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trauma Flashcards

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1
Q

at what ages is dental trauma most likely to be seen in the primary dentition?

A

2-4 years

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2
Q

at what ages is dental trauma most likely to be seen in the permanent dentition?

A

7-8 years

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3
Q

what are three types of soft tissue injuries that can occur to the lips, gingivae and oral mucosa?

A
  • lacerations
  • contusions
  • abrasion
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4
Q

what is a laceration?

A

wound in skin or mucosa penetrating into the soft tissues

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5
Q

what is contusion

A

Bruise without breaking skin or mucosa represented as a subcutaneous or submucosal tissue haemorrhage

Can be isolated to soft tissue or can indicate an underlying bone fracture

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6
Q

what is abrasion?

A

Superficial wound produced by rubbing or scraping of the mucosa or skin leaving a raw bleeding surface which is still covered partially by epithelium

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7
Q

identify the soft tissue injury

in this case, what further questions should you ask the parents? what special investigations should be used?

A

laceration of the upper lip

fracture of the UR1 can be seen

ask - were all the tooth fragments accounted for?

possibly embedded in the lips

use radiographs - soft tissue view with low exposure can be used

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8
Q

what are the treatment principles of soft tissue injuries?

A
  • cleaning and debridement of the wound
    • with 0.3% chlorhexidine or saline
  • assess for any foreign bodies and remove if present
    • soft tissue radiographs may be needed
  • reposition any displaced tissues
  • sutures if needed
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9
Q

what sutures should be used for deeper layers?

A

resorbable sutures

  • vicryl
  • vicryl rapide
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10
Q

what sutures should be used for skin layers?

A
  • ethilon (nylon)
  • prolene (polypropylene)
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11
Q

what post-op management should you discuss with the patient and parents after a soft tissue injury?

A
  • good oral hygiene with soft brush
  • mouthwash 0.2% chlorhexidine if can be spat out
    • if not - ask parent to apply
  • soft diet
  • review
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12
Q

what is the most common injury in primary dentition?

A

luxation injuries

due to strong bone around primary teeth

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13
Q

how can primary trauma increase risk of problems in the permanent dentition?

A

energy from acute impact can easily be transmitted to developing tooth germ

inflammation from pulpal injuries in the traumatised tooth may add further injury

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14
Q

what is the diagnosis and treatment?

A

uncomplicated crown fracture in enamel URA

as is primary dentition - sufficient to smooth any sharp edges

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15
Q

diagnosis and possible treatments?

A

uncomplicated crown fracture in enamel and dentine

  • treatments
    • if no dentine exposed - then smooth off sharp edges
    • if dentine exposed - dress with GIC
    • if larger fracture - can restore with composite
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16
Q

what is the management of uncomplicated crown fractures in the primary dentition?

A
  • if confined to enamel
    • smooth any sharp edges
  • if dentine exposed
    • seal exposed dentine with GIC
    • if larger fracture - restore with composite if patient is compliant
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17
Q

what is a complicated crown fracture?

A

a fracture involving enamel and dentine and exposes the pulp

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18
Q

what is the management for a complicated crown fracture?

A
  • partial pulpotomy (if possibly)
    • calcium hydroxide applied over pulp and dressed with GIC
    • restored with composite
  • if child cannot tolerate pulpotomy or tooth beyond restoring then extraction
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19
Q

diagnosis and treatment

A
  • complicated crown root fracture URA
    • treatment : extraction
  • uncomplicated crown fracture in enamel ULA
    • treatment : smooth sharp edges
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20
Q

what is a crown root fracture?

A

fracture involving enamel, dentine, cementum +/- pulp

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21
Q

what is the management for a crown root fracture in the primary dentition?

A
  • fragment removal only
    • if only involves small part of the root and remaining fragment restorable
    • extraction
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22
Q

what is a root fracture?

A

fracture involving dentine, cementum and pulp

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23
Q

what is the management of a root fracture in primary dentition?

