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ENDO II > trauma > Flashcards

trauma Flashcards

1
Q

crown infarction

A

incomplete fracture of the enamel without loss of tooth structure

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2
Q

complicated crown fractur

A

INVOLVES PULP

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3
Q

Ellis class I

A

only in enamel

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4
Q

ellis class II

A

enamel and dentin fracture

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5
Q

ellis class III

A

pulpy pulp

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6
Q

root fractures

A

involve cementum, dentin and pulp

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7
Q

ellis class VI

A

apparently your whole root breaks like horizontally

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8
Q

concussion

A

injury to tooth supporting structures WITH NO ABNORMAL LOOSENING, tooth is tender to percussion

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9
Q

subluxation

A

injury to tooth supporting structures WITH LOOSENING but NO clinical or radiographic evidence of displacement

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10
Q

intrusive luxation

A

displacement of tooth deeper into alveolar bone, communition/fracture of alveolar bone

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11
Q

extrusive luxation

A

partial displacement of tooth out of socket

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12
Q

lateral luxation

A

displacement in a direction other than axially, fracture of socket

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13
Q

exarticulations

A

complete avulsion (totally displaced out of socket)

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14
Q

communition of alveolar socket

A

cracked of socket, associated with intrusive or lateral luxation

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15
Q

a fracture of the alveolar socket wall is confined to…

A

facial or lingual socket wall

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16
Q

laceration

A

shallow or deep wound in mucosa resulting form a tear

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17
Q

contusion

A

bruise, usually not accompanied with a break in mucosa

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18
Q

abrasion

A

superficial wound produced by rubbing or scraping and leaving a raw, bleeding surface

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19
Q

what percentage of battered children/spouse get facial injuries

A

50%

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20
Q

predisposing factors to dental trauama

A

increased overate with protrusion and insufficient closure

tooth injuries TWICE as frequentt in children with protrusive incisors

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21
Q

prevalence of dental trauma

A

4-14% (probably higher)

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22
Q

are boys or girls more affected by dental truama

A

boys

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23
Q

what tooth most commonly gets fucked up

A

anterior teeth, usually single tooth

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24
Q

what type of injury do primary teeth usually get

A

luxation and/or avulsion

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25
Q

what type of injury do permanent teeth usually get

A

crown fractures

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26
Q

what questions to ask when a pt comes in

A

when? (affects prognosis, tx plan)

where? (tetanus booster, abtcs?)

how? (type of injury)

pain (past, present, duration, type, location)

previous oral injuries (could be a neurologic cause)

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27
Q

objective info to gather when pt comes in

A 
extraoral wounds?
palpate facial bones for fracture
intraoral soft tissue--check for tooth fragments/FB
crown fracture? 
displaced or missing teeth?
abnormal occlusion?
mobililty?
percussion? 
vitality tests?
intraoral photos
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28
Q

PA radiographs

A

take form multiple angles to determine fracture!

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29
Q

tx of uncomplicated crown fracture (no dentin)

A

no treatment, smooth rough edges or repair

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30
Q

tx of uncomplicated crown fracture (dentin involved)

A

decal or GI cement covered with composite resin or temporary crown

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31
Q

prognosis for uncomplicated crown fracture with dentin exposed

A

5-13% incidence of pulp necrosis, better for younger teeth!

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32
Q

treatment options for complicated crown fracture

A

pulp capping with CAOH, MTA, bioceramics

partial pulpectomy

pulpotomy/ RCT

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33
Q

what impacts the treatment plan for complicated crown fracture

A

maturity of tooth

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34
Q

pulp capping indications for complicated crown fracture

A

small, recent (less than one day) exposure

no associated luxation injuries

absences of caries/restorations

young pulp has better prog

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35
Q

partial pulpotomy indications for complicated crown fracture

A

large exposure or immature tooth

exposure less than one week old

allows for vitality testing and cervical maturation

prognosis: 7-28% incidence of necrosis

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36
Q

pulpectomy indications for complicated crown fracture

A

mature tooth, post and core required to restore tooth

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37
Q

pulp regeneration indications for complicated crown fracture

A

pulp tissue is necrotic and immature (open) apex present

disinfect canal space, place scaffold to induce bleeding in canal, seal with MTA and composite and monitor

ONLY WHEN YOU HAVE OPEN APEX!!

