Trauma

Question 1

What is a concussion of a tooth?

Answer 1

The tooth is tender to touch but it has not yet been displaced

It has normal mobility and no sulcular bleeding

Question 2

Treatment for concussion of tooth

Answer 2

No baseline radiograph indicated
No treatment is needed.
Observation
Advice - Care when eating, clean affected area with soft toothbrush and cholrohexidn mouthwash twice a day for one week to encourages gingival healing and prevent plaque accumulation

Question 3

What are the clinical findings of a subluxation

Answer 3

The tooth is tender to touch and it has increased mobility however the tooth has not been displaced

Bleeding from the gingival crevice may be noted

Question 4

What kind of radiograph would be taken for a subluxation injury and what would expect to be seen

Answer 4

A periapical of affected tooth should be taken to establish a baseline - Normal to slight widening of the PDL space expected

Question 5

Is any treatment required for a subluxation injury

Answer 5

No treatment required
Care on eating
Soft brushing and chlorohexidine mouth wash applied topically for 1 week twice daily

Question 6

Child comes in following injury and there tooth appears to be enlongated and is excessively mobile, there is an occlusion interference

Which type of injury is this

Answer 6

Extrusive luxation

The tooth has PARTIAL displacement out of its socket

Question 7

What treatment should be carried out for an extrusive luxation injury

Answer 7

Periapicals should be taken to establish a baseline ( slight increase to substantially widened PDL space apically)

Treatment depends on the degree of displacement, mobility and the ability of the child to cooperate in an emergency situations

Not interfering with occlusion - let it spontaneously respotion
Excessively mobile or extruded more than 3mm. -extract under LA

Soft brushing and chlorohexide topicalally to the area 2x daily for a week

Question 8

What is lateral luxation

Answer 8

The tooth is displaced usually in a palatal/lingual/labial direction. The tooth will be immobile, occlusal interference may be present

Question 9

When would extraction be indicated in a lateral luxation

Answer 9

When the tooth is at risk of aspiration or ingestion

Question 10

What kind of treatment can be offered for a severe lateral luxation, other than extraction

Answer 10

Gently reposition the tooth,if its unstable in its new position, splint for 4 weeks using a flexible splint attached to the adjacent uninjured teeth

Question 11

Child comes in following a traumatic injury, clinical findings are the tooth has almost or completely disappeared into the socket and can be palpated labailly.

What has happened here and what is the diagnosis

Answer 11

This is intrusive luxation

The tooth has most likely been displaced through the labial. Bone plate , it can impinge on developing permanent tooth bud

Question 12

How can we radiographically tell if a intrusive luxation injury has been displaced toward a permanent tooth germ

Answer 12

The apical tip cannot be visualised and the image of the toooth will appear ELONGATED

Question 13

If in an intrusive luxation the tooth has been is placed through the lateral bone plate how would this present on a radiograph

Answer 13

The apical tip can be seen and the image of the tooth will appear shorter than the contralateral tooth

Question 14

Which kind of treatment should be carried out for an intrusive luxation

Answer 14

The tooth should be allowed to spontaneously reposition itself, irrespective of the direction of the displacement

Spontaneous reposition usually occurs within 6months but can take up to a year

Excercose care with eating, topically apply chloroehexidine mouthwas 2x daily for a week

Question 15

Clinical findings - the tooth is completely out of the socket what kind of injury is this

Answer 15

An avulsion

Question 16

What must you check for when a patient comes in presenting with an avulsion injury

Answer 16

The location of the missing tooth should be explored during the trauma history and examination - especially if the injury was not witnessed by an adult or there was loss of consciousness

There is a risk it may be embedded in the soft tissues of lip,cheek r tongue,pushed into the nose or aspirated

Question 17

What should you do if an avulsed tooth cannot be found

Answer 17

If the avulsed tooth cannot be found then the child should be referred for a medical evaluation to an emergency room for further examination - especially if there are respiratory symptoms

Question 18

Treatment for an enamel dentine fracture when the pulp is not exposed

Answer 18

Cover all of the exposed dentine with GI or composite, lost tooth structure can be restored with composite immediately or at a later date.

Excersice care when eating to not cause further trauma to injured tooth, encouraging return to normal function ASAP.
Encourage gingival healing and prevent plaque accumulation by parents cleaning affected area with a soft brush or cotton swab with alcohol free chlorhexidne mouthwash applied topically 2x daily for 1 week.

Question 19

What is the patient/parent care advice for all trauma injuries

Answer 19

Excersice care when eating to not cause further trauma to injured tooth, encouraging return to normal function ASAP.

Encourage gingival healing and prevent plaque accumulation by parents cleaning affected area with a soft brush or cotton swab with alcohol free (0.1-0.2%) chlorhexidine gluconate mouthwash applied topically 2x daily for 1 week.