A
  • leave if no displacement
  • if displaced then extract coronal fragment only
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24
Q

diagnosis and treatment? when should we follow up?

A

lateral luxation (palatally) URA, ULA with associated soft tissue traum labially

  • treatment options
    • If no occlusal interferance - can allow to reposition spontaneously
    • if only slight interference - can consider slightly grinding teeth
    • Gentle repositioning
    • Extraction
      • If root has gone palatally and there is risk to predecessor
  • Follow up in 1 week, 2-3 weeks, 6-8 weeks (radiograph), year (radiograph)
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25
what is lateral luxation?
tooth displacement in a direction other than axially
26
what is the management for lateral luxation in primary denition?
* if only minor occlusal interferences * slight grinding * if more severe occlusal interferencees * gentle repositioning under LA * if tooth severely displaced or patient cannot tolerate any other treatment * extraction
27
diagnosis and treatment
extrusion of ULA * treatment options * if interfering with occlusion * extraction
28
what is extrusive luxation?
partial displacement of tooth out of its socket
29
what is the management for extrusive luxation in primary dentition?
* minor extrusion \<3mm * careful repositioning or leave for spontaneous realignment * major extrusion or fully formed primary tooth * extraction
30
diagnosis and treatment
intrusion of ULA * treatment * if tooth apex is displaced towards or through labial bone plate * leave for spontaneous re-eruption * if displaced towards developing follicle * extract
31
what is intrusive luxation?
displacement of tooth into alveolar bone
32
what is management of intrusive luxation in the primary dentition?
treatment * if tooth apex is displaced towards or through labial bone plate * leave for spontaneous re-eruption * if displaced towards developing follicle * extract
33
how can you tell radiographically how the tooth is displaced in intrusion injuries?
* if apex displaced towards or through labial bone * apex can be visualised * appears shorter than the contralateral tooth * if apex displaced into the developing follicle * apical tip cannot be visualised * tooth appears elongated
34
diagnosis and treatment
avulsion injury ULA * leave * monitor eruption of UL1 enamel fracture URA * smooth sharp edges
35
what complications can follow trauma to the primary dentition?
tell patients and document
36
what is the most common type of injury in the permanent dentition?
uncomplicated crown fractures
37
what are predisposing factors for trauma in the permanent dentition?
* increased overjet * maxillary incisors proclined * incompetent lips
38
diagnosis and treatment
uncomplicaated crown fractures into enamel UL1 UR1 treatment : restore with composite
39
diagnosis and treatment
uncomplicated crown fracture UR3 very close to pulp however * treatment : * retraction cord under LA * orthodontic extrusion * place calcium hydroxide base and cover with glass ionomer cement * the restore with composite
40
what is the management for amn uncomplicated crown fracture in the permanent dentition?
* if confined to enamel * rebonding of any lost fragments * contouring or restoration with composite * dentine exposed * rebonding of any lost fragments * sesal exposed dentine with GIC then restore with composite * if close to pulp (within 0.5mm) * calcium hydroxide lining * dress with GIC * restore if no clinical / radiographic signs of necrosis
41
diagnosis and treatment
complicated crown fracture UL1,2 * RCT * possibly pulp cap uncomplicated crown fracture UR1 * restore
42
what is the management for a complicated crown fracture in the permanent dentition?
* immature teeth (open apices) * pulp cap (calcium hydroxide) * partial pulpotomy * mature teeth (complete root formation and closed apices) * RCT * partial pulpotomy or pulp cap where exposure us small, recent and clean
43
diagnosis
complicated crown root fracture UL1
44
what is the management of crown root fractures in the permanent dentition?
* RCT in most cases * removal of coronal fragment and restoration of remaining tooth substance * fragment removal and gingivectomy * orthodontic extrusion * surgical extrusion * extraction
45
diagnosis
* UR1 well aligned mid 1/3 root fracture - appears to be healing * UL1 mid 1/3 root fracture - resorption in fracture line - not healing * also has a crown fracture
