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BDS5 OSCE Revision > Paediatric Dentistry - Trauma > Flashcards

Paediatric Dentistry - Trauma Flashcards

(86 cards)

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1
Q

what is a concussion injury

A

tooth tender to touch but has not been displaced

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2
Q

what is a subluxation injury

A

tooth tender to touch
increased mobility
but not been displaced

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3
Q

what is a lateral luxation injury

A

tooth displaced palatal-lingual or labial direction

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4
Q

what is an intrusion injury

A

tooth displaced through labial bone
can impinge on permanent tooth bud

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5
Q

what is an extrusion injury

A

partial displacement of tooth out of socket

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6
Q

how do you take a trauma examination (7 points)

A

reassure pt/ carer
history
examination
diagnosis
emergency tx
give important information to pt/carer
plan further tx and reviews

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7
Q

what are the six aspects of trauma stamp

A

mobility
colour
TTP
sinus
percussion note
radiograph

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8
Q

what is the emergency treatment for trauma

A

observation most appropriate option in emergency
provision of dental tx depends on childs maturity and ability to cope

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9
Q

what should you inform carers about to optimise healing

A

brush teeth with soft toothbrush after every meal
0.1-0.2% chlorhex twice daily via swab for one week
soft diet 10-14 days or normal diet with everything cut small and chew with molars
analgesia
warn re signs of infection

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10
Q

how is an enamel fracture treated in primary teeth

A

smooth sharp edges

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11
Q

how is an enamel-dentine fracture treated in primary teeth

A

cover all exposed dentine with GIC or composite

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12
Q

how is enamel dentine pulp fracture treated in primary teeth

A

partial pulpotomy
extract
treatment depends on child’s maturity and ability to sit for treatment

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13
Q

how is crown-root fracture treated in primary teeth

A

remove loose fragment
- if restorable and no pulp exposed - cover exposed dentine with GIC
- if restorable and pulp exposed - pulpotomy
- if unrestorable - XLA loose fragments and do not dig in case injury to permanent tooth bud

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14
Q

how is root fracture treated in primary teeth

A

if coronal fragment not displaced = no tx
if coronal fragment displaced but not excessively mobile = leave coronal fragment to spontaneously reposition
if coronal fragment displaced and excessively mobile : XLA loose coronal fragment or reposition loose coronal fragment and splint 4 weeks

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15
Q

what is the treatment for concussion injury in primary teeth

A

no tx
observation

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16
Q

what is the treatment for subluxation injury in primary teeth

A

no tx
observation

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17
Q

what is the treatment for lateral luxation injury in primary teeth

A

if minimal or no occlusal interference = allow spontaneous repositioning
if severe displacement = XLA or reposition and splint for 4 weeks

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18
Q

what is the treatment for intrusion injury in primary teeth

A

allow spontaneous reposition irrespective of direction of displacement
can take up to 1 year to fully reposition but usually takes 6 months

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19
Q

how to determine direction of displacement of intrusion

A

not parallax as only taking 1 radiograph
use either periapical or lateral pre-maxilla (E/O)

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20
Q

how would you know the risk of damage to permanent tooth germ from radiographic image following intrusion injury

A

if apical tip of intruded tooth is seen and tooth appears shorter = apex displaced towards labial bone plate and away from permanent successor
if apex of intruded tooth not seen on radiograph and tooth appears elongated = apex displaced towards permanent tooth germ

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21
Q

how is an extrusion injury treated in primary dentition

A

no interference with occlusion = spontaneous repositioning
excessive mobility or if extruded more than 3mm = XLA tooth

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22
Q

how is an avulsion injury treated in primary teeth

A

radiograph to confirm avulsion
DO NOT REPLANT

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23
Q

how is alveolar fracture treated in primary teeth

A

reposition segment
stabilise with flexible splint to adjacent uninjured teeth for 4 weeks
teeth may need extracted after alveolar healing has occurred

