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Trauma to primary and permanent teeth Flashcards

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1
Q

What is the approach for dental trauma?

A 
History
Exam/DX
Emergency TX
Follow Up
Definitive TX
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2
Q

What are the components of the general evaluation of a patient who has sustained trauma?

A

General appearance
Vital signs
Consciousness

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3
Q

What are the components of the extra oral examination of a patient who has sustained trauma?

A 
Check for clear nasal fluid discharge
Bruises
Swelling
Neck movements
Steps at the border of bones
Mandibular movements
Lacerations
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4
Q

What are the components of the cranial nerve examination of a patient who has sustained trauma?

A

Eye movements- vision (double/blurred), pupil constriction
Olfactory- can they smell
Auditory- can they hear
Talk, swallow, open mouth, stick tongue out, raise eyebrows, squeeze eyelids, smile, pucker lips, shrug shoulders

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5
Q

What are the minimum questions to ask when a patient has sustained trauma?

A

Did the patient lose consciousness

Any vomiting since the injury happened

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6
Q

What are the 3 components of an intraoral exam?

A

1- soft tissue
2- occlusion- alignment, steps in occlusion
3- teeth- fractures, tooth displacement, all teeth present

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7
Q

Which injuries are hard tissue injuries?

A

Cracked teeth
Fractured teeth
Pulp exposure
Color change

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8
Q

Which injuries are supporting tissue injuries?

A 
Displacement of teeth
Mobility of teeth
Mobility of alveolar fragments
Occlusion abnormality
Percussion sensitivity
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9
Q

What type of radiograph should be taken for primary dental trauma?

A

Occlusal films

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10
Q

What is the timeline for radiographic evidence of pathology?

A

2 wks- pulpal necrosis
3 wks- inflammatory resorption
6 wks- replacement resorption

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11
Q

What are the effects of trauma?

Pulpal hyperemia

A

Trauma effect:

May lead to cold sensitivity

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12
Q

What are the effects of trauma?

Internal hemorrhage

A

Trauma effect:

(Transient) discoloration

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13
Q

What are the effects of trauma?

Pulpal necrosis

A

Trauma effect:

Percussion + / Periapical radiolucency

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14
Q

What are the effects of trauma?

Pulp canal obliteration

A

Trauma effect:

Tooth turns yellow

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15
Q

What are the effects of trauma?

Inflammatory resorption

A

Trauma effect:
Radiographic appearance changes
Change in mobility

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16
Q 
What are the effects of trauma?
Replacement resorption (ankylosis)
A

Trauma effect:

Lack of mobility, dull percussion sound

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17
Q

T/F

Pulpal necrosis subsequent to PCO (pulp canal obliteration) was uncommon (1%)

A

True

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18
Q

What are the characteristics of replacement resorption?

A

Direct union of bone and root
Resorption of root and replacement with bone
Direct result of loss of vital PDL

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19
Q

What are the two main goals of emergency management of dental trauma?

A

Cover fractured teeth temporarily
Reposition luxated teeth and stabilize

This leads to need for follow up plan

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20
Q

Cold test and EPT should NOT be considered in which cases?

A

Testing:
Children
Open apices
Shortly after trauma

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21
Q

Which are the most reliable forms of diagnostic testing for dental trauma initially?

A 
Testing:
Radiography
Percussion
Palpation
Mobility
Swelling
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22
Q

Which tests are primarily best for teeth with closed apices?

A

Testing:
EPT
Cold Test

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23
Q

Which tests are used as diagnostic and to determine a baseline record?

A

Testing:
Radiography
Swelling

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24
Q

Which tests are used to evaluation the severity of luxation injuries?

