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BDS3 paeds > Trauma I > Flashcards

Trauma I Flashcards

1
Q

accidental damage to permanent teeth occurence

A

25% all school children experience dental trauma

33% adults - permanent dentition mostly before 19yrs

Boys:girls approximately 3:1

70% not treated

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2
Q

what is the most common injury in primary dentition

A

luxation

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3
Q

what is the most common injury in permanent dentition

A

crown fractures

  • enamel dentine fracture
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4
Q

peak period for trauma to permanent teeth

A

7-10 years

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5
Q

what makes trauma to permanent teeth more likely

A

large overjet (likely not fixed by ortho yet)

OJ > 9mm doubles the incidence of trauma

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6
Q

causes of trauma (4)

A

Falls
- 50%

Bike, skateboard, RTA.
- 17-35%

Sport
- 14 – 25%

Fights
- 3%

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7
Q

what should you take in dental history of trauma child

A

How did it happen
When did it happen exactly
Where are the lost teeth/fragments
Any other symptoms

Take a dental and medical history
- Important to identify if any aspects of MH may influence treatment options

Be aware if :
- Rheumatic Fever
- Congenital heart defects
- Immunosuppression
These conditions are not contraindications to treatment but appropriate additional treatment may need to be given.
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8
Q

what types of MH may influence dental Tx for trauma child pt

A 
Be aware if :
- Rheumatic Fever
- Congenital heart defects
- Immunosuppression
These conditions are not contraindications to treatment but appropriate additional treatment may need to be given.
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9
Q

order of EO and IO examination for child trauma pt

A

rule out facial/jaw fracture

Extra oral

  • Laceration
  • Haematomas
  • Haemorrhage / CSF
  • Subconjunctival haemorrhage
  • Bony step deformities
  • Mouth opening

Intraoral

  • Soft tissue
  • Alveolar bone
  • Occlusion
  • Teeth
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10
Q

what may be in the wound of child dental trauma

A

foreign bodies

Check for soft tissue damage

  • Penetrating wounds, foreign bodies
  • Soft tissue radiograph to check lacerations
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11
Q

tooth mobility tested with

A

probe

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12
Q

tooth mobility may indicate (2)

A
  • displacement of tooth
  • root or bone fracture (horizontal or vertical - transillumination can help)

potential pulpal involvement

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13
Q

5 stages in detailed intra oral exam of child pt with trauma

A

Sensibility tests

  • Thermal: ethyl chloride (ECL) or warm Gutta-Percha
  • Electrical: electric pulp tester (EPT).

Percussion
- duller note may indicate root#

Occlusion
- traumatic occlusion demands urgent treatment

Radiographs
- intra-oral, occlusal, OPT, soft tissue.

Classify the trauma

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14
Q

percussion of traumatised tooth

A

duller note = indicate root fracture

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15
Q

sensibility tests assess

A

nerve response

vitality – blood – Laser Dopler

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16
Q

types of sensibility tests (2)

A
  • Thermal: ethyl chloride (ECL) or warm Gutta-Percha

- Electrical: electric pulp tester (EPT).

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17
Q

what type of occlusion needs urgent treatment

A

traumatic occlusion

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18
Q

trauma sticker

A

Label FDI notation at top

+/- for:

  • sinus,
  • TTP,
  • ECL,
  • P.NOTE,
  • radiograph (see below)

Color describe

Mobility grade

EPT score after test

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19
Q

how to carry out a sensibility test

A

Compare injured tooth with the adjacent non-injured tooth.
- Always test adjacent teeth and opposing teeth in addition to those obviously injured. These teeth must have received either direct or indirect concussive injuries.