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24
Q

what are some direct complications of trauma to primary tooth

A

discolouration
discolouration and infection
delayed exfoliation

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25
what do different discolourations of teeth after trauma suggest (mild grey and opaque/yellow)
mild grey = may maintain vitality opaque/ yellow = pulp obliteration
26
what are consequences of trauma to primary dentition on the permanent successor
enamel defects abnormal crown/ root morphology delayed eruption ectopic tooth position arrested development complete failure of tooth to form odontome formation
27
what enamel defects can occur in permanent dentition due to trauma of primary dentition
enamel hypomineralisation (normal thickness but white/yellow defect) - treated by composite masking or tooth whitening enamel hypoplasia (reduced thickness but brown defects) - treated by composite masking
28
what is dilaceration of teeth (either crown or root)
abrupt deviation of the long axis of crown or root portion of tooth
29
how are dilacerations managed
surgical exposure and orthodontic realignment
30
how can delayed eruption affect permanent teeth from trauma in primary teeth
premature loss of primary teeth can result in thickening of mucosa and delayed eruption of 1 year radiographs should be taken if contralateral tooth not erupted in 6 months surgical exposure and orthodontic alignment may be required
31
how is ectopic tooth position corrected following trauma to primary tooth
surgical exposure and orthodontic realignment extraction
32
how is arrested development in permanent teeth treated after trauma to primary tooth
endodontic treatment if tooth has favourable root length or XLA
33
when taking history of how trauma occurred to a tooth what four things should you ask the parent/ carer
how did it happen when exactly did it happen where are the lost teeth or fragments any other symptoms
34
what may tooth mobility suggest when a patient presents with dental trauma
displacement of tooth root fracture bone fracture
35
what does the prognosis of a tooth after dental trauma depend on
stage of root development type of injury if PDL is damaged time between injury and treatment presence of infection
36
how is enamel fracture treated in permanent teeth
bond fragment to tooth or smooth sharp edges take 2 PA radiographs to rule out root fracture or luxation follow up 6-8 weeks, 6 months and 1 year
37
how is enamel dentine fracture treated in permanent teeth
account for fragment place composite bandage and line with CaOH if close to pulp take two PA radiographs to rule out root fracture or luxation sensibility test and evaluate tooth maturity composite restoration follow up 6-8 weeks, 6 months and 1 year
38
what are treatment options for enamel-dentine-pulp fracture in permanent teeth
evaluate : size of exposure, time since injury, associated PDL injuries either: pulp cap, partial pulpotomy, full coronal pulpotomy
39
when would you place a pulp cap after EDP# and what is the process
tiny exposure (less than 1mm) in a 24 hour window trauma stamp and radiograph assessment LA and rubber dam clean area with water then disinfect area with sodium hypochlorite apply CaOH or MTA white to pulp exposure restore tooth with composite review in 6-8 weeks, 6 months and 1 year
40
when would you opt for a partial pulpotomy following EDP# and what is the process
larger exposure (more than 1mm) or 24 hours + since trauma trauma stamp and radiographic assessment LA and rubber dam clean area with saline and then disinfect with sodium hypochlorite remove 2mm of pulp with high speed place saline soaked CW pellet over exposure until haemostasis achieved (if no haemostasis achieved proceed to full pulpotomy) apply CaOH then GI or white MTA then restore with composite 97% success rate
41
what is the process for full coronal pulpotomy
begin with partial pulpotomy (LA and rubber dam) assess for haemostasis with saline soaked CWP if hyperaemic or necrotic proceed to remove all coronal pulp place CaOH in pulp chamber GIC liner composite restoration 75% success rate
42
what is the aim of pulpotomy
keep vital pulp tissue within the canal to allow normal root growth
43
if a tooth is non-vital following trauma what is the treatment
full pulpectomy
44
what is the clinical problem with full pulpectomy in immature incisors
no apical stop to allow obturation with GP
45