46
what is the management for root fractures in the permanent dentition?
* reposition if displaced * check position radiographically * flexible splint 4 weeks * 4 months if cervical third fracture * if pulp necrosis occurs then RCT up to fracture line
47
what is subluxation
* TTP * increased mobility * but not been displaced
48
what is the management of lateral luxation in permanent dentition?
* reposition tooth out of bony lock then gentle reposition into original location * flexible splint 4 weeks * monitor pulp vitality * if pulp necrosis - RCT
49
what is the management for extrusive luxation in the permanent dentition?
* reposition tooth back into socket and itss original position * flexible splint for 2 weeks * monitor pulp vitality * mature teeth * will most likely require RCT * immature teeth * only need RCT if signs of pulp necrosis
50
management for intrusion with immature teeth in the permanent dentition?
allow spontaneous re-eruption if no movement within a few weeks then orthodontic reposition or surgical repositioning if intruded \>7mm
51
management for intrusion with mature teeth in the permanent dentition
* if intruded \<3mm * allow spontaneous re-eruption * if no movement after 2-4 weeks, surgical or orthodontic repositioning * if intruded 3-7mm * orthodontic or surgical repositioning and splint for 4 weeks * if intruded \>7mm * surgical repositioning and splint 4 weeks * if total intrusion * surgical repositioning and splint 4 weels * RCT most likely required in all repositioning cases
52
what is concussion?
tooth TTP but no displacement or mobility
53
what is the treatment for concussion in the permanent dentition?
no treatment needed but pulpal vitality needs to be monitored
54
what is the treatment for subluxation?
if excessively mobible then flexible splint 2 weeks, otherwise no treatment required
55
what should happen at the scene when there is avulsion of a permanent tooth?
* prognosis very dependent on what occurs at scene * keep calm * handle avulsed tooth by the crown * if dirty - wash tooth gentle under cold running water for max 10 seconds * try and replant the tooth straight away and ask patient to bite on handkerchief to hold in place * if cannot be replanted then place in a glass of milk or could be kept inside the patients mouth * attend dental clinic asap
56
what is the management of an avulsed tooth with complete root development once the tooth has been replanted at the scene
flexible splint for 2 weeks RCT 7-10 days after replantation and before splint removal
57
what is the management of an avulsed tooth with complete root development if the tooth has not been replanted but has been kept in a suitable storage medium - has been dry for less than 60 minutes
* LA * clean socket with salina * replant tooth * flexible splint for 2 weeks * RCT
58
what is the management of an avulsed tooth with complete root development if the tooth has not been replanted and has been dry for more than 60 minutes
* LA * clean socket with saline * replant tooth * flexible splint 4 weeks * RCT before/after replantation * very poor prognosis * if evidence of ankylosis or resorption then extraction
59
what is the management of an avulsed tooth with incomplete root development if the tooth has been replanted at the scene
flexible splint for 2 weeks if loss of vitality or pulp necrosis then RCT
60
what is the management of an avulsed tooth with complete root development if the tooth has not been replanted but has been kept in a suitable storage medium - has been dry for less than 60 minutes
* LA * clean socket with saline * replant tooth * flexible splint 2 weeks * review
61
what is the management of an avulsed tooth with complete root development if the tooth has not been replanted and has been dry for more than 60 minutes
* LA * clean socket with saline * replant tooth * flexible splint for 4 weeks * RCT before/after replantation
62
what are the properties of an ideal splint?
* easy to maintain oral hygiene * allows access to teeth for * pulp tests * colour * RCT * easy to place and remove * functional splint
63
what complications may follow trauma to the permanent dentition?
* pulp necrosis * arrested development * pain * infection * discolouration * pulp obliteration * pathological root resorption * inflammatory resorption * external * internal * cervical * replacement (ankylosis)

z paeds (6 decks)

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