A

Testing:
Palpation
Mobility

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25
Which test is used to evaluate concussion to tooth injuries?
Testing: | Percussion
26
What are the primary categories of dental trauma?
Fracture | Luxation
27
What is an enamel infarction?
Crack
28
What is an uncomplicated crown fracture?
Fracture of enamel and/or dentin in the crown without pulp exposure aka Class I and II
29
What is a complicated crown fracture?
Fracture of enamel/dentin in the crown with pulp exposure | aka Class III
30
What is an uncomplicated crown-root fracture?
Fracture of enamel and/or dentin of crown and root without pulp exposure
31
What is a complicated crown-root fracture?
Fracture of enamel and/or dentin of crown and root with pulp exposure
32
What is an isolated root fracture?
Fracture of root only
33
What is the emergency treatment for class I fractures in primary teeth?
Emergency Tx: Do nothing Smooth rough edges Restore with composite
34
What is the emergency treatment for class I fractures in permanent teeth?
``` Emergency Tx: Do nothing Smooth rough edges Restore with composite Follow up in 4 wks ```
35
What is the emergency treatment for class II fractures in primary teeth?
``` Emergency Tx: Do nothing Composite/GI band-aid Monitor for symptoms Restore with composite/GI ```
36
What is the emergency treatment for class II fractures in permanent teeth?
``` Emergency Tx: Do nothing Bond fragement if available Composite/GI band-aid Monitor for symptoms Restore with composite/GI Follow up in 4 wks ```
37
What is the emergency treatment for class III fractures in primary teeth?
``` Emergency Tx: Dependent primarily on behavior Tx options include-- Partial pulpotomy Pulpectomy Extraction ```
38
What is the emergency treatment for class III fractures in permanent teeth?
``` Emergency Tx: Dependent on stage of tooth maturity Young tooth- open apex or close apex --Direct pulp cap --Partial pulpotomy (Cvek technique) Mature tooth with closed apex --Pulpectomy ```
39
When does apex closure occur for: | Max centrals
Apex closure Mx: | 10 years
40
When does apex closure occur for: | Max laterals
Apex closure Mx: | 11 years
41
When does apex closure occur for: | Max canines
Apex closure Mx: | 13-15 years
42
When does apex closure occur for: | Mandibular centrals
Apex closure Md: | 9 years
43
When does apex closure occur for: | Mandibular laterals
Apex closure Md: | 10 years
44
When does apex closure occur for: | Mandibular canines
Apex closure Md: | 12-14 years
45
What are the criteria for success for Cvek partial pulpotomy?
``` No clinical signs or symptoms No radiographic pathology Continued development of immature roots Formation of calcific barriers Sensitivity to EPT ```
46
What are the typical sequelae of dental trauma?
Discoloration of teeth Acute pain Abscess or inflammation due to necrosis of tooth Tooth mobility Sensitivity to cold/hot foods Gingival irritation or inflammation Damage to developing tooth (if damage is done to primary tooth)
47
What do we ask parents to watch out for in terms of dental trauma?
``` For the tooth to start hurting --Waking up at night --Stops eating and drinking Color change Swelling --Facial swelling --Pimple of pus on the gums above the tooth Tooth getting loose ```
48
What is the appropriate treatment for discoloration of primary teeth?
NO TREATMENT NECESSARY
49
What are the primary results of chin trauma?
Posterior crown fractures Mandibular condylar fractures Cervical spine injury
50
What is the treatment for isolated root fractures?
No tx Splint (if increased mobility) for 4 wks Splint for 4 months if the fracture is more cervical
51
When there are more traumatic injuries than one in a patient, what determines the follow-up?
The most critical injuries determine follow-up duration | Always take initial x-ray from all traumatized teeth
52
What is the emergency treatment for a primary tooth concussion?
Emergency tx: No emergency tx Discuss potential sequelae with parents Monitor for symptoms
53
What is the emergency treatment for a permanent tooth concussion?
``` Emergency tx: No emergency tx Discuss potential sequelae with parents Monitor for symptoms Follow up in 4 wks ```
54
What is subluxation?
An injury to tooth-supporting structures with abnormal loosening, but without displacement of the tooth
55
What is the emergency treatment for subluxation of a primary tooth?
Emergency tx: No emergency tx Monitor for symptoms Tooth may tighten
56
What is the emergency treatment for subluxation of a permanent tooth?
``` Emergency tx: No emergency tx Monitor for symptoms Tooth may tighten Follow up in 4 wks ```
57
What is the follow-up for subluxation?
Follow up: 2-4 wks Radiograph 1 month
58
What is intrusive luxation?
