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Trauma Flashcards

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1
Q

What is the follow up regimen for enamel fracture of primary teeth?

A

No follow up

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2
Q

What is the follow up regimen for enamel/dentin fracture of primary teeth?

A

8 weeks

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3
Q

What is the follow up regimen for crown fracture of primary teeth?

A
  • 1 week
  • 8 weeks
  • 1 year
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4
Q

What is the follow up regimen for crown/root fracture of primary teeth?

A
  • 1 week
  • 8 weeks
  • 1 year
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5
Q

What is the follow up regimen for root fracture of primary teeth?

A
  • 1 week
  • 4 weeks (IF SPLINTED, SPLINT REMOVAL)
  • 8 weeks
  • 1 year
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6
Q

What is the follow up regimen for alveolar fracture of primary teeth?

A
  • 1 week
  • 4 weeks (IF SPLINTED, SPLINT REMOVAL + RADIOGRAPH)
  • 8 weeks
  • 1 year (RADIOGRAPH)
  • At 6yo
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7
Q

What is the follow up regimen for concussion of primary teeth?

A
  • 1 week
  • 8 weeks
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8
Q

What is the follow up regimen for subluxation of primary teeth?

A
  • 1 week
  • 8 weeks
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9
Q

What is the follow up regimen for extrusion of primary teeth?

A
  • 1 week
  • 8 weeks
  • 1 year
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10
Q

What is the follow up regimen for lateral luxation of primary teeth?

A
  • 1 week
  • 4 weeks (IF SPLINTED, REMOVE SPLINT)
  • 8 weeks
  • 6 months
  • 1 year
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11
Q

What is the follow up regimen for intrusion of primary teeth?

A
  • 1 week
  • 8 weeks
  • 6 months
  • 1 year
  • At 6yo
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12
Q

What is the follow up regimen for avulsion of primary teeth?

A
  • 1 week
  • 8 weeks
  • At 6yo
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13
Q

What is the follow up for infarction, permanent tooth?

A

No follow up

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14
Q

What is the follow up for enamel fracture, permanent tooth?

A
  • Clinical + radiographic follow up:
    • 6-8 weeks
    • 1 year
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15
Q

What is the follow up for enamel/dentin fracture, permanent tooth?

A
  • Clinical + radiographic follow up:
    • 6-8 weeks
    • 1 year
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16
Q

What is the follow up for crown fracture, permanent tooth?

A
  • Clinical + radiographic follow up:
    • 6-8 weeks
    • 3 mo
    • 6 mo
    • 1 year
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17
Q

What is the follow up for crown/root fracture, permanent tooth?

A
  • Clinical + radiographic follow up:
    • 6-8 weeks
    • 3 mo
    • 6 mo
    • 1 year
    • Yearly for at least 5 years
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18
Q

What is the follow up for root fracture (apical third, mid-third), permanent tooth?

A
  • Clinical + radiographic follow up:
    • 4 weeks (Splint removal)
    • 6-8 weeks
    • 4 mo
    • 6 mo
    • 1 year
    • Yearly for at least 5 years
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19
Q

What is the follow up for root fracture (cervical third), permanent tooth?

A
  • Clinical + radiographic follow up:
    • 4 weeks
    • 6-8 weeks
    • 4 mo (splint removal)
    • 6 mo
    • 1 year
    • Yearly for at least 5 years
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20
Q

What is the follow up for alveolar fracture, permanent tooth?

A
  • Clinical + radiographic follow up:
    • 4 weeks (splint removal)
    • 6-8 weeks
    • 4 mo
    • 6 mo
    • 1 year
    • Yearly for at least 5 years
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21
Q

What is the follow up for concussion, permanent tooth?

A
  • Clinical + radiographic follow up:
    • 4 weeks
    • 1 year
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22
Q

What is the follow up for subluxation, permanent tooth?

A
  • Clinical + radiographic follow up:
    • 2 weeks (splint removal)
    • 3 mo
    • 6 mo
    • 1 year
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23
Q

What is the follow up for extrusion, permanent tooth?

A
  • Clinical + radiographic follow up:
    • 2 weeks (splint removal)
    • 4 weeks
    • 6-8 weeks
    • 3 mo
    • 6 mo
    • 1 year
    • Yearly for at least 5 years
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24
Q

What is the follow up for lateral luxation, permanent tooth?

