4133416
Description
Flashcards by Michael Brown, updated more than 1 year ago
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Created by Michael Brown
about 9 years ago
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| Question | Answer |
| What should a trauma pt be asked? | Where, how, when the accident occurred Any need to tetanus? Were they unconscious? - nausea, vomit, amnesia may indicate a brain injury -> A&E |
| What is the trama stamp? | C - Colour D- Displacement - NB only at 1st visit M - Mobility S - Sinus/Tenderness in sulcus E - Electric Pulp Test T - Thermal Pulp Test T - Tenderness to Percussion R - Radiographs |
| What factors affect prognosis? | Pt age ∴ apex open/closed Injury type Associated injuries Time passed until Rx Infection |
| What general advice is given to a trauma pt? | Soft diet Avoid sports for 2/52 Use soft TB after meals CHX rinse 2x daily for 1/52 Rv apts important |
| How may crown and root fractures be classified? | CROWN -> uncomplicated ∴ enamel or enamel and dentine complicated ∴ inc.pulp ROOT -> apical 1/3 mid 1/3 coronal 1/3 CROWN-ROOT -> pulp or no pulp involvement |
| Detail the management of an uncomplicated crown # | Assess -> history, exam - trauma stamp Account for missing fragments -> if not, poss.inhalation? Rebond tooth fragment -> NB discolouration over time /or/ Composite restoration +/- CaOH Rv |
| How is trauma monitored? What are you looking for? | Trauma Stamp Follow up apts at 1/12, 3/12, 6/12 and 1year Monitor re: root development, resorption, necrosis, injury to permanent successors |
| How is a complicated crown # managed? What factors are important in deciding Rx? | Assess -> history, exam - trauma stamp If small exposure and <24 hours -> direct pulp cap and restore If large exposure and/or >24 hours -> pulpotomy/pulpectomy and restore |
| Describe a pulpotomy | Decide if partial (Cvek) or full pulpotomy BOTH -> history, exam, LA, isolation PARTIAL -> remove 2-3mm circumference of exposure Assess bleeding -> if stopped: CaOH and restore if not, may need full pulpotomy FULL -> access and remove coronal pulp w/s.speed/excavator Control haemorrhage -> ferric sulphate ONLY IN PRIMARY TEETH DUE TO STAIN otherwise CWR If still bleeding, may require pulpectomy CaOH/MTA @ pulp stumps Restore (SSC in primary molars) |
| Name the different splints and duration of use for trauma cases | SEA LAM CD FLEX 2/52 - Sublux, Extrusion, Avulsion FLEX 4/52 - Lux, Apical 1/3 root, Mid 1/3 root FLEX 4/12 - Coronal 1/3 root RIGID 4/52 - Dento-alveolar # |
| What is the difference between a flexible and a rigid splint? | Same material (ortho wire, composite bonded) FLEX - 1 tooth either side of all traumatised teeth RIGID - 2 teeth either side |
| How are root fractures managed? What factors determine Rx? | Displacement and mobility None - monitor and gen.advice Displaced/Mobile - Reposition, splint depends on type of root # If RCT required, RCT to # line. Fragment will remain/resorb |
| What type of root # healing can occur? | HEALING Calcified -> # close together ∴ may be visible Connective Tissue -> # line seen but w/rounded edges Bone -> bony bridge separates fragments NON-HEALING Granulation tissue and loss of vitality |
| What is the treatment of a crown-root #? | XLA /or/ Extrusion if more than 50:50 crown:root |
| Define concussion | Injury to the PDL but with NO mobility or displacement |
| Define subluxation | Injury to PDL with mobility but NO displacement |
| How are concussions and subluxations managed? | Trauma stamp Monitor No Rx /or/ FLEX 2/52 Pt advice |
| Define extrusion | Partial displacement OUT of socket PDL damage NO bone damage |
| Define lateral luxation | Partial displacement from socket in ALL OTHER directions PDL damage 1 surface alveolar bone # |
| Define intrusion | Displacement IN to socket PDL and bone damage |
| How is an intrusion managed? What factors define Rx? | Open vs closed apex <6mm> OPEN APEX <6mm disimpact and allow to erupt >6mm poss. surgical reposition FLEX 4/52 CLOSED APEX <6mm disimpact and move w/ortho >6mm surgical reposition FLEX 4/52 |