displacement of the tooth into the alveolar bone | this injury is typically accompanied by comminution or fracture of the alveolar socket
59
What is the emergency treatment for intrusion of primary teeth?
Emergency tx: If the tooth was displaced labially- allow for spontaneous eruption If the tooth was displaced into the developing tooth bud, then extract
60
Labial displacement of intruded primary teeth in an occlusal radiograph will appear...
Elongated in occlusal radiograph
61
Lingual displacement, towards a developing tooth bud, of an intruded primary tooth in an occlusal radiograph will appear...
Shortened in occlusal radiograph
62
What to expect when developing teeth are damaged?
``` Discoloration Enamel hypoplasia Crown or root dilaceration Arrested development Disturbance in eruption ```
63
What ages hold the greatest risk for damage to developing teeth?
1-3 years old
64
What is the emergency treatment for intrusion of permanent teeth with an open apex?
Emergency tx: Open apex- up to 7mm- spontaneous eruption Open apex- more than 7mm- orthodontic or surgical repositioning
65
What is the emergency treatment for intrusion of permanent teeth with a closed apex?
Emergency tx: Closed apex- up to 3mm- spontaneous eruption Closed apex- 3-7mm- orthodontic or surgical repositioning Closed apex- more than 7mm- surgical repositioning
66
What is the follow up treatment for permanent teeth that experience intrusion?
Pulpectomy- remove pulp and fill with CaOH within 7-14 days | Complete gutta percha fill in 2 months if no inflammatory resorption
67
What is the emergency treatment for extruded primary teeth?
``` Emergency tx: <3mm --Reposition no splint --Spontaneous alignment Severe --Extract ``` considerations: occlusal interference, aspiration risk
68
What is the emergency treatment for extruded permanent teeth?
Emergency tx: Reposition with digital pressure Flexible splint for 2 wks Rx chlorhexidine mouth rinse Pulpectomy: remove pulp and fill with CaOH within 7-14 days Complete gutta percha fill in 2mo if no inflammatory resorption
69
What is the emergency treatment for primary teeth that are laterally luxated?
Emergency tx: Retrusion --If no occlusal interference, allow for spontaneous repositioning --With occlusal interference- must be repositioned/extracted (no splint) Protrusion --Extract (may contact developing tooth bud)
70
What is the emergency treatment for permanent teeth that are laterally luxated?
``` Emergency tx: Reposition with digital pressure Flexible splint for 4 wks Rx chlorhexidine mouth rinse Pulpectomy- CaOH fill within 7-14 Complete gutta percha obturation in 2-4 mo if no resorption ```
71
What is emergency treatment for avulsion of primary teeth?
None, NEVER reimplant primary teeth
72
What is the emergency treatment for avulsion of permanent teeth?
Emergency tx: Reimplant as soon as possible (every minute counts) Flexible splint- 2 wks Medications: systemic antibiotics, CHX mouth rinse, ibuprofen: pain + inhibition of bone resorption, tetanus Prognosis: Open apex vs. Close apex Dry time
73
How to manage root surface of avulsed permanent teeth?
Maintain PDL cell vitality Keep moist in HBSS Do not handle root surface Gently remove persistent debris
74
How to manage socket of avulsed teeth?
If clot present use saline irrigation Do not curette socket If alveolar bone collapsed, use blunt instrument to reposition Manually compress bony plates after replantation
75
How to manage soft tissue around avulsed teeth?
After repositioning... | Tight suture any soft tissue lacerations, particularly in the cervical region
76
How to splint teeth?
Use fish line/acid-etch resin; soft arch wire/resin; ortho brackets with passive arch wire; suture as last resort Maintain splint up to 2 wks, longer if tooth is still excessively mobile
77
What are the home care instructions for splinted teeth?
NO BITING on splinted teeth Soft diet Good oral hygiene
78
What is the follow up for avulsed permanent teeth?
Pulpectomy- remove pulp, place CaOH within 7-14 days | Complete gutta percha obturation fill in 2-12 mo (don't complete endo if it becomes ankylosed)
79
How to manage avulsion of immature permanent teeth?
Replant ASAP Splint Recall every 3-4 wks At first sign of necrosis, extirpate pulp and do revascularization procedure
80
What is the revascularization procedure?
Stimulation of bleeding through apex Place MTA on top of clot Allows continued root development and root wall thickening
81
What is the main thing to consider after a tooth fracture?
Where is the tooth fragment - -Ground - -Imbedded in soft tissue - -Ingested - -Aspirated
82
What are the clinical signs of aspiration?
``` No symptoms Initial choking and coughing Irritating cough Wheezing Unilateral obstructive emphysema Atelectasis Pulmonary suppuration ```

Pedo OSCE (6 decks)

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