Trauma Guidelines Flashcards

Question

Permanent tooth avulsion (mature apex) follow up

Answer 1

2 weeks splint removal + radiograph 4 weeks + radiograph 3 months + radiograph 6 months + radiograph 1 year + radiograph Yearly up to 5 years

Answer 2

2 weeks splint removal + radiograph 4 weeks + radiograph 6-8 weeks + radiograph 3 months + radiograph 6 months + radiograph 1 year + radiograph Yearly up to 5 years

Answer 3

2 weeks (if splinted at all)

Answer 4

4 weeks (if splinting required)

Answer 5

4 weeks (if splinting required)

Answer 6

Lateral luxation

Answer 7

Crown fracture

Answer 8

Tooth malformation Impacted teeth Eruption disturbances

Answer 9

Several conventional 2D imaging projections and angulations (but needs to be justified and individualized) Justification is based on if the image obtained will impact the management of the injury -one parallel PA aimed through midline -one parallel PA aimed at right tooth (with trauma tooth visible) -one parallel PA aimed at left tooth (with trauma tooth visible) -occlusal radiograph -opposing arch PA

Answer 10

Asymptomatic Positive response to pulp sensibility testing Good quality restoration (as needed) Continued root development in immature teeth Periodontal healing

Answer 11

Symptomatic Pulp necrosis and infection Discoloration Apical periodontitis Lack of further root development in immature teeth Loss or breakdown of restoration (if placed) Breakdown of marginal bone Resorption Ankylosis

Answer 12

If severe, etch and seal Otherwise no treatment necessary

Answer 13

If tooth fragment is available, rebond Tooth edges can be smoothed, composite resin restoration placed

Answer 14

If tooth fragment is available, rebond (soak in water or saline for 20min) Cover exposed dentin with GI or bonding agent and resin If exposed dentin is within 0.5mm of pulp (pink but no bleeding), place calcium hydroxide lining and cover material with GI

Answer 15

With open apices, partial pulpotomy to preserve root development Conservative pulp treatment also preferred treatment in teeth with complete root development Calcium hydroxide or calcium silicate cements can be placed on pulp wound If post is required for retention of crown, endo should be completed (for complete root development) If tooth fragment is available it can be rebonded after rehydration and pulp treated Otherwise build up with composite

Answer 16

Temporary stabilization of loose fragment until treatment plan is finalized If pulp is not exposed, removal of coronal/mobile fragment and subsequent restoration Cover exposed dentin with GI or bonding agent Future options (pending pt age and behavior): -ortho extrusion of apical or non-mobile fragment -surgical extrusion -RCT and restoration -root submergence (decoronation) -intentional replantation with or without rotation of the root -extraction -autotransplantation

Answer 17

Temporary stabilization of loose fragment until treatment plan is finalized In immature tooth, partial pulpotomy In mature teeth, removal of pulp is indicated Cover exposed dentin with GI or bonding agent Future options (pending pt age and behavior): -completion of RCT and restoration -ortho extrusion of apical or non-mobile fragment -surgical extrusion -RCT and restoration -root submergence (decoronation) -intentional replantation with or without rotation of the root -extraction -autotransplantation

Answer 18

If displaced, reposition coronal fragment ASAP Check repositioning radiographically Stabilize coronal segment with passive and flexible splint Do not start RCT at the emergency visit Monitor healing for at least 1 year RCT may be needed for coronal segment In mature teeth with coronal fracture, removal of coronal segment, RCT and post/crown usually required -other options like ortho extrusion, surgical extrusion and others can also be considered)

Answer 19

Reposition any displaced segment Stabilize segment with splint (passive/flexible) Suture gingival lacerations if present RCT contraindicated at emergency visit Monitor pulp condition of all teeth involved

Answer 20

No treatment needed Monitor pulp for at least 1 year

Answer 21

No treatment usually needed Splint may be considered if excessive mobility Monitor pulp for at least 1 year

Answer 22

Reposition tooth (push back with use of LA) Stabilize tooth for 2 weeks using passive/flexible splint Monitor pulp condition

Answer 23

Reposition tooth digitally under LA Stabilize with flexible/passive splint 4 weeks Monitor pulp condition (make endo eval at 2 week visit) Immature teeth may spontaneously revascularize; if any resorption visible endo should be started ASAP Mature teeth will likely necrose; endo treatment started when they do

Answer 24

Allow re-eruption without intervention If no re-eruption in 4 weeks, initiate ortho repositioning Monitor pulp condition Spontaneous pulp revascularization can occur, but if necrotic or resorption, initiate endo ASAP

