Trauma 4 - (Examination) Flashcards by Amy Rooney

What are causes of primary tooth trauma?

Falls

Bumps into objects - playing, poor coordination, learning how to walk

Non accidental - abuse - always consider

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What are most commonly affected teeth?

Maxillary central incisors

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Why is lunation most common injury in children

the bone is softer so bone yields to force and pressure and absorbs the pressure

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How do we manage a pt with trauma?

Reassure and calm pt

pt history - CO, HPC, MH, DH, FH, SH

Exam

Diagnosis - allows us to formulate tx plan

Emergency tx

Advise parent of potential damage to permanent teeth - must record in notes

Further tx and reviews

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What do we have to ask about the injury?

When?
Where?
How?
Any other symptoms?
Lost teeth/fragments accounted for?

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What must we consider in the medical history?

Is pt immunocompromised?
congenital heart defects or heart problems

rheumatic fever?

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What dental history must w consider?

Have they had previous trauma

Past dental experience - gives us insight into what they can handle

parents and Childs attitude - how they feel towards tx

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What do we look for extra orally?

lacs
haematomas 
haemorrhage 
subconjunctival haemorrhage in eyes 
bony step deformities in eye sockets and jaw
mouth opening - normal or limited?

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What do we look for intra orally?

soft tissue injuries - any penetrating wounds or foreign bodies

alveolar bone - is it solid?

occlusion - is it damage or is the tooth interfering?

teeth - any mobile teeth? - can indicate displacement , root fracture or bone fracture

transillumination - curing light can help show fracture lines in teeth, pulpal degeneration or caries

tactile test with pulp

percussion - dull note can indicate root # or if it sounds diff from other teeth

occlusion - traumatic occlusion needs urgent tx

radiographs

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What does the trauma stamp contain?

Tooth 
mobility 
colour 
ttp
sinus
percussion note 
radiograph

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What tests are not useful in smaller children?

EPT, thermal pulp tests because the child can be too young to understand making the testing pointless - child may want to please us by telling us the answer they think we want to hear

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What are the classifications of trauma injuries?

Enamel #
Enamel dentine #
enamel dentine pulp # - complicated 
Crown root - uncomplicated
crown root - complicated 
concussion 
subluxation 
intrusion 
extrusion 
avulsion 
root # 
alveolar #
lateral luxation

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What are the 3 types of crown fractures?

Enamel only
enamel and dentine
enamel dentine and pulp

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What are the 3 luxation injuries?

Lateral
Intrusion
Extrusion

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What is home management for all injuries dentally?

Soft diet for 10-14 days (esp when splint in place) - still eat a normal diet just cut food up, chew with molars

Brush teeth after every meal

topical CHX by parent twice daily for one week - children can’t swallow properly till age of 4 so risk of swallowing

review 1,3,6 monthly

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What injury requires more freq reviews?

Intrusion as we want to monitor reeruption

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How to we treat enamel fracture only?

Flowable composite

smooth off sharp edges

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How do we repair enamel or enamel dentine #?

Restore/bandage with composite resin or compomer - NOT GI!!!

We need to ensure we cover up exposed dentine or bacteria can enter and pulp will die

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how do we repair enamel dentine pulp fractures?

In children majority xla

but we can do end therapy - but children have wide canal with open apex so we need to fill with MTA 5-6mm and the backfill with GP

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In primary molar ends how far back do we go from radiographic apex?

2mm to avoid risking follicle around perm tooth

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Do we take radiographs of ends file in children?

No, risk they bite down on it

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How do we deal with crown and root fractures?

Get rid of coronal fragment - extract coronal fragment

leave any non obvious root fragments - we don’t want to damage adult tooth - leave it to resorb

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Why do we avoid going looking for any root fragments in children?

We don’t want to damage the adult tooth - leave it to resorb physiologically

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How do we treat alveolar bone fracture?

Reposition the segment
splint to adjacent teeth for 3-4 weeks

teeth may need xla after alveolar stability has been achieved

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What type of splint do we use for alveolar bone fractures?

Flexible splint

How do we treat concussion and subluxation?

Observation

How do we treat lateral luxation?

Radiograph - check the PDL space Consider repositioning but sometimes we prefer to allow it to spontaneously reposition

Why do our teeth sit in arches?

Because of forces applied by lip and tongue - this can help move any luxated teeth back into position

In lateral luxation if there is no occlusal interference what do we do?

We allow spontaneous repositioning

In lateral luxation if there is occlusal interference what do we do?