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38
Q

for crown root fractures, what extra things do you need to assess?

A

depth of fracture….tooth fragment must be removed, consider biologic wdith

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39
Q

t/f: pulp treatment for crown-root fractures is the same as just a regular crown fracture

A

true

40
Q

what root fracture has the poorest prognosis

A

near crestal bone

41
Q

if you have a long rooted tooth that gets fractured…what are your options?

A

could do ortho extrusions and periodontal sx

42
Q

coronal 1/3 root fracture tx

A

conservative…reduce and stabilize with splint for 10-12 weeks (take post reduction radiograph)

periodic pulp testing

43
Q

incidence of pulp necrosis w/i first two months in coronal 1/3 root fracture

A

20-44%

44
Q

t/f: the apical segment of a tooth with a coronal 1/3 root fracture often remains vital

A

t

45
Q

what are the four types of healing for root fractures

A

healing w/…

calcified tissue
connective tissue
bone and connective tissue
granulation tissue

46
Q

when a root fracture heals with granulation tissue what is this due to

A

pulp necrosis causing inflammation at fracture line

47
Q

what are treatment options for apical root fractures if pulp necrosis occurs?

A

RCT of coronal segment

RCT of coronal sement followed by surgical removal of apical segment

intraradicular splint

endoosseous implant (stablilizer) following removal of apical segment

48
Q

luxation injuries are _____% of trauma to permanent teeth

A

20-40%

49
Q

luxation injuries are ____% of trauma to primary teeth

A

62%

50
Q

treatment for concussion and subluxation

A

adjust occlusion

periodic recalls

51
Q

treatment for extrusive luxation

A

reduction and stabilization of tooth

remove splint after 10-14 days

begin RCT in mature teeth

monitor pulp status in immature teeth

52
Q

how long to leave splint on for extrusive luxation

A

10-14 days

53
Q

what type of tooth probably needs RCT following extrusive luxation?

A

mature tooth (monitor pulp status in immature teeth)

54
Q

lateral luxation treatment

A

reduction and stabilization within 48 hours
concomitant alveolar fracture requires splinting for 3-8 weeks

ortho tx may be required if reduction not possible (if after 48 hours after injury)

55
Q

what is the time limit for reducing a laterally luxated tooth

A

48 hours

56
Q

how long to splint if you have an alveolar fracture associated w/ luxation

A

3-8 weeks

57
Q

t/f intrusive luxation of immature and mature teeth usually DO NOT experience pulp necrosis

A

FALSE 96% OF INTRUSIVE LUXATION = NECROSIS

58
Q

if an immature tooth is less than 7 mm intruded during injury….

A

it may spontaneously erupt. if it hasn’t started moving in 3 weeks start doing ortho

59
Q

when to do surgical repositioning of an immature tooth that has been intruded

A

more than 7 mm intrusion

60
Q

when should you start ortho treatment for a mature tooth that has been intruded?

A

if it has been intruded less than 7 mm start within 3 weeks of trauma

61
Q

for a mature tooth that has been intruded, what and when should tx start?

