Dental Trauma Case Presentation

Report
AUSTRALASIAN COLLEGE FOR EMERGENCY MEDICINE
54th FELLOWSHIP EXAMINATION
16th October 2014
Written Exam:
2 SAQs and 5 MCQs
Clinical Exam
2 OSCEs
Duration: 30 minutes, 3 teams
SAQ 1
Case Stem:
This is Logan. He is from Logan.
He drives a Holden.
On weekends he also sells…
SAQ 1
Case Stem:
This is Logan. He is from Logan.
He drives a Holden.
On weekends he also sells…
vitamins and supplements.
SAQ 1
Sat night
watching TV on couch
4 guys bashed him up for no reason
SAQ 1. Describe the dental injuries in this photo. (2 minutes)
Dental Trauma
3 take home points
1. Two groups of dental trauma: Fractures & Luxations
2. Dental Box with 2 types of cement: Calcium & GIC
- “Fractures = Calcium to put a Cap”
- “Luxations = GIC to close the Gap”
3. Avulsions: <1hr, Saliva/Milk, Splint
Dental Trauma
2 groups of dental trauma:
1. Hard Dental tissue injury = FRACTURES
What Ellis class is the fracture of tooth 11?
What Ellis class is the fracture of tooth 21?
Clinical significance:
Class 2 and 3 need emergency capping to reduce risk of pulp infection
Dental Trauma
Two groups of dental trauma:
2. Periodontal tissue injury = LUXATIONS
4 types of luxation
SUBLUX = loose but no displacement
LATERAL = Sideways displacement
INTRUSIVE = into socket
EXTRUSIVE = partially out of socket
Avulsion = tooth completely out of socket
SAQ 1. Describe Logan’s dental injuries.
Vocab:
Luxation – lateral, extrusive, intrusive
Avulsion
Complex dental injury involving teeth 22 and 23 and surrounding
gingiva, lip and adjacent alveolar bone. Complete avulsion of tooth 23
with exposed peri-odontal ligament cells and possible Ellis 4 root
fracture. Anterior displacement of tooth 22 with intrusive luxation.
SAQ 2a. Describe and interpret Logan’s OPG. (1 minute)
SAQ 2a. Describe and
interpret Logan’s OPG.
REPORT:
Oblique fracture is seen extending through the left maxilla.
Movement artefact obscuring the apices of the upper jaw teeth.
Previous dental work noted.
No mandibular fracture is identified.
The temporomandibular joints are normally opposed.
No air-fluid level within the right maxillary antra.
Different Case Stem = but same location of pain.
37yr aboriginal woman, No trauma, left toothache 4 days, left upper
gingival swelling, and fevers.
SAQ 2b. Describe and interpret this OPG (1 minute)
REPORT:
Multiple missing teeth. Multiple dental fillings. Multiple dental caries.
Lucency surrounding root of tooth 23 concerning for dental abscess.
Dental Trauma
MCQ 1
In avulsion dental injuries, how soon should the tooth
be re-inserted to maximize the viability of the periodontal ligament cells?
1hr, 2hrs, 3hrs, 4hrs
Dental Trauma
MCQ 1
In avulsion dental injuries, how soon should the tooth be
re-inserted to maximize the viability of the peri-odontal
ligament cells?
1hr, 2hrs, 3hrs, 4hrs
Answer: Aim to reinsert tooth with intact viable periodontal cells within 1 hr. Timing – 85-97% tooth survival
if reimplanted within 5 mins, <1% survival if >60mins coz
periodontoid ligament cells dead and apex socket closes
over. If place tooth in isotonic solution = increase viability
time to 4-6 hrs.
Dental Trauma
MCQ 2
All of the following are an appropriate transportation
medium for an avulsed tooth, EXCEPT
Saliva
milk
contact lens solution
chocolate yoghurt
Dental Trauma
MCQ 2
All of the following are an appropriate transportation medium
for an avulsed tooth, EXCEPT
Saliva,
milk,
contact lens solution,
chocolate yoghurt
Answer: Maintain periodontal cells via saliva, milk (isotonic,
mg and ca), sterile saline, contact lens solution. NOT soy,
choc milk, juice. Prolongs viability of cells to 4-6hrs.