what are the options when root treating immature incisors
CaOH placed in canal aiming to induce hard tissue barrier to form (apexification) MTA/ Biodentine placed at apex of canal to create cement barrier
46
describe the process of pulpectomy in open apex tooth
LA rubber dam access haemorrhagic control with sterile water diagnostic radiograph for EWL file 2mm short of EWL dry canal, apply non-setting CaOH for no longer than 4-6 weeks place CW in pulp chamber GIC temporary restoration
47
what are treatment options for crown-root fractures in permanent teeth
fragment removal and restore only fragment removal and gingivectomy orthodontic extrusion of apical portion surgical extrusion decoronation (preserve bone for future implant) extraction
48
how does concussion injury present and what is the treatment in permanent teeth
pain on percussion no treatment follow up in 4 weeks and 1 year
49
what are the clinical findings of subluxation injury and treatment in permanent teeth
increased mobility TTP bleeding from gingival crevice no treatment or flexible splint if excessively mobile follow up - 2 weeks for splint removal, 3 months, 6 months and 1 year
50
what do you assess on radiographs after concussion or subluxation injury
root development compare with contralateral tooth resorption
51
what are clinical findings and treatment of extrusion injury in permanent teeth
tooth appears elongated usually displaced palatally tooth mobile bleeding from gingival sulcus reposition tooth by gently pushing back into place and splint for 2 weeks follow up - 2 weeks, 4 weeks, 8 weeks, 3 months, 6 months, 1 year and yearly for 5 years
52
what are the clinical findings and treatment for lateral luxation injuries in permanent teeth
tooth appears displaced in socket tooth mobile high ankylotic percussion tone may be bleeding from gingival sulcus root apex may be palpable in sulcus reposition under LA, splint and monitor with endo evaluation 2 weeks after injury follow up - 2 weeks, 4 weeks, 8 weeks, 6 months and 1 year yearly for 5 years
53
how does complete vs incomplete root formation affect treatment of lateral luxation of permanent tooth
incomplete - spontaneous revascularisation may occur, if pulp becomes necrotic or external resorption occurs commence RCT complete - pulp will likely become necrotic, commence RCT
54
what are the clinical findings of intrusion injury in permanent teeth
crown appears shortened bleeding from gingivae high ankylotic tone
55
what is treatment of intrusion injuries in permanent teeth
immature root formation = spontaneous repositioning, if no re-eruption within 4 weeks requires orthodontic repositioning, monitor pulp condition, commence endo if pulp becomes necrotic mature root formation : - less than 3mm = spontaneous repositioning, if no eruption within 8 weeks reposition and surgically splint for 4 weeks - 3-7mm = reposition surgically - more than 7mm = reposition surgically commence endo 2 weeks after injury or as soon as tooth position allows
56
what are repositioning options for intrusion injuries and the follow up regime
spontaneous fixate orthodontic elastic around arch wire and bracket for traction forceps 2 weeks, 4 weeks, 8 weeks, 3 months, 6 months, 1 year and yearly for 5 years
57
what is emergency advice you would give after an avulsion injury
ensure permanent tooth hold by crown encourage attempt to place tooth immediately in socket (rinse with milk, saline or patient's saliva) bite on handkerchief to hold in place once replanted seek immediate dental advice
58
how is avulsion managed in a tooth with a closed apex and tooth already replanted
clean injured area verify replanted tooth position and apical status with radiograph splint suture any gingival lacerations consider antibiotics and check tetanus status provide POI follow up
59
how is avulsion managed in a tooth with a closed apex with EADT less than 60 mins
remove debris take history and examination with tooth in appropriate storage medium replant tooth under LA splint suture gingival lacerations consider antibiotics and check tetanus status provide POI follow up
60
how is avulsion managed in a tooth with a closed apex with EADT more than 60 mins
PDL cells likely to be non-viable remove debris replant tooth under LA splint suture gingival lacerations consider antibiotics and check tetanus status provide POI follow up
61
how soon after avulsion injury should endodontic treatment be started