A
  • Clinical + radiographic follow up:
    • 2 weeks
    • 4 weeks (splint removal)
    • 6-8 weeks
    • 3 mo
    • 6 mo
    • 1 year
    • Yearly for at least 5 years
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25
What is the follow up for **intrusion, permanent tooth**?
* Clinical + radiographic follow up: * 2 weeks * **4 weeks (splint removal)** * 6-8 weeks * 3 mo * 6 mo * 1 year * Yearly for at least 5 years
26
What is the follow up for **avulsion (mature), permanent tooth**?
* Clinical + radiographic follow up: * **2 weeks (splint removal)** * 4 weeks * 3 mo * 6 mo * 1 year * Yearly for at least 5 years
27
What is the follow up for **avulsion (immature), permanent tooth**?
* Clinical + radiographic follow up: * **2 weeks (splint removal)** * 4 weeks * 6-8 weeks * 3 mo * 6 mo * 1 year * Yearly for at least 5 years
28
Concurrent crown fractures significantly increase risk of pulp necrosis + infection in teeth w/ what type of dental trauma?
Concussion + subluxation
29
Crown fractures w/ and w/o pulp exposure significantly increase the risk of pulp necrosis + infection in teeth w/ what type of dental injury?
Lateral luxation
30
Radiographs to take for dental trauma
* One parallel PA aimed through the midline to show the two maxillary central incisors * One parallel PA aimed at the maxillary right lateral incisor (should also show the right canine + central incisor) * One parallel PA aimed at the maxillary left lateral incisor (should also show the left canine + central incisor) * One maxillary occlusal radiograph * At least one parallel PA of the lower incisors centered on the two mandibular centrals
31
Why do we also take an occlusal radiograph in addition to PA's for dental trauma?
Occlusal radiograph provides a different vertical view of the injured teeth + surrounding tissue, which is helpful in detecting lateral luxation, root fracture, and alveolar bone fractures
32
What type of dental injuries is CBCT helpful for?
* Root fractures * Crown/root fractures * Lateral luxations
33
How do you rehydrate a tooth fragment that you will bond back on to a tooth that sustained dental trauma?
Soak the fragment in water or saline for 20 min before bonding
34
What materials should you use for a partial pulpotomy following traumatic pulp exposure?
Non-setting calcium hydroxide or non-staining calcium silicate
35
Marginal bone loss + periodontal inflammation is an unfavorable outcome for what type of dental trauma?
Uncomplicated + complicated crown-root fractures
36
What dental injury might you see bleeding from the gingival sulcus?
Root fracture
37
What dental injury might you have negative sensibility testing?
* Root fracture * Subluxation * Extrusive luxation * Lateral luxation * Intrusive luxation
38
What type of root fractures have the potential to heal?
Cervical root fractures
39
What dental injuries might you see external inflammatory resorption as an unfavorable outcome?
* Alveolar fracture * Subluxation * Extrusive luxation * Lateral luxation * Intrusive luxation
40
Ankylosis is an unfavorable outcome with what dental injury?
* Lateral luxation * Intrusive luxation
41
What is likely to happen with the pulp of a subluxated permanent tooth?
Necrosis - RCT should be started w/ corticosteroid-abx OR calcium hydroxide to prevent external resorption
42
Intrusive luxation: immature permanent teeth tx
* Allow re-eruption * If no re-eruption in **4 wks**, initiate orthodontic repositioning * Monitor * Spontaneous revascularization may occur
43
Intrusive luxation: mature permanent teeth tx
* If **\<3mm:** Allow re-eruption * If no re-eruption in **8 wks**, reposition surgically + splint for 4 weeks OR reposition orthodontically before ankylosis develops * If **3-7mm**, reposition surgically (preferable) or orthodontically * **\>7mm** reposition surgically * Monitor * Spontaneous revascularization may occur
44
Why is sensibility testing unreliable following dental trauma?
* Due to a transient lack of neural response or undifferentiation of A delta nerve fibers of young teeth
45
What is used to measure blood flow of traumatized teeth?
Pulse oximetry Limited due to lack of sensors Laser + ultrasound doppler are also being investigated
46
Short term, passive, flexible splint dimensions
SS 0.4mm in diameter
47
Pulp canal obliteration in dental trauma
* Occurs more frequently in teeth w/ open apices which have suffered a severe luxation injury * Indicates presence of viable tissue w/in the root canal * Extrusion, intrusion + lateral luxation have high rates of PCO * Common following root fractures
48
What type of dental injuries will you see pulp canal obliteration?
* Extrusion, intrusion + lateral luxation have high rates of PCO * Common following root fractures
49
How long can CaOH2 sit in canal of initiated RCT following trauma?
up to 1 mo Should be placed 1-2 wk after trauma
50