Question 20

What is the difference between a complicated and non complicated fracture

Answer 20

Complicated involves pulpal exposure, non complicated does not

Question 21

How do we manage a complicated crown fracture

Answer 21

Preserve the pulp via a PARTIAL PULPOPTOMY
- la required
- non setting calcium hydroxide paste should be applied over the pulp and then GI over than and then restored with composite resin.

Question 22

If the child presents with a complicate crown fracture with a large pulp exposure what kind of treatment is indicated

Answer 22

Cervical pulpotomy

Question 23

For note about treatment plan

Answer 23

The treatment depends on the child’s maturity and ability to tolerate the procedure
Therefore discussing treatment options with the parent is essential.
Each option is invasive and has the potential to cause long term dental anxiety.
Treatment is best preformed b a child-oritenteated team with the exerperience and expertise in the management of paediatrics trauma injuries

Often no treatment may be the most appropriate option in the emergency scenario but only when there is potential for rapid referral (within several days) to the child oriented teeth.

Question 24

What are the 6 things to make a note of on the trauma stamp

Answer 24

Mobility
Colour
TTP
Presence of sinus
Percussion note
Radiograph

Question 25

Following trauma the tooth has turned mild grey what does this suggest?

Answer 25

Immediate discolouration may maintain vitality

Question 26

Why may a tooth turn opaque/ yellow following dental trauma

Answer 26

Pulp. Obliteration

Pulp is laying down an increased thickness of dentine to protect itself, the tooth becomes more opaque as the dentine becomes thicker

Question 27

Why when carrying out root canal treatment on an immature incisor, what is the issue with using CaOH in the canal?

Answer 27

This is not done routinely because it has been shown shown to increase the risk of root fracture as non-settin CaOH increases the brittleness of the root

Question 28

When examining a patient with dental trauma, which of the following is not a sign of brain injury requiring medical assessment?

Select one:

A.
Nausea

B.
Amnesia

C.
Vomiting

D.
Dry mouth

Answer 28

D

Question 29

When considering avulsion of a primary tooth, which one of the following are true?

Select one:

A.
The patient requires review until eruption of the permanent successor

B.
The permanent successor is always damaged

C.
Suturing of the soft tissues is required

D.
The avulsed tooth should be reimplanted

Answer 29

A

Question 30

Following replantation of a permanent tooth after an avulsion injury, successful pulpal and periodontal healing are more likely if:
Select one:

A.
The avulsed tooth has a closed apex and is replanted immediately/within 15minutes of avulsion

B.
The avulsed tooth has an open apex and is replanted immediately/within 15 minutes of avulsion

C.
The avulsed tooth has a closed apex and is replanted within 30 minutes of avulsion

D.
The avulsed tooth has an open apex and is replanted within 30 minutes of avulsion

Answer 30

B

Question 31

What radiographic finding would suggest loss of vitality following dental trauma

Select one:

A.
Continuation in root maturation

B.
External inflammatory root resorption (EIRR)

C.
Pulp canal obliteration

D.
Intact lamina dura

Answer 31

B

Question 32

An 11-year-old child presents to your Practice 48 hours after sustaining a complicated crown fracture to tooth 21. Which of the following is true?

Select one:

A.
Ankylosis is the most likely long-term outcome

B.
A pulpotomy (Cvek or coronal) should be completed

C.
The tooth should be extirpated within 2 weeks

D.
The definitive restoration must be placed at this visit

Answer 32

B

Question 33

Following an intrusion injury of 3-7mm to tooth 11 in a 13-year-old child

Select one:

A.
Spontaneous pulp revascularisation is likely

B.
Pulpal necrosis is likely

C.
An ankylotic percussion note would not be detected until at least 2 weeks following the injury

D.
Surgical repositioning should be undertaken immediately

Answer 33

B

Question 34

With respect to root fractures in permanent teeth following dental trauma:

Select one:

a.
Cervical root fractures should be splinted for 4 weeks

b.
Loss of vitality of both the coronal and apical portions of the tooth is likely

c.
Hard tissue healing may occur

d.
Apical root fractures have a hopeless long term prognosis

Answer 34

C

Question 35

Which of the following permanent tooth injuries has a splinting time of 4 weeks?

Select one:

a.
Extrusion

b.
Lateral luxation

c.
Avulsion

d.
Root fracture (cervical 1/3)

Answer 35

B

Question 36

Which of the following is true of teeth with pulp canal obliteration?

Select one:

a.
It occurs more frequently in teeth with open apices

b.
It usually indicates the presence of necrotic tissue

c.
Avulsion injuries have a high rate of pulp canal obliteration

d.
It occurs more freqenly in tooth which have suffered a mild luxation injury

Answer 36

A