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Pedo OSCE > Trauma to primary and permanent teeth > Flashcards

Trauma to primary and permanent teeth Flashcards

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
Q

Which test is used to evaluate concussion to tooth injuries?

A

Testing:

Percussion

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26
Q

What are the primary categories of dental trauma?

A

Fracture

Luxation

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27
Q

What is an enamel infarction?

A

Crack

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28
Q

What is an uncomplicated crown fracture?

A

Fracture of enamel and/or dentin in the crown without pulp exposure
aka Class I and II

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29
Q

What is a complicated crown fracture?

A

Fracture of enamel/dentin in the crown with pulp exposure

aka Class III

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30
Q

What is an uncomplicated crown-root fracture?

A

Fracture of enamel and/or dentin of crown and root without pulp exposure

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31
Q

What is a complicated crown-root fracture?

A

Fracture of enamel and/or dentin of crown and root with pulp exposure

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32
Q

What is an isolated root fracture?

A

Fracture of root only

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33
Q

What is the emergency treatment for class I fractures in primary teeth?

A

Emergency Tx:
Do nothing
Smooth rough edges
Restore with composite

34
Q

What is the emergency treatment for class I fractures in permanent teeth?

A 
Emergency Tx:
Do nothing
Smooth rough edges
Restore with composite
Follow up in 4 wks
35
Q

What is the emergency treatment for class II fractures in primary teeth?

A 
Emergency Tx:
Do nothing
Composite/GI band-aid 
Monitor for symptoms
Restore with composite/GI
36
Q

What is the emergency treatment for class II fractures in permanent teeth?

A 
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
Q

What is the emergency treatment for class III fractures in primary teeth?

A 
Emergency Tx:
Dependent primarily on behavior
Tx options include--
Partial pulpotomy
Pulpectomy
Extraction
38
Q

What is the emergency treatment for class III fractures in permanent teeth?

A 
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
Q

When does apex closure occur for:

Max centrals

A

Apex closure Mx:

10 years

40
Q

When does apex closure occur for:

Max laterals

A

Apex closure Mx:

11 years

41
Q

When does apex closure occur for:

Max canines

A

Apex closure Mx:

13-15 years

42
Q

When does apex closure occur for:

Mandibular centrals

A

Apex closure Md:

9 years

43
Q

When does apex closure occur for:

Mandibular laterals

A

Apex closure Md:

10 years

44
Q

When does apex closure occur for:

Mandibular canines

A

Apex closure Md:

12-14 years

45
Q

What are the criteria for success for Cvek partial pulpotomy?

A 
No clinical signs or symptoms
No radiographic pathology
Continued development of immature roots
Formation of calcific barriers
Sensitivity to EPT
46
Q

What are the typical sequelae of dental trauma?

A

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
Q

What do we ask parents to watch out for in terms of dental trauma?

A 
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
Q

What is the appropriate treatment for discoloration of primary teeth?

A

NO TREATMENT NECESSARY

49
Q

What are the primary results of chin trauma?

A

Posterior crown fractures
Mandibular condylar fractures
Cervical spine injury

50
Q

What is the treatment for isolated root fractures?

A

No tx
Splint (if increased mobility) for 4 wks
Splint for 4 months if the fracture is more cervical

51
Q

When there are more traumatic injuries than one in a patient, what determines the follow-up?

A

The most critical injuries determine follow-up duration

Always take initial x-ray from all traumatized teeth

52
Q

What is the emergency treatment for a primary tooth concussion?

A

Emergency tx:
No emergency tx
Discuss potential sequelae with parents
Monitor for symptoms

53
Q

What is the emergency treatment for a permanent tooth concussion?

A 
Emergency tx:
No emergency tx
Discuss potential sequelae with parents
Monitor for symptoms
Follow up in 4 wks
54
Q

What is subluxation?

