Trauma, pulp, and diagnosis decisions

Work through trauma, pulpal decisions, and a diagnostic differential out loud.

90 minutes in 4 steps. Covers Trauma, emergencies & surgery, Pulpal diagnosis & therapy, Diagnosis, pathology & imaging.

Learning objectives

Distinguish primary from permanent trauma and pulp pathways.
Keep lesion diagnosis provisional until the required findings are available.

Rehearse one step at a time

Full agenda and answer review

Step 1, 30 minutes
Trauma case, then the primary-tooth version.
An 8-year-old fell off a bike an hour ago. The upper right permanent central incisor is displaced palatally and locked firm. No loss of consciousness.
Change one thing
Now it is a 3-year-old with an intruded primary incisor. Why can’t you reuse the plan?
Show changed plan
Changed plan · authored self-check
- Use the primary-intrusion pathway: allow spontaneous repositioning rather than applying permanent lateral-luxation repositioning and splinting.
- Arrange prompt assessment by a child-oriented trauma team, document baseline findings, and explain possible effects on the permanent successor. Direction toward the tooth germ alone is not an extraction indication.
- Provide home-care advice and injury-specific follow-up; new swelling, a sinus tract, pain, or other infection signs require reassessment.
Sources
- Primary trauma
Review this theme and its sources
Step 2, 25 minutes
Two pulp cases side by side: primary versus permanent.
Two deep carious molars: (a) a 6-year-old’s lower primary second molar with brief pain to cold, no swelling; (b) a 9-year-old’s lower permanent first molar with spontaneous pain and a normal periapex.
Change one thing
(a) now has a draining sinus tract and a furcation radiolucency. What are your options?
Show changed plan
Changed plan · authored self-check
- A sinus tract and furcation radiolucency indicate infected, nonvital disease; indirect pulp treatment and vital pulpotomy no longer fit.
- Assess restorability, root resorption, remaining tooth life, and the successor. Consider pulpectomy for a maintainable tooth; extract when nonrestorable or the overall prognosis does not justify retention.
- Consider LSTR only for selected teeth with significant preoperative root resorption (external >1 mm and/or internal), with planned temporary retention up to 12 months when extraction is deferred. Monitor closely in the first year; if retained longer, continue clinical surveillance and radiographs at least every 12 months. Discuss space consequences rather than plan multiyear retention solely from the child’s age.
Sources
- Primary nonvital pulp
Review this theme and its sources
Step 3, 20 minutes
Oral lesion: describe it, build a differential, decide next steps.
A 10-year-old has a painless, bluish, fluctuant swelling on the lower lip that has come and gone for three weeks. They bite their lip.
Change one thing
The same kind of swelling is in the floor of the mouth. What is it likely to be, and who manages it?
Show changed plan
Changed plan · authored self-check
- A ranula becomes a leading working diagnosis because the swelling is in the floor of the mouth; location alone does not confirm it.
- Assess size, depth, symptoms, and the differential. Refer to an oral surgeon or appropriate specialist when investigation or treatment exceeds your scope; do not assume a routine lower-lip excision applies.
- Document reassessment and definitive diagnostic planning. The prompt supplies no lesion size or extent, so it cannot determine the operation.
Sources
- Oral pathology
Review this theme and its sources
Step 4, 15 minutes
Check one uncertain point in a source and repeat the answer concisely.

To finish

State how dentition, pulp status, and lesion location change the plan; name the finding that would require referral.

Trauma case, then the primary-tooth version.

An 8-year-old fell off a bike an hour ago. The upper right permanent central incisor is displaced palatally and locked firm. No loss of consciousness.

Show changed plan

Changed plan · authored self-check

Use the primary-intrusion pathway: allow spontaneous repositioning rather than applying permanent lateral-luxation repositioning and splinting.
Arrange prompt assessment by a child-oriented trauma team, document baseline findings, and explain possible effects on the permanent successor. Direction toward the tooth germ alone is not an extraction indication.
Provide home-care advice and injury-specific follow-up; new swelling, a sinus tract, pain, or other infection signs require reassessment.

Sources

Primary trauma

Review this theme and its sources

Two pulp cases side by side: primary versus permanent.

Two deep carious molars: (a) a 6-year-old’s lower primary second molar with brief pain to cold, no swelling; (b) a 9-year-old’s lower permanent first molar with spontaneous pain and a normal periapex.

Show changed plan

Changed plan · authored self-check

A sinus tract and furcation radiolucency indicate infected, nonvital disease; indirect pulp treatment and vital pulpotomy no longer fit.
Assess restorability, root resorption, remaining tooth life, and the successor. Consider pulpectomy for a maintainable tooth; extract when nonrestorable or the overall prognosis does not justify retention.
Consider LSTR only for selected teeth with significant preoperative root resorption (external >1 mm and/or internal), with planned temporary retention up to 12 months when extraction is deferred. Monitor closely in the first year; if retained longer, continue clinical surveillance and radiographs at least every 12 months. Discuss space consequences rather than plan multiyear retention solely from the child’s age.

Sources

Primary nonvital pulp

Review this theme and its sources

Oral lesion: describe it, build a differential, decide next steps.

A 10-year-old has a painless, bluish, fluctuant swelling on the lower lip that has come and gone for three weeks. They bite their lip.

Show changed plan

Changed plan · authored self-check

A ranula becomes a leading working diagnosis because the swelling is in the floor of the mouth; location alone does not confirm it.
Assess size, depth, symptoms, and the differential. Refer to an oral surgeon or appropriate specialist when investigation or treatment exceeds your scope; do not assume a routine lower-lip excision applies.
Document reassessment and definitive diagnostic planning. The prompt supplies no lesion size or extent, so it cannot determine the operation.

Sources

Oral pathology

Review this theme and its sources

Learning objectives

Rehearse one step at a time

Trauma case, then the primary-tooth version.

Check your answer

Changed plan · authored self-check

Sources

Two pulp cases side by side: primary versus permanent.

Check your answer

Changed plan · authored self-check

Sources

Oral lesion: describe it, build a differential, decide next steps.

Check your answer

Changed plan · authored self-check

Sources

Check one uncertain point in a source and repeat the answer concisely.

To finish

Learning objectives

Rehearse one step at a time

Trauma case, then the primary-tooth version.

Check your answer

Changed plan · authored self-check

Sources

Two pulp cases side by side: primary versus permanent.

Check your answer

Changed plan · authored self-check

Sources

Oral lesion: describe it, build a differential, decide next steps.

Check your answer

Changed plan · authored self-check

Sources

Check one uncertain point in a source and repeat the answer concisely.

To finish