2 weeks use calcium hydroxide or ledermix as intracanal medicament for 4-6 weeks
62
what is the follow up regime for avulsion injury to permanent tooth with closed apex
2 weeks (splint removal) 4 weeks 3 months 6 months 1 year yearly for 5 years
63
how is avulsion injury managed in permanent tooth open apex that has already been replanted
clean injured area verify tooth replanted and apical status with radiograph place splint suture gingival lacerations consider antibiotics and check tetanus status provide POI follow up
64
what is the management for avulsion of permanent tooth open apex and EADT less than 60 mins
remove debris history and exam whilst tooth in storage medium replant under LA splint suture gingival lacerations if present consider giving antibiotics and check tetanus status provide POI follow up
65
what is the management of avulsion in permanent tooth open apex and EADT more than 60 mins
PDL cells likely non-viable remove debris replant under LA splint suture gingival lacerations consider antibiotics and check tetanus status give POI follow up
66
what is the follow up for avulsion injury in permanent tooth with open apex
1 week 2 week (splint removal) 3 moths 6 months 1 year annually for 5 years
67
when should you not replant an avulsed permanent tooth
if child is immunocompromised other serious injuries requiring preferential emergency treatment
68
what is the splinting time for subluxation and extrusion
2 weeks
69
what is the splinting time for avulsion
2 weeks
70
what is the splinting time for intrusion and lateral luxation
4 weeks
71
what is the splinting time for root fractures
4 weeks for for mid root and apical third 4 months for cervical third
72
what is the splinting time for dento-alveolar fracture
4 weeks
73
what are the properties of splint that would be placed following dental trauma
flexible and passive facilitates sensibility testing and clinical monitoring allows oral hygiene aesthetic
74
what is the composite and wire splint
stainless steel wire 0.4mm diameter passive and flexible include one tooth either side of injured tooth/teeth
75
what is the titanium trauma splint
rhomboid mesh structure 0.2mm thick secured to teeth with composite resin
76
when is an acrylic splint useful
when very few abutment teeth
77
what are the four main post-trauma complications
pulp necrosis and infection pulp canal obliteration root resorption breakdown of marginal gingivae and bone
78
what is pulp canal obliteration and how does it present
initial response of vital pulp progressive hard tissue formation within pulp cavity gradual narrowing of pulp chamber management = conservative
79
what is external surface resorption
superficial resorption lacunae repaired with new cementum response to localised injury
80
what is external infection related to inflammatory root resorption
non-vital tooth initiated by PDL damage - propagates by root canal toxins reaching external root surface indistinct root surface, root canal tramlines intact
81
what is the management of external infection related inflammatory root resorption
remove stimulus (infected canal contents) endodontic treatment should be commenced dress tooth with non-setting CaOH for 4-6 weeks
82
what is cervical resorption
abnormal form of external infection related inflammatory root resorption from very small entry point may extend widely before perforating pulp chamber
83
what is ankylosis related to replacement root resorption
form of root resorption which follows extreme luxation or avulsion injuries that cause damage to PDL if more than 20% of PDL damaged then the bone cells are able to grow into the root of tooth radiographically the root appears ragged in outline and no obvious PDL space separating it from bone
84
what is the treatment for ankylosis related replacement root resorption
associated tooth becomes infraoccluded plan for tooth loss once there is discrepancy of more than 3mm of gingival margin of affected tooth compared to adjacent tooth the tooth should be decoronated
85
what is internal infection related inflammatory root root resorption
due to progressive pulp necrosis may present as pink discolouration of affected tooth radiographically - seen as oval radiolucency in canal
86
what is treatment for internal infection related inflammatory root resorption
endodontic treatment tooth dressed with non-setting CaOH paste for 4-6 weeks before obturation with GP

BDS5 OSCE Revision (16 decks)

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