A

An injury to tooth-supporting structures with abnormal loosening, but without displacement of the tooth

55
Q

What is the emergency treatment for subluxation of a primary tooth?

A

Emergency tx:
No emergency tx
Monitor for symptoms
Tooth may tighten

56
Q

What is the emergency treatment for subluxation of a permanent tooth?

A 
Emergency tx:
No emergency tx
Monitor for symptoms 
Tooth may tighten
Follow up in 4 wks
57
Q

What is the follow-up for subluxation?

A

Follow up:
2-4 wks
Radiograph 1 month

58
Q

What is intrusive luxation?

A

displacement of the tooth into the alveolar bone

this injury is typically accompanied by comminution or fracture of the alveolar socket

59
Q

What is the emergency treatment for intrusion of primary teeth?

A

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
Q

Labial displacement of intruded primary teeth in an occlusal radiograph will appear…

A

Elongated in occlusal radiograph

61
Q

Lingual displacement, towards a developing tooth bud, of an intruded primary tooth in an occlusal radiograph will appear…

A

Shortened in occlusal radiograph

62
Q

What to expect when developing teeth are damaged?

A 
Discoloration
Enamel hypoplasia
Crown or root dilaceration
Arrested development
Disturbance in eruption
63
Q

What ages hold the greatest risk for damage to developing teeth?

A

1-3 years old

64
Q

What is the emergency treatment for intrusion of permanent teeth with an open apex?

A

Emergency tx:
Open apex- up to 7mm- spontaneous eruption
Open apex- more than 7mm- orthodontic or surgical repositioning

65
Q

What is the emergency treatment for intrusion of permanent teeth with a closed apex?

A

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
Q

What is the follow up treatment for permanent teeth that experience intrusion?

A

Pulpectomy- remove pulp and fill with CaOH within 7-14 days

Complete gutta percha fill in 2 months if no inflammatory resorption

67
Q

What is the emergency treatment for extruded primary teeth?

A 
Emergency tx:
<3mm
--Reposition no splint
--Spontaneous alignment
Severe
--Extract

considerations: occlusal interference, aspiration risk

68
Q

What is the emergency treatment for extruded permanent teeth?

A

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
Q

What is the emergency treatment for primary teeth that are laterally luxated?

A

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
Q

What is the emergency treatment for permanent teeth that are laterally luxated?

A 
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
Q

What is emergency treatment for avulsion of primary teeth?

A

None, NEVER reimplant primary teeth

72
Q

What is the emergency treatment for avulsion of permanent teeth?

A

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
Q

How to manage root surface of avulsed permanent teeth?

A

Maintain PDL cell vitality
Keep moist in HBSS
Do not handle root surface
Gently remove persistent debris

74
Q

How to manage socket of avulsed teeth?

A

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
Q

How to manage soft tissue around avulsed teeth?

A

After repositioning…

Tight suture any soft tissue lacerations, particularly in the cervical region

76
Q

How to splint teeth?

A

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
Q

What are the home care instructions for splinted teeth?

A

NO BITING on splinted teeth
Soft diet
Good oral hygiene

78
Q

What is the follow up for avulsed permanent teeth?

A

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
Q

How to manage avulsion of immature permanent teeth?

A

Replant ASAP
Splint
Recall every 3-4 wks
At first sign of necrosis, extirpate pulp and do revascularization procedure

80
Q

What is the revascularization procedure?

A

Stimulation of bleeding through apex
Place MTA on top of clot
Allows continued root development and root wall thickening

81
Q

What is the main thing to consider after a tooth fracture?

A

Where is the tooth fragment

  • -Ground
  • -Imbedded in soft tissue
  • -Ingested
  • -Aspirated
82
Q

What are the clinical signs of aspiration?

A 
No symptoms
Initial choking and coughing
Irritating cough
Wheezing
Unilateral obstructive emphysema
Atelectasis
Pulmonary suppuration

Pedo OSCE (6 decks)

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