A

start RCT within 2 weeks using CaOH as inter-appointment medication

62
Q

mature tooth intruded more than 7 mm needs…

A

surgical repositioning and stabilization for two weeks

63
Q

when can a mature tooth spontaneously erupt after intrusion injury

A

intrusion less than 3 mm, pt less than 17 yo

64
Q

what are three prognosis factors for luxation injuries

A

nature and severity of injury

time duration before treatment rendered

stage of root development

65
Q

pulp canal obliteration occurs in ____% of all luxation injuries combined

A

22%

66
Q

pulpal necrosis ___% in concussion

A

2%

67
Q

pulpal necrosis ___% in subluxation

A

26%

68
Q

pulpal necrosis ___% in extrusive/lateral luxation

A

64%

69
Q

pulpal necrosis ___% in intrusive luxation

A

96%

70
Q

what injury has the highest rate of pulpal necrosis

A

intrusive luxation

71
Q

list in order from highest percentage to lowest percentage of pulpal necrosis: subluxation, intrusive luxation, concussion, subluxation

A

intrusive
extrusive/lateral
subluxation
concussion

72
Q

what injury is most likely to have progressive root resorption

A

intrusive luxation (52%)

73
Q

are you likely to get progressive root resorption with subluxation or extrusive/lateral

A

no (4% and 7%)

74
Q

follow up treatments for laxation injuries

A 
vitality and radiographic checks
RCT
treatment of root resorption
apexification
extraction
75
Q

what material do you use to prevent root resorption

A

CaOH

76
Q

how often do you recall a pt with a primary tooth luxation injury

A

for concussion and subluxation: periodic recall once a year

extrusive luxation: EXT

77
Q

when do you extract an injured primary tooth

A

extrusive luxation…yank it

if intrusive/lateral impinges on permanent tooth bud

78
Q

what ages/what teeth/what sex for avulsion injuries

A

7-10 years old
maxillary centrals
boys

79
Q

relationship between extra oral time and root resorption:

0-30 mins?
over two hours?

A

0-30 mins: 10%

over 2 hrs: 90%

80
Q

options for transport media for avulsed teeth

A 
HBSS
viaspan/custodiol
milk
physiologic saline
saliva
water
contact lens solution
gatorade
81
Q

initial tx for avulsions

A

irrigate and aspirate socket to remove blood clot

do not curette socket

do not handle root of avulsed tooth

do not scrape or rub root surface

replant tooth as soon as possible

verify with x ray

stabilize tooth

82
Q

should you treat the root surface of an avulsed tooth with medications or chemicals

A

no, only if the root has been dry for over and hour

83
Q

what do you do if the root of an avulsed tooth is dirty

A

rinse with saline gently

84
Q

are abtx recommended for avulsions?

A

yes

doxy 100 mg bid for 7 days
penicillin V 500 mg bid for 7 days

85
Q

why refer to physician for avulsions

A

tetanus coverage…refer within 48 hours

86
Q

drug therapy for avulsions

A

abtcs
tetanus?
CHX for 10 days
analgesics

87
Q

post op instructions for avulsions

A

dont bite on splinted teeth
soft diet
increase fluid intake
keep area clean

88
Q

what are 4 contraindications to replantation

A

deciduous teeth

evidence of decay/perio dz

fractured/crusehd roots

other emergency considerations

89
Q

what sort of endo treatment do you do for an avulsed tooth with a closed apex

A

extirpate pulp 1-2 weeks after preimplantation

CaOH for 7 days to 6 months (longer better)

gutta percha dat shit

90
Q

what do you do for an avulsed tooth that has been DRY for more than one hour

A

can do endo in hand before you reimplant

soak tooth for 20 min in 2.4% sodium flurodie

91
Q

what do you soak a dry tooth in and whats the pH

A

2.4% sodium fluoride, pH 5.5

92
Q

what do you do for an avulsed tooth with an open apex

A

reimplant ASAP

Soak in doxycycline if contaminated

SYSTEMIC ABTS

monitor for pathological changes, do extirpation/CaOH
therapy if anything comes up, try to do pulp regeneration

93
Q

four healing patterns for avulsed teeth

A

normal
surface resorption
inflammatory resorption
replacement resorption/ankylosis

94
Q

what is the biggest factor affecting survival of avulses teeth?

A

stage of root development

MATURE TEETH SURVIVE LONGER

95
Q

what sort of follow up do you want for avulsions

A

annual radiographs

f/u eval for at least 5 years

ENDO II (11 decks)

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