primary teeth
reposition displacement and splint
133
follow up following alveolar fracture in permanent teeth
- 4 weeks - splint removal
- 6-8 weeks
- 4 months
- 6 months
- 1 year
Yearly for 5 years
134
follow up after alveolar fracture in primary teeth
- 1 week
- 4 week remove splint and x-ray
- 8 week
- 1 year x-ray
At 6 years of age to monitor permanent tooth eruption