Extract

What types of film can we use to localise intrusion injury?

PA Lateral premaxilla

How do we localise intrusion injury with one PA?

Take PA if apical tip appears shorter than contralateral tooth - displaced towards or through buccal plate if apical tip indistinct and elongated then apex is displaced towards tooth germ

If the apical tip appears shorter than contralateral tooth in PA for intrusion injury what does this mean ?

This means the tooth has been displaced towards or through the buccal plate

What is the preferred direction of an intruded tooth?

Towards or through buccal plate AWAY from developing tooth germ

What does it mean if the apical tip is indistinct and tooth appears elongated?

This mean tooth has been displaced towards permanent tooth germ

How do we manage intrusion injuries?

Monitor re-eruption - draw a pic as reminder If no re-ruption within 6 months consider xla to avoid problems with adult tooth

When would we consider other options if intruded tooth hasn't re-erupted ?

6 months - we would want to xla to avoid issues with eruption of adult tooth

How do we tx extrusion injuries?

Extract or reposition under la and then flexible splint for 2 weeks

If we reposition extruded tooth what are risks?

Damage to perm tooth

How to we treat avulsions in kids?

NEVER replant primary tooth - damages permanent tooth!!!

What are some long term effect of trauma in primary teeth?

Discolouration discolouration and infection delayed exfoliation

What do we investigate if tooth is discoloured?

Vitality

What if tooth id discoloured ad vital?

Leave it - no tx needed

What if tooth is discoloured and non vital?

PA abscess, sinus then consider xla or Rct if no abscess or sinus then leave and review

What does opaque tooth on x-ray suggest?

Canal have sclerosed - natures own rct

What do we do if tooth id discoloured and infected?

RCT or XLa

Why may be need to extract a primary tooth that won't resorb?

To ensure perm successor doesn't erupt ectopically

What does a pink colour of tooth suggest?

Pink: immediate colour, tooth can maintain vitality and get better the reason for pink is because BV is pulp ruptures and blood goes into dentinal tubules as it has nowhere else to go if pulp repairs = normality returns

What are intermediate colours changes?

Brown black grey

What does an intermediate colour change suggest?

Happens weeks after trauma indicates tooth is NV

Where does intermediate discolour come from?

Necrotic pulp products in the dentine tubules - haemosiderin and eosin

What does immediate discolouration suggest:?

Tooth may maintain vitality

What can happen to primary tooth after trauma?

it can fail to resorb or may become ankylosed

If primary tooth doesn't resorb or becomes ankylosed what do we do?

Xla may be needed to ensure perm successor erupts normally or else it can be pushed ectopically

What is most likely complication of primary trauma?

Enamel defect then abnormal tooth or root morphology (such as crown ir root dilac and crown or root duplication)

What are some long term effects of trauma in perm teeth?

Enamel defects abnormal tooth or root morphology delayed eruption ectopic tooth position arrest in tooth formation complete failure of tooth to form odontome formation

What age and type of injuries has worst prognosis for adult teeth?

Bad injury young age 0-2 yrs = 63% chance of complication but 7-8 only 25%

What are some enamel defects?

hypo mineralisation hypoplasia

What is hypo mineralisation?

White yellow spots with normal enamel thickness

What are tx options for hypo mineralisation?

No tx - leave mask with Comp localised removal and comp restoration external bleaching - icon and micro abrasion

What is hypoplasia?

This is when there are yellow and brown areas with less than normal enamel thickness

What are tx options for hypoplasia?

Restore with comp - restores appearance and replaced missing tissue or when pt is old enough - youngest 16 but realistically 20ish then we can do a porcelain veneer when gingival level stabilised

How do we treat crown dilacerations?

Surgical exposure ortho realignment improve appearance restoratively

How do we tx root dilacs/angulations/duplications

Combo of surgical and ortho

How do we tx arrest of root development?

RCT/xla RCT - if enough root if not then consider pt as hypodontia pt

How do we tx odontome?

XLa

How do we tx undeveloped tooth germ?

may erupt spontaneously but may need to be removed if causing problems with other teeth erupting

Why can premature loss of a primary tooth delay eruption?

Due to thickened mucosa in the area

How long can premature loss of primary tooth delay eruption by?

1 year

What might we need to do to encourage eruption of adult tooth when there was premature loss of primary tooth?

Incision in gum to allow tooth to come through

When would we take a radiograph if tooth isn't erupting?

6 months after contralateral tooth has erupted always palpate for tooth also

Trauma 4 - (Examination) Flashcards

(71 cards)