Dentistry in a Nutshell > Trauma > Flashcards

Trauma Flashcards

(24 cards)

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1
Q

trauma stamp (8)

A

sinus
colour
TTP
mobility
EPT
ethyl chloride
percussion note (dull / high)
radiograph

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2
Q

tooth trauma with:
- displacement
- single tooth mobility
- radiographic sign of root #

A

ROOT #
- if coronal fragment displaced; reposition & confirm radiographically
- stabilise for 4wks with passive flexible splint (cervical # may need up to 4mths)
- do not start pulp therapy but monitor pulp status up to 1yr
- in mature teeth if # is above alveolar crest consider XLA & post core crown
- other tx options inc: orthodontic / surgical extrusion, crown lengthening or XLA

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3
Q

tooth trauma with:
- displacement
- single tooth mobility
- NO radiographic sign of root #

A

EXTRUSION
- reposition under LA & splint for 2wks
- extra 4wks if # of marginal bone
- monitor pulp status

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4
Q

tooth trauma with:
- displacement
- NO single tooth mobility
- multiple teeth moving as a unit

A

ALVEOLAR #
- reposition segment & splint with passive flexible splint for 4wks
- suture gingival lacerations & do not start root tx
- monitor pulpal status at follow up visits

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5
Q

tooth trauma with:
- displacement
- NO single tooth mobility
- NO multiple teeth moving as a unit
(INTRUSION)

A

if INCOMPLETE root formation:
- allow for re eruption without intervention for 4wks
- if no re eruption then orthodontic repositioning
- monitor pulp status, RCT if required

if COMPLETE root formation:
- <3mm allow for re eruption
- if no eruption at 8wks then surgical reposition & splint
- 3-7mm reposition surgically / orthodontically
- >7mm surgical reposition
- pulp death is likely, initiate RCT at 2wks or when tooth position allows
- use corticosteroid antibiotic cream or CaOH as intra canal medicament to prevent external resorption

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6
Q

tooth trauma with:
- displacement
- NO single tooth mobility
- NO multiple teeth moving as a unit
(LATERAL LUXATION)

A
  • reposition under LA & splint for 4wks using a passive & flexible splint
  • additional splinting may be required if # of marginal bone / alveolar socket wall
  • assess need for pulpal intervention at 2wks, therapy should be based on root formation
  • if carrying out endo therapy use corticosteroid antibiotic or CaOH as an intracanal medicament to prevent external resorption
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7
Q

tooth trauma with:
- no displacement
- mobility
- TTP

A

SUBLUXATION
- no tx needed
- monitor pulp status for at least 1yr

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8
Q

tooth trauma with:
- no displacement
- mobility
- not TTP
- # either none or above gingival margin

A
  • ENAMEL ONLY; depending on fragment size, bond fragment back on or restore with composite resin
  • ENAMEL-DENTINE; if available bond fragment back on after rehydrating in saline for 20 mins or restore with GIC/composite resin. if exposed dentine is within 0.5mm of pulp (pink but no bleeding) place CaOH liner & restore with GIC
  • ENAMEL-DENTINE-PULP; partial pulpotomy/pulp cap followed by bonding rehydrated fragment or GIC/ composite resin, if post required for crown retention then RCT first
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9
Q

tooth trauma with:
- no displacement
- mobility
- no TTP
- # below gingival margin (i.e. crown-root)

A
  • NO PULP EXPOSURE;
    stabilise mobile fragment, if not possible then XLA & cover with comp/GI. long term tx options inc: orthodontic extrusion of non mobile fragment +/- RCT, crown lengthening, XLA, auto transplantation, root submergence
  • PULP EXPOSURE;
    stabilise or XLA mobile fragment
    immature roots = carry out pulpectomy unless <1mm exposure & <24h then perform partial pulpotomy
    mature roots = pulpectomy + GI/comp restoration
    long term = RCT & permanent restoration
    other management options: orthodontic/surgical extrusion, crown lengthening, xla, auto transplantation, root submergence
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10
Q

tooth trauma with:
- no displacement
- no mobility

A

CONCUSSION
- no tx usually needed
- monitor pulp status for at least 1yr
- if excessive mobility then splint for 2wks

