Karteikarten
Paediatrics - Trauma
Karten in diesem Stapel (38)
- 1What 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 - 2What 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 - 3What factors affect prognosis?Pt age ∴ apex open/closed
Injury type
Associated injuries
Time passed until Rx
Infection - 4What 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 - 5How 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 - 6Detail 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 - 7How 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 - 8How 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 - 9Describe a pulpotomyDecide 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) - 10Name the different splints and duration of use for trauma casesSEA 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 # - 11What 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 - 12How 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 - 13What 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 - 14What is the treatment of a crown-root #?XLA
/or/
Extrusion if more than 50:50 crown:root - 15Define concussionInjury to the PDL but with NO mobility or displacement
- 16Define subluxationInjury to PDL with mobility but NO displacement
- 17How are concussions and subluxations managed?Trauma stamp
Monitor
No Rx /or/ FLEX 2/52
Pt advice - 18Define extrusionPartial displacement OUT of socket
PDL damage
NO bone damage - 19Define lateral luxationPartial displacement from socket in ALL OTHER directions
PDL damage
1 surface alveolar bone # - 20Define intrusionDisplacement IN to socket
PDL and bone damage - 21How 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 - 22What 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 - 23What 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 - 24How 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 - 25How 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 - 26How 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 - 27How 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 - 28How is a dento-alveolar # managed?Assess, exam, trauma stamp
Reposition under LA
RIGID 4/52
Monitor - 29Explain the four types of resorption1. 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 - 30How 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 - 31What is pulp canal obliteration?Response of a vital pulp to trauma
Progressive hard tissue formation in pulp
Gradual narrowing until obliteration
Rx - monitor - 32What 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 - 33How are primary tooth crown #s managed?Uncomplicated -> restore
Complicated -> RCT/XLA
Crown-Root -> XLA and possibly leave root fragment if difficult to retrieve - 34How 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 - 35How 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 - 36What effects can trauma have on primary teeth?Discolouration -> colour and presentation time dictates Rx
Infection
Resorption -> XLA
Delayed exfoliation -> XLA - 37What 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 - 38—
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- Der Nutzer hat seine Fachbereichs-Information gelöscht. Karteikarten am Paediatrics - Trauma, erstellt von Gelöschter Nutzer am 05/04/2017.
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- Erstellt von Michael Brown · 27 Nov 2015
- Kopiert von Megan Geib · 5 Apr 2017
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