Answer 25

Allow re-eruption without intervention if tooth is intruded less than 3mm If no re-eruption within 8 weeks, reposition surgically and splint for 4 weeks or reposition orthodontically before ankylosis develops If tooth is intruded 3-7mm, reposition surgically (preferably) or orthodontically If tooth is intruded beyond 7mm, reposition surgically Pulp almost always will necrose; RCT should be started at 2 weeks or as soon as position of tooth allows

Answer 26

Severe caries Severe periodontal disease Uncooperative patient Severe cognitive impairment requiring sedation Severe medical conditions such as immunosuppression or severe cardiac conditions *not reimplanting is irreversible decision, so in most cases it should be attempted

Answer 27

1. Clean injured area with water, saline or CHX 2. Verify correct position of replanted tooth clinically and radiographically 3. Leave tooth/teeth in place (unless malpositioned, then use digital pressure to reposition) 4. Administer LA preferably without vasoconstrictor 5. Stabilize tooth for 2 weeks using passive flexible splint (unless alveolar fracture present, then more rigid splint for 4 weeks) 6. Suture gingival lacerations, if present 7. Initiate RCT within 2 weeks 8. Administer systemic antibiotics 9. Check tetanus status 10. Provide post-op instructions 11. Follow up

Answer 28

1. If there is visible contamination, rinse root surface with stream of saline or osmolality-balanced solution 2. Put or leave the tooth in the storage medium while taking history, examining patient, and preparing for replantation 3. Administer LA preferably without vasoconstrictor 4. Irrigate socket with sterile saline 5. Examine the alveolar socket; if there is a fracture of the socket wall, reposition the fractured fragment into its original position 6. Removal of coagulum with saline stream may allow better repositioning of the tooth 7. Replant the tooth slowly with slight digital pressure; don't use excessive force 8. Verify the correct position of the replanted tooth clinically and radiographically 9. Stabilize tooth for 2 weeks using passive flexible splint (unless alveolar fracture present, then more rigid splint for 4 weeks) 10. Suture gingival lacerations, if present 11. Initiate RCT within 2 weeks 12. Administer systemic antibiotics 13. Check tetanus status 14. Provide post-op instructions 15. Follow up

Answer 29

1. If there is visible contamination, rinse root surface with stream of saline or osmolality-balanced solution 2. Put or leave the tooth in the storage medium while taking history, examining patient, and preparing for replantation 3. Administer LA preferably without vasoconstrictor 4. Irrigate socket with sterile saline 5. Examine the alveolar socket; if there is a fracture of the socket wall, reposition the fractured fragment into its original position 6. Removal of coagulum with saline stream may allow better repositioning of the tooth 7. Replant the tooth slowly with slight digital pressure; don't use excessive force 8. Verify the correct position of the replanted tooth clinically and radiographically 9. Stabilize tooth for 2 weeks using passive flexible splint (unless alveolar fracture present, then more rigid splint for 4 weeks) 10. Suture gingival lacerations, if present 11. Initiate RCT within 2 weeks 12. Administer systemic antibiotics 13. Check tetanus status 14. Provide post-op instructions 15. Follow up Poor long-term prognosis; expected outcome is ankylosis

Answer 30

1. Clean injured area with water, saline or CHX 2. Verify correct position of replanted tooth clinically and radiographically 3. Leave tooth/teeth in place (unless malpositioned, then use digital pressure to reposition) 4. Administer LA preferably without vasoconstrictor 5. Stabilize tooth for 2 weeks using passive flexible splint (unless alveolar fracture present, then more rigid splint for 4 weeks) 6. Suture gingival lacerations, if present 7. Pulp revascularization is the goal; risk of external resorption should be weighed against chances of revascularization. If spontaneous revasc does not occur, apexification, pulp revitalization/revascularization, or RCT should be initiated when pulp necrosis is identified 8. Administer systemic antibiotics 9. Check tetanus status 10. Provide post-op instructions 11. Follow up

Answer 31

1. If there is visible contamination, rinse root surface with stream of saline or osmolality-balanced solution 2. Put or leave the tooth in the storage medium while taking history, examining patient, and preparing for replantation 3. Administer LA preferably without vasoconstrictor 4. Irrigate socket with sterile saline 5. Examine the alveolar socket; if there is a fracture of the socket wall, reposition the fractured fragment into its original position 6. Removal of coagulum with saline stream may allow better repositioning of the tooth 7. Replant the tooth slowly with slight digital pressure; don't use excessive force 8. Verify the correct position of the replanted tooth clinically and radiographically 9. Stabilize tooth for 2 weeks using passive flexible splint (unless alveolar fracture present, then more rigid splint for 4 weeks) 10. Suture gingival lacerations, if present 11. Pulp revascularization is the goal; risk of external resorption should be weighed against chances of revascularization. If spontaneous revasc does not occur, apexification, pulp revitalization/revascularization, or RCT should be initiated when pulp necrosis is identified 12. Administer systemic antibiotics 13. Check tetanus status 14. Provide post-op instructions 15. Follow up