This applies to both sensibility tests AND when viewing root surfaces on radiographs

Continue sensibility tests for at least 2 years after an injury

Never make clinical judgements on sensibility tests alone

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20
Q

classification of crown and root fracture

A

enamel fracture

enamel dentine fracture

enamel dentine pulp fracture

uncomplicated crown root fracture

root fracture (apical, middle or cervical third)

complicated crown root fracture

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21
Q

uncomplicated fracture means

A

the pulp is not involved

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22
Q

complicated fracture means

A

pulp is the involved

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23
Q

prognosis of traumatised tooth depends on (5)

A

Stage of root development - positive and negative impacts

Type of injury

If PDL is damaged to

Time between injury and treatment

Presence of infection

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24
Q

general aims and principles of treatment

emergency Tx
5

A

Aim to retain vitality of any damaged or displaced tooth by protecting exposed dentine by an adhesive ‘dentine bandage’

Treat exposed pulp tissue

Reduction and immobilisation of displaced teeth

Tetanus prophylaxis

Antibiotics - Depends on location trauma

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25
general aims and principles of treatment | immediate Tx 2
+/- Pulp treatment Restoration - Minimally invasive e.g. acid etch restoration
26
general aims and principles of treatment | permanent Tx 5
Apexigenesis - normal biological process of apex growing and closing - worked Apexification - intervene to provide an apex as developmental process halter Root filling +/- root extrusion Gingival and alveolar collar modification if required Coronal restoration
27
apexigenesis
normal biological process of apex growing and closing - worked
28
apexification
intervene to provide an apex as developmental process halter
29
how to manage an enamel fracture (2 options)
Either - Bond fragment to tooth or - Simply grind sharp edges Take 2 periapical radiographs to rule out root fracture or luxation Follow up - 6-8weeks and at 1 year Prognosis – 0% risk of pulp necrosis
30
follow up for enamel fracture
6-8weeks and at 1 year
31
prognosis of enamel fracture
0% risk of pulp necrosis
32
how to manage an enamel dentine fracture 2 options
Either - Bond fragment to tooth or - Place composite bandage Line the restoration if the fracture is close to the pulp then definitive restoration
33
how to manage an enamel dentine fracture first step
Account for fragment – know where it is, bond on/composite bandage/ composite
34
Special tests for enamel dentine fracture
Take 2 periapical radiographs to rule our root fracture or luxation Radiograph any lip or cheek lacerations to rule out embedded fragment Sensibility testing and evaluate tooth maturity
35
when is follow up for enamel dentine fracture
Follow up – 6-8 weeks and at 1 year
36
prognosis of restored crown after ED fracture
5% chance pulp necrosis at 10 years
37
what to check on radiographs for in follow up fo ED fracture
root development - width of canal and length comparison with other side internal + external inflammatory resorption periapical pathology
38
effect on concussion on pulpal survival in ED fracture open apex
95%
39
effect on concussion on pulpal survival in ED fracture closed apex
85%
40
effect on subluxation on pulpal survival in ED fracture open apex
80%
41
effect on subluxation on pulpal survival in ED fracture closed apex
50%
42
effect on extrusion on pulpal survival in ED fracture open apex
60%
43
effect on extrusion on pulpal survival in ED fracture closed apex
20%
44
effect on lateral luxation on pulpal survival in ED fracture open apex
65%
45
effect on lateral luxation on pulpal survival in ED fracture closed apex
15%
46
effect on intrusion on pulpal survival in ED fracture open apex
0%
47
effect on intrusion on pulpal survival in ED fracture closed apex
0%
48
mature Vs immature tooth chance of pulpal survival after trauma
Chances of pulp survival better in immature tooth – open, lots of access to nerves and blood vessels compared to single point entry for closed apex
49
3 things to evaluate after enamel-dentine-pulp exposure
size of pulp exposure time since injury associated PDL injuries
50
treatment options for enamel-dentine-pulp exposure (3)
pulp cap - less than 24hr ``` partial pulpotomy (Cvek Pulpotomy) - more than 24hr old ``` full coronal pulpotomy - damage to pulp is and length exposed - last resort
51
what is the aim of treatment for enamel-dentine-pulp exposure
to preserve pulp vitality