How long can corticosteroid/abx sit in canal of initiated RCT following trauma?
up to 6 wks
51
Would you consider early RCT w/ immature tooth that has been intruded + crown fracture (combined injury)?
Yes - at a higher risk of pulp necrosis
52
When should RCT be initiated if external resorption is detected?
Immediately. CaOH2 should be placed for 3 weeks + replaced every 3mo until radiolucencies of the resorptive lesions disappear. Final obturation can be completed when boen repair is visible radiographically
53
What type of dental injury is most frequent in the primary dentition?
Luxation
54
What type of dental injury is most common in permanent dentition?
Crown fracture
55
TDI comprise \_% of all injuries?
5%
56
What % of school children experience dental trauma?
25%
57
What % of adults experience dental trauma?
33%; majority of injuries occur before 19yo
58
What % of dental injuries is avulsion of permanent teeth?
0.5-0.16%
59
What type of situations is replantation of an avulsed permanent tooth not indicated?
* Severe caries or periodontal disease * Uncooperative patient * Severe cognitive impairment requiring sedation * Severe medical conditions such as immunosuppression * Severe cardiac conditions
60
What do you do if an avulsed permanent tooth is dirty?
Rinse in milk, saline or patient's saliva prior to replanting it
61
Storage mediums for an avulsed permanent tooth
* Milk * HBSS * Saliva * Saline Water is a poor medium but it is better than the tooth being dry
62
What is the condition of PDL cells of avulsed permanent tooth dependent on?
EO dry time + storage medium
63
What is critical for survival of PDL cells of an avulsed permanent tooth?
Dry time
64
After what amount of EO dry time are most PDL cells non-viable?
EO dry time of 30 minutes
65
When are PDL cells most likely viable (avulsed permanent tooth)?
* Tooth has been replanted immediately or w/in a very short time (**~15min**) at the place of accident
66
When are PDL cells viable but compromised (avulsed permanent tooth)?
* Tooth has been kept in a storage medium + total EO dry time is **\<60min**
67
When are PDL cells likely not viable (avulsed permanent tooth)?
* Total EO dry time is **\>60min** regardless of storage medium
68
How long following dental trauma can you reposition a malpositioned avulsed permanent tooth?
up to 48 hours
69
Ideal splint dimensions for avulsed permanent tooth
0.016" or 0.4mm wire Nylon fishing line (0.13-0.25mm)
70
What is the expected outcome w/ delayed replantation? (avulsed permanent tooth)
Ankylosis (replacement root resorption)
71
What are examples of osmolality balanced media?
milk + HBSS
72
Why are systemic abx recommended after replantation? (avulsed permanent tooth)
Prevent infection-related rxns + ⇓ occurrence of inflammatory root resorption
73
What is the 1st line abx? (avulsed permanent tooth)
PCN/amoxicillin Allergy: Doxycycline (anti-microbial, anti-inflammatory, anti-resorptive effects) – **not recommended \<12yo**
74
Oral injuries account for \_% of all physical injuries in children 0-6yo?
18% Mouth is second most common area of body to be injured
75
World prevalence of TDI of primary teeth?
22.7%
76
At what age do TDI of primary teeth most commonly occur?
2-6yo, w/ injury to periodontal tissues most frequently
77
What age group are ST injuries most commonly found?
0-3yo
78
What type of TDI is most commonly associated w/ development anomalies in permanent teeth?
Intrusion + avulsion
79
When do you EXT an extruded primary tooth?
Excessive mobility or extruded **\>3mm**
80
What will an intruded primary tooth look like radiographically if apex is displaced toward or through the **labial** bone plate?
The apical tip can be seen + the image of the tooth will appear **shorter (foreshortened)** than the contralateral tooth
81
What will an intruded primary tooth look like radiographically if apex is displaced **toward the permanent tooth germ**?
The apical tip **cannot** be seen + the image of the tooth will appear **elongated**
82
Reasons why we don't replant avulsed primary teeth
* Treatment burden for a child * May cause further damage to permanent tooth or its eruption * **_To avoid a medical emergency from aspiration of the tooth_**
83
Tetanus vaccines w/ wound management
* \<7yo w/ h/o 3+ vaccine: For all wounds ***except clean + minor***, give DTaP if \>5yo since last dose. * \>7yo w/ h/o 3+ vaccine: * Clean + minor wounds: give Tdap or Td if **\>10yr** since last dose * All other wounds: Give Tdap or Td if **\>5yr** since last dose * Tdap is preferred for 11yo+ who have not previously received Tdap or whose Tdap hx is unknown * If a tetanus vaccine is indicated for a pregnant patient – use Tdap
84
What % of children ages 6-17yo participate in sports per 2020 health survey?
54.1%
85
What % of athletes experience dental trauma?
10-61%
86
What % of injuries in children occur during sports activities?