Dental Trauma
MCQ 3
When handling an avulsed tooth you should always:
Scrub the root clean,
hold only the crown,
boil the tooth for sterilization,
Lick your fingers first
Dental Trauma
MCQ 3
When handling an avulsed tooth you should always:
Scrub the root clean,
hold only the crown,
boil the tooth for sterilization,
Lick your fingers first
Answer: do not scrub root, only handle crown, thus
avoid disruption of periodontal ligament cells
Dental Trauma
MCQ 4
An infra-orbital nerve block in dental trauma results in
local anaesthesia to which teeth:
Front 2 incisors 11 and 21,
Maxillary Incisors / Canine / Molars,
Mandibular teeth 31 to 35,
Maxillary teeth 21 to 25
Dental Trauma
MCQ 4
An infra-orbital nerve block in dental trauma results in
local anaesthesia to which teeth:
Front 2 incisors 11 and 21,
Maxillary Incisors / Canine / Molars,
Mandibular teeth 31 to 35,
Maxillary teeth 21 to 25
Answer: infra-orbital nerve block (maxillary teeth 15), individual maxillary teeth local block, inferioralveolar block (all mandibular teeth)
Dental Trauma
MCQ 5
To splint an avulsed tooth to an adjacent tooth, all of
the following methods are acceptable EXCEPT:
Blutac and tinfoil,
Using Glass Ionomer Cement,
Using Calcium hydroxide cement,
Mouth guard
Dental Trauma
MCQ 5
To splint an avulsed tooth to an adjacent tooth, all of the following methods are
acceptable EXCEPT:
Blutac and tinfoil, Glass Ionomer Cement, Calcium hydroxide, Mouth guard
Remember:
2 types of cement in Dental Box
• Calcium Hydroxide = FRACTURES
• Glass Ionomer Cement = LUXATIONS
“Calcium = CAP”
“GIC = GAP”
Calcium hydroxide for
“capping” a tooth
with an Ellis 2 or 3
dental fracture.
GIC to splint an
avulsed tooth that
has left a “gap”
Dental Trauma
MCQ 5
To splint an avulsed tooth to an adjacent tooth, all of the following methods are
acceptable EXCEPT:
Blutac and tinfoil, Glass Ionomer Cement, Calcium hydroxide, Mouth guard
Remember:
2 types of cement in Dental Box
• Calcium Hydroxide = FRACTURES
–
–
–
Fractures only = Ellis 2 or 3 only with pulp exposed
Calcium Hydroxide for pulp capping only
4 benefits: antibacterial, localized buffer to
neutralize acid, binds strongly to dentin, alters the
physical matrix of dentin to decrease
demineralisation
“Calcium = CAP”
“GIC = GAP”
Calcium hydroxide for
“capping” a tooth
with an Ellis 2 or 3
dental fracture.
GIC to splint an
avulsed tooth that
has left a “gap”
Dental Trauma
MCQ 5
To splint an avulsed tooth to an adjacent tooth, all of the following methods are
acceptable EXCEPT:
Blutac and tinfoil, Glass Ionomer Cement, Calcium hydroxide, Mouth guard
Remember:
2 types of cement in Dental Box
• Glass Ionomer Cement = LUXATIONS
–
–
–
–
Splinting of Luxations & Avulsions, NOT fracture
pulp capping
polymer of silicon, fluoride and aluminum.
3 benefits: tooth coloured, binds to strongly to
enamel, releases fluoride.
Cons: lower compressible strength thus mainly for
outside of tooth fillings or splinting, not
mastication surface of tooth, thus not for capping
“Calcium = CAP”
“GIC = GAP”
Calcium hydroxide for
“capping” a tooth
with an Ellis 2 or 3
dental fracture.
GIC to splint an
avulsed tooth that
has left a “gap”
Dental Trauma
OSCE 1
CLINICAL SCENARIO STEM:
You are an emergency physician working in a rural district hospital.
A 34yr old man called Logan has been assaulted in his home and presents with a dental avulsion of his left tooth.
You have a dental trauma box and no other assistance.
INSTRUCTIONS:
You are required to use the contents of the dental box to reinsert and splint his tooth into anatomical position.
You have 4 minutes.
Dental Trauma
OSCE 2
CLINICAL SCENARIO STEM:
You are an emergency physician working in a rural district hospital.
A 34yr old man called Logan has been assaulted in his home and presents with a dental fracture of his left
tooth with exposed pulp.
You have a dental trauma box and no other assistance.
INSTRUCTIONS:
You are required to use the contents of the dental box to apply a dental cap to prevent a pulp infection.
You have 4 minutes.
References and Resources:
- Dental Trauma Box. Dr Tony Skapetis.
Clinical Senior Lecturer in the Faculty of
Dentistry at Sydney University, BDS,
MEd, PhD, Dentistry/Medical Education
- Emergency Dental, Handbook for
Medical practitioners. 2010. Dr Tony
Skapetis.
- Classification of Dental Trauma &
Management of dental avulsions:
Powerpoint slides by Tony Skapetis
- Paul Lawless @ Annerley Meats for the
teeth
Dental Trauma
3 take home points
1. Two groups of dental trauma: _____ & _____
2. Dental Box with 2 types of cement: ____ & ____
- “Fractures = ______ to put a Cap”
- “Luxations = GIC to close the ______”
3. Avulsions: ____, milk/saliva, _____
Dental Trauma
3 take home points
1. Two groups of dental trauma: Fractures & Luxations
2. Dental Box with 2 types of cement: Calcium & GIC
- “Fractures = Calcium to put a Cap”
- “Luxations = GIC to close the Gap”
3. Avulsions: <1hr, Saliva/Milk, Splint
Dental Trauma
THE END
BEFORE
AFTER
AUSTRALASIAN COLLEGE FOR EMERGENCY MEDICINE
54th FELLOWSHIP EXAMINATION
16th October 2014
END OF THE EXAM.
EVERYONE PASSED !

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