| What advice would you give to a patient over the phone about an avulsion? | Don't panic Handle crown NOT root Check if tooth is whole or not Rinse under cold water Replant ASAP If replanted, gently bite on handkerchief /or/ Store in milk/saliva/saline Visit GDP ASAP |
| What are the critical factors for an avulsed tooth? | Amount of damage to PDL & pulp Extra-alveolar dry time - EADT <60mins< Extra-alveolar time - EAT Storage medium |
| How do you manage an avulsed tooth w/ EADT <60mins? | FOR OPEN AND CLOSED APICES Assess, history, trauma stamp Account for all tooth tissue If replanted, remove Do not handle root Rinse PDL and apex w/saline LA Recontour and irrigate socket as needed Gently replant Confirm position radiographically FLEX splint 2/52 ABs/CHX/Tetanus as needed Rv |
| How do you manage an avulsed tooth w/ EADT <60mins but EAT >45mins? | SAME FOR CLOSED AND OPEN APICES Replant as normal FLEX 2/52 Extirpate before splint removal Dress w/ledermix/NSCaOh for 1/52 OPEN APEX ->Place MTA to get apical stop, then obturate CLOSED APEX -> Obturate as needed |
| How do you manage an open apex avulsed tooth with EAT <45mins? | Replant as usual Monitor as may revascularise alone RCT as needed if no improvement |
| How do you manage an avulsed tooth with EADT >60mins? | SAME FOR OPEN AND CLOSED APICES Remove necrotic PDL Soak in NaF for 20mins Extirpate and obturate OUTSIDE mouth Replant FLEX 4/52 |
| How is a dento-alveolar # managed? | Assess, exam, trauma stamp Reposition under LA RIGID 4/52 Monitor |
| Explain the four types of resorption | 1. External Surface -> PDL damage that heals ∴ non-progressive e.g. excessive orthodontics 2. External Inflammatory -> Progressive, PDL damage. Necrotic pulp tissue via dentinal tubules 'feeds' resorption. Acidic environment ∴ osteoclasts stimulated Indistinct root surface but 'tramlines' intact 3. Internal Inflammatory -> Progressive, due to partially non-vital tooth Vital part of tooth 'feeds' resorption Indistinct 'tramlines' but root surface intact 4. Replacement Resorption -> Ankylosis Severely damaged PDL and cementum ∴ no normal healing Tooth resorbs as part of bone remodelling and becomes fused to bone |
| How is resorption managed? | External Surface -> extripate NSCaOh every 3/12 up to 1 year Once resorption stops, RCT If still progressive, plan for replacement Internal Surface -> same management as ext. Ankylosis -> monitor for PA path. Other Rx re: aesthetics |
| What is pulp canal obliteration? | Response of a vital pulp to trauma Progressive hard tissue formation in pulp Gradual narrowing until obliteration Rx - monitor |
| What colour changes can occur with trauma? | Immediate = Pink -> bleeding into dentinal tubules Can resolve If not, suspect necrosis Days = Brown/Black -> pulp necrosis Weeks/Months = yellow/opaque -> excessive tertiary dentine formation and poss.obliteration |
| How are primary tooth crown #s managed? | Uncomplicated -> restore Complicated -> RCT/XLA Crown-Root -> XLA and possibly leave root fragment if difficult to retrieve |
| How are primary teeth root #s managed? | Undisplaced and no mobility -> monitor Others -> XLA of fragments retrievable Leave apical root fragments to resorb and avoid damaging permanent successor |
| How are primary concussion, sublux, lux. and avulsion injuries managed? | Conussion and sub.lux. -> monitor Lat.Lux -> XLA if affecting occlusion. Monitor if not Intrusion -> PA to localise Assess root tip position If BUCCAL -> leave or XLA after 6/12 w/no eruption If PALATAL -> XLA Extrusion -> XLA Avulsion -> DO NOT REPLANT check for fragments |
| What effects can trauma have on primary teeth? | Discolouration -> colour and presentation time dictates Rx Infection Resorption -> XLA Delayed exfoliation -> XLA |
| What effects on the permanent dentition can primary tooth trauma have? | Varies w/age -> younger = greater damage due to developing permanent tooth Enamel defects e.g. hypomineralisation, hypoplasia Abnormal morphology e.g. dilaceration Delayed eruption Arrested development Odontome formation Ectopic |
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