31.8%
87
Children ages 17yo and younger represent what % of the total dental injuries that presented to US emergency rooms from 1990-2003? What age range comprise the majority of these ER visits?
80.6% Children younger than 7yo
88
What sports require protective equipment in the US?
- High school field hockey - Football - Ice hockey - Lacrosse - Wrestling (if student has braces)
89
What sport accounts for the most injuries in 7-12yo?
Baseball
90
What sport has the highest incidence of sports-related dental injuries for high school boys?
Basketball (2.4 per 100,000 athletic exposures)
91
What sport has the highest rate of injuries for high school girls?
Field hockey (3.5 per 100,000 athletic exposures)
92
Most common consumer sports products related to dental injuries in children?
- Bicycle - Playground equipment - Skates, inline skates - Trampolines
93
Is the rate of dental injuries in high school athletes higher in competition or practice?
3x higher in competition
94
Type I mouthguard
Custom-fabricated
95
Type II mouthguard
Mouth-formed (i.e. boil and bite)
96
Type III mouthguard
Stock Must be held in place with clenching the teeth
97
How should the fit of a custom mouthguard be for maximum protection?
Cover all teeth in at least one arch (usually the maxillary, less the third molar)
98
What is the appropriate thickness of a properly fitting mouthguard?
3mm
99
What percent of dental injuries involve the maxillary incisors?
50-90%
100
Majority of sport-related dental and orofacial injuries affect...?
- Upper lip - Maxilla - Maxillary incisors
101
Most common dental injuries in order of incidence?
- Lacerations - Crown fractures - Avulsions
102
Most common injury to **permanent teeth**?
- Crown fractures - Subluxations - Avulsions
103
Greater than __% of all dental injuries sustained by baseball, softball, and field hockey players are due to __ contact.
87% Player-object
104
Frequency of dental trauma is higher for children with increased overjet: **greater than __mm in the primary dentition**
3mm
105
Frequency of dental trauma is higher for children with increased overjet: **greater than __mm in the permanent dentition**
5mm
106
What type of mouthguard is recommended for Class III malocclusions?
Mandibular
107
What mouthguard type is most used amongst athletes?
Type II
108
What mouthguard type might be a good option for patients with orthodontic brackets, appliances, and periods of rapidly changing occlusion?
Type III
109
Establishing __ can prevent or reduce injury by better absorbing and distributing the force of impact?
Proper anterior occlusion of the maxillary and mandibular arches. Mouthguards may also reduce the incidence or severity of condylar displacement injuries as well as the potential for concussions.
110
Cranial nerve check: CN I
CN I - Olfactory Sense of smell w/ aromatics
111
Cranial nerve check: CN II
CN II - Optic Check visual acuity and light/dark
112
Cranial nerve check: CN III
CN III - Oculomotor Pupil reaction to light/ptosis
113
Cranial nerve check: CN IV
CN IV - Trochlear Check eye movement
114
Cranial nerve check: CN V
CN V - Trigeminal Check muscles of mastication
115
Cranial nerve check: CN VI
CN VI - Abducens Check range of movement of eyes
116
Cranial nerve check: CN VII
CN VII - Facial Check facial muscles and taste
117
Cranial nerve check: CN VIII
CN VIII - Auditory Check hearing (Weber, Rinne tests)
118
Cranial nerve check: CN IX
CN IX - Glossopharyngeal Gag reflex
119
Cranial nerve check: CN X
CN X - Vagus Check palatal function
120
Cranial nerve check: CN XI
CN XI - Accessory Check sternocleidomastoid, trapezius function
121
Cranial nerve check: CN XII
CN XII - Hypoglossal Check tongue function
122
Signs of bony fracture
- Change in occlusion - Inability to close - Step on mandibular border - Vertical laceration on alveolus - Facial asymmetry - Pain on mastication - Sublingual hematoma - Contusions
123
What type of fracture has an increased likelihood of occurrence if impact is directly on chin?
Condylar fracture
124
LeForte I fracture
Maxillary separation from midface
125
LeForte II fracture
Nasomaxillary fracture
126
LeForte III fracture
Cranial base facial separation, airway edema
127
Battles sign
LeForte III fracture Mastoid hematoma Posterior cranial fracture
128
Raccoon sign
LeForte III fracture Orbital hematoma Anterior cranial bone fracture
129
What might you observe with a skull fracture?
Cerebral spinal fluid (clear) in nose
130
Exposure time for soft tissue radiograph evaluating for tooth fragments in lip with sensor placed between the lip and the dental arch?
1/4 that of conventional radiographs
131
Exposure time for soft tissue radiograph evaluating for tooth fragments in lip with sensor placed on the cheek with lateral exposure?
1/2 that of conventional radiographs
132
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