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11
Q

emergency advice for over the phone when avulsion

A
  1. reassure pt
  2. hold tooth by crown & avoid touching the root
  3. if tooth is visibly dirty rinse it gently with milk / saline / pt saliva & avoid scrubbing
  4. if possible replant the tooth immediately back into the tooth socket & get pt to gently bite down onto tissue / napkin
  5. if replantation not possible you can store the tooth in milk / saliva / saline / hank’s balanced salt solution (if these mediums are unavailable leave in water as still better than leaving in the air
  6. take pt to see dentist ASAP & bring tooth
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12
Q

how to manage avulsion in clinic

A
  1. clean & soak tooth in saline to remove dead cells from root surface
    - if tooth been out of mouth for >60mins then remove attached non viable soft tissue with gauze & consider carrying out root tx prior to reimplantation ( warn of akylosis)
  2. give LA & irrigate socket with saline
  3. reposition any socket # with suitable instrument
  4. using gently pressure reimplant tooth & suture any gingival lacerations
  5. after examiming clinically take radiograph to esnure normal position of replanted tooth
  6. apply flexible splint for 2wks
  7. prescribe antibiotics (if o12 teracycline doxycycline 2x daily for 7 days or if u12then amoxicillin
  8. after 7-10 days start RCT; place CaOH for 4wks as intracanal medicament, or immediately after reimplantaion place antibiotic corticorsteroid past for 2 wkks then compete RCT
    - 2wks follow iup, remove splint, clinical & radiographic contol
    - clinical & radiographic control after 1 3 6 12 months
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13
Q

when dealing with avulsion what 2 things to consider:
a) open apex / immature root
b) post op advice

A

a) same steps as normal but avoid RCT unless there are clinical & radiographic evidence of pulp necrosis
aim is revascularisation of the pulp space

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14
Q

when dealing with avulsion what post op advice

A
  • avoid contact sports
  • soft diet for 2wks
  • brush teeth after every meal the soft toothbrush
  • use CHX 0.1% MW x2 daily for 7 days `
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15
Q

process of splinting

A
  • take detailed medical dental & accident hx of trauma (safeguarding issues)
  • examine head & neck for EO & IO bony & soft tissue injuries i.e. lacerations / haematoma and missing tooth fragments e.g. embedded in lip
  • assess teeth with trauma & surrounding teeth (colour / mobility / tenderness)
  • explain splinting process to parent / guardian
  • +/- LA reposition fragment & any bony segments (for root # confirm position radiographically) & suture any gingival lacerations
  • splint using appropriate wire 1 tooth either side of traumatised tooth
  • give OHI, soft diet for 2wks, CHX MW 2wks & advise parent on discolouration of teeth & any pain
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16
Q

splinting for root #

Study These Flashcards
A

passive flexible
4wks - 4wk splint removal followed by review at 6-8wks, 4, 6, 12mths
4mths if near cervical - 4mth splint removal then review at 12wks, 6, 12mths

17
Q

splinting for subluxation

Study These Flashcards
A

passive flexible
2wks
remove at 2wks review at 12wks 6, 12mths

18
Q

splinting for extrusive luxation

Study These Flashcards
A

passive flexible
2wks
remove at 2wks review at 4, 8, 12wks 6, 12 mths

19
Q

splinting for lateral luxation

Study These Flashcards
A

passive flexible
4wks
post 2wks endodontic evaluation remove splint at 4wks review 8, 12wks 6, 12mths

20
Q

splinting for intrusive luxation

Study These Flashcards
A

passive flexible
4wks
1. incomplete root formation = allow for re eruption without intervention for 4wks if no re eruption then orthodontic splinting
2. complete root formation =
- <3mm allow for re eruption but if none within 8wks then surgical repositioning & splint
- 3-7mm reposition surgically / orthodontically
- >7mm surgical repositioning

21
Q

splinting for alveolar #

Study These Flashcards
A

rigid flexible
4wks
remove splint at 4wks review 6-8wks, 4, 6, 12mths

22
Q

subluxation

Study These Flashcards
A

injury to periodontal tissues
tooth is mobile but has not moved from original position

23
Q

lateral luxation

Study These Flashcards
A

traumatic displacement of tooth in any direction other than axially

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