52
treatment of choice in open and closed apices with EDP exposure
preserve pulp vitality by pulp capping or partial pulpotomy - in order to secure further root development. This treatment is also the treatment of choice in patients with closed apices. Calcium hydroxide compounds and MTA (white) are suitable materials for such procedures.
53
direct pup cap when
tiny exposure (1mm) 24hr window
54
direct pulp cap procedure
Trauma sticker and radiographic assessment - Should be non-TTP and positive to sensibility tests LA and rubber dam Clean area with water then disinfect area with sodium hypochlorite Apply calcium hydroxide (Dycal) or MTA White to pulp exposre Restore tooth with quality composite restoration Review 6-8 weeks then 1 year
55
partial pulpotomy (Cvek pulpotomy) when
larger exposure (>1mm) 24+ hours since trauma
56
partial pulpotomy (Cvek pulpotomy) procedure
Trauma sticker and radiographic assessment LA and rubber dam Clean area with water then disinfect area with sodium hypochlorite Remove 2mm of pulp with high speed round diamond bur Place saline soaked CW pellet over exposure until haemostasis achieved - If no bleeding or can’t arrest bleeding (hyperaemic) proceed to full coronal pulpotomy Apply CaOH then vitrebond (or white MTA) then restore with quality composure resin should get continued root development from wide open apex
57
full coronal pulpotomy procedure
Begin with partial pulpotomy - Assess for haemostasis after application of saline soaked cotton-wool (Last resort) If hyperaemic or necrotic, then proceed to remove ALL of the coronal pulp Place calcium hydroxide in pulp chamber Seal with GIC lining and quality coronal restoration
58
when do you resort full coronal pulpotomy
when assessing haemostasis at partial - saline soaked cotton wool hyperaemic or necrotic (no bleeding), then proceed to remove ALL of the coronal pulp
59
partial (Cvek) Vs full coronal pulpotomy
partial - 97% success full coronal - 75% success
60
aim of pulpotomy
to keep vital pulp tissue within the canal to allow normal root growth (apexogenesis) both in the length of the root and the thickness of the dentine.
61
follow up for pulpotomy
6-8 weeks and 12 months clinical and radiographic review
62
root treatment for immature incisors tooth non-vital then
full pulpectomy needed
63
root treatment for immature incisors tooth non-vital but apex of tooth is open
clinical problem is the need to have an apical stop to allow obturation with GP
64
how to achieve apical stop in open apex tooth needing pulpectomy (3 options)
CaOH placed in canal aiming to induce hard-tissue barrier to form (apexification) - Not great, takes 9 months to form properly but CaOH denatures dentine after 4 weeks or MTA/BioDentine/bioceramic placed at apex of canal to create cement barrier Or Regenerative Endodontic Technique to encourage hard tissue formation at apex - Stem cells activate and differentiate into odontoblasts, then make dentine (sometimes bone so still in early stage)
65
best material for achieve apical stop in open apex tooth
MTA/BioDentine/bioceramic placed at apex of canal to create cement barrie
66
pulpectomy - open apex
- Rubber dam - Access - Haemorrhage control - LA / sterile water - Diagnostic radiograph for WL - File 2mm short of estimated WL - Dry canal, Non-setting Ca(OH)2 , CW in pulp chamber Extirpate pulp and place MTA plug and heated GP obturation (5-6mm of MTA) - cylinder of GP to fill wide canal Glass-ionomer temporary cement in access cavity and evaluate MTA fill level with radiograph
67
how is MTA placed
use carriers
68
final coronal restoration of pulpectomy
Once obturation complete Consider bonded composite short way down canal as well as in access cavity Bonded core Try to avoid post crown
69
crown-root fracture with no pulp exposure extends beyond gum – past gingival level and crestal bone treatment options (7)
fragment removal only and restore Fragment removal and gingivectomy - Indicated in crown-root fractures with palatal subgingival extension Orthodontic extrusion of apical portion 1. Extrusion 2. Endodontic 3. Post crown Surgical extrusion - Removing all PDL and lowering tooth into place – severe. If pulp alive unlike Orthodontic extrusion of apical portion Decoronation - Preserve bone for future implant Extraction May need to do temporary treatment as need more information before can proceed
70
when is fragment removal and ginivectomy indicated in crown-root fractures
Indicated in crown-root fractures with palatal | subgingival extension
71
purpose of decoronation
perserve boen for future implant
72
post crown
not wanted in crown-root fracture Tx but sometimes needed

BDS3 paeds (15 decks)

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