Answer 32

1. If there is visible contamination, rinse root surface with stream of saline or osmolality-balanced solution 2. Put or leave the tooth in the storage medium while taking history, examining patient, and preparing for replantation 3. Administer LA preferably without vasoconstrictor 4. Irrigate socket with sterile saline 5. Examine the alveolar socket; if there is a fracture of the socket wall, reposition the fractured fragment into its original position 6. Removal of coagulum with saline stream may allow better repositioning of the tooth 7. Replant the tooth slowly with slight digital pressure; don't use excessive force 8. Verify the correct position of the replanted tooth clinically and radiographically 9. Stabilize tooth for 2 weeks using passive flexible splint (unless alveolar fracture present, then more rigid splint for 4 weeks) 10. Suture gingival lacerations, if present 11. Pulp revascularization is the goal; risk of external resorption should be weighed against chances of revascularization. If spontaneous revasc does not occur, apexification, pulp revitalization/revascularization, or RCT should be initiated when pulp necrosis is identified 12. Administer systemic antibiotics 13. Check tetanus status 14. Provide post-op instructions 15. Follow up Poor long-term prognosis; PDL is not expected to regenerate, leading to ankylosis

Answer 33

Amoxicillin or penicillin is first choice If allergic, can use another type of antibiotic Doxycycline or tetracycline is appropriate if pt is older than 12

Answer 34

Stainless steel wire up to diameter of 0.016" or 0.4mm Nylon fishing line (0.13-0.25mm) (caution if not enough permanent teeth to bond to though) Place composite/wire on labial surfaces Keep composite away from gingiva to facilitate OH

Answer 35

1. Avid participation in contact sports 2. Maintain soft food diet for up to 2 weeks, according to tolerance of patient 3. Brush their teeth with a soft toothbrush after each meal 4. Use CHX mouth rinse twice a day for 2 weeks Reference manual does not mention pain medication, but can suggest OTC pain medication

Answer 36

Decoronation Autotransplantation Resin-retained bridge RPD Ortho space closure with or without composite resin modification Implant treatment after growth is completed

Answer 37

Smooth any sharp edges Encourage good OH; can consider CHX

Answer 38

Cover exposed dentin with GI or composite Encourage good OH; can consider CHX

Answer 39

Preserve pulp with partial pulpotomy Treatment depends on child's ability to tolerate treatment Encourage good OH; can consider CHX

Answer 40

Remove loose fragment and determine if crown can be restored If restorable and no pulp exposed, cover exposed dentin with GI; if pulp is exposed, perform pulpotomy or RCT If unrestorable, extract all loose fragments, taking care not to damage permanent successor Treatment depends on child's ability to tolerate treatment Encourage good OH; can consider CHX

Answer 41

If coronal fragment is not displaced, no treatment is required If coronal fragment is displaced and not excessively mobile, leave coronal fragment to spontaneously reposition, even if there's some occlusal interference If coronal fragment is displaced, excessively mobile and interfering with occlusion, 2 options are available: -extract only the loose fragment -reposition the loose coronal fragment, stabilize with flexible splint for 4 weeks Treatment depends on child's ability to tolerate treatment Encourage good OH; can consider CHX

Answer 42

Reposition any displaced segment that is mobile or causing occlusal interference Stabilize with flexible splint for 4 weeks Encourage good OH; can consider CHX

Answer 43

No treatment needed Observation

Answer 44

No treatment is needed Observation

Answer 45

Depends on degree of displacement, mobility, interference with occlusion, root formation, and ability of child to tolerate emergency situation If tooth is not interfering with occlusion, let tooth spontaneously reposition If excessively mobile or extruded >3mm, extract

Answer 46

If there is minimal or no occlusal interference, the tooth should be allowed to spontaneously reposition itself Spontaneous repositioning usually occurs within 6 months In situations of severe displacement, two options: -extraction when risk of ingestion or aspiration -gently reposition the tooth, if unstable splint for 4 weeks

Answer 47

Tooth should be allowed to spontaneously reposition itself, irrespective of direction of displacement Spontaneous improvement in position of intruded tooth usually occurs within 6 months (can take up to 1 year)

Answer 48

Do not replant

Trauma Guidelines Flashcards

(80 cards)