Primary Trauma Flashcards
Enamel only fracture
X-rays: none
Tx: smooth
P/O: care when eating, brush w/ 0.12% CHX rinse 2x/day for 1 wk
F/U: none
Enamel + Dentin (no pulp)
X-rays: Baseline optional, soft tissue PRN
Tx:
- Cover exposed dentin with GI or composite
- restore w/ composite now or later
P/O: care when eating, brush w/ 0.12% CHX rinse 2x/day for 1 wk
F/U:
- 6-8wk (x-ray only if clinical signs of pulp infection)
- tells parents to monitor for unfavorable outcomes
Complicated crown fracture (exposed pulp)
X-rays: PA/Occlusal, soft tissue PRN
Tx:
- Partial Pulpotomy (CaOH paste, GI cement, composite)
- Cervical Pulpotomy for larger pulp exposures
P/O: care when eating brush w/ CHX 2x/day for 1 wk
F/U:
- 1 wk
- 6-8wk
- 1y (x-ray, unless pathoses earlier)
- tell parents to monitor for unfavorable outcomes
Crown root fracture (pulp or no pulp exposure)
X-rays: PA/Occlusal
Tx:
- Remove loose fragments, determine if restorable
- If restorable and no pulp exposure: restore w/ GI over dentin and restoration
- If restorable and pulp exposure: do pulpotomy/pulpectomy and restore
- If unrestorable ext all loose pieces or entire tooth
P/O: Care when eating, brush with CHX 2x/day for 1 wk
F/U:
- 1 wk
- 6-8wk
- 1 y (x-ray, unless pathoses earlier)
- tell parents monitor for unfavorable outcomes
Root Fracture
X-rays: PA/Occlusal
Tx:
- Coronal fragment not displaced –> no tx
- Coronal fragment displaced, but not very mobile –>
- let it reposition itself even if slight occlusal
- interference
- Coronal fragment displaced, very mobile –> ext loose
- fragment or reposition and splint 4 wks
P/O: Care when eating, brush with CHX 2x/day for 1 wk
F/U: x-rays only when signs of pathoses
- No displacement –> 1 wk, 6-8wk, 1y until perm tooth
- Displacement w/ ext –> 1 y
- Displacement w/ splint –> 1 wk, 4wk (splint removed), 8wk, 1 yr
- tell parents monitor for unfavorable outcomes
Alveolar Fracture
X-rays: PA/Occlusal, lateral, further imaging only if it will change tx
Tx: reposition and stabilize w/ flex splint 4 wks
P/O: Care when eating, brush with CHX 2x/day for 1 wk
F/U:
- 1 wk
- 4 wk (splint removal + PA)
- 8 wk, 1y (x-ray)
- 6yrs old to monitor eruption of perm teeth
- If fracture at apex can –> abscess
- tell parents monitor for unfavorable outcomes
Concussion (tender, no mobility/bleeding)
X-rays: None
Tx: None, observation
P/O: care when eating, brush w/ 0.12% CHX 2x/day for 1 wk
F/U:
- 1 wk
- 6-8wk
- X-rays only when signs of pathoses
tell parents monitor for unfavorable outcomes
Subluxation (tender, mobility, no displacement, bleeding)
X-rays: PA/Occlusal
Tx: None, observation
P/O: care when eating, brush w/ 0.12% CHX 2x/day for 1wk
F/U:
- 1 wk
- 6-8 wk
- X-ray only when signs of pathoses, f/u every yr until perm teeth erupt if concerned
tell parents to monitor for unfavorable outcomes
Extrusion (can be mobile)
X-rays: PA/Occlusal
Tx:
- If not interfering w/ occlusion let it reposition itself
- If VERY mobile or extruded >3mm –> ext
P/O: care when eating, brush w/ 0.12% CHX 2x/day for 1wk
F/U:
- 1 wk
- 6-8 wk
- 1y
- X-ray only when signs of pathoses, f/u every yr until perm teeth erupt if concerned
tell parents to monitor for unfavorable outcomes
Intrusion (either thru labial bone or into perm bud)
X-rays: PA/Occlusal
Tx:
- Allow to spont reposition itself (usually w/in 6 mo-1y)
P/O: care when eating, brush w/ 0.12% CHX 2x/day for 1wk
F/U:
- 1 wk
- 6-8 wk
- 6 mo
- 1 y
- 6yr old f/u for severe intrusion to check perm teeth
- X-ray only when signs of pathoses
tell parents to monitor for unfavorable outcomes
Lateral Luxation (displaced palatally or labialy, not mobile)
X-rays: PA/Occlusal
Tx:
- If minimal or no occlusal interference allow to reposition itself w/in 6 mo
- If severe displacement ext if risk of asp or resposition + splint 4 wks
P/O: care when eating, brush w/ 0.12% CHX 2x/day for 1wk
F/U:
- 1 wk
- 4 wk if splinted to remove splint
- 6-8 wk
- 6 mo
- 1 y
- X-ray only when signs of pathoses, f/u every yr until perm teeth erupt if concerned
- tell parents to monitor for unfavorable outcomes
Avulsion (find tooth, if can’t send to ED esp if resp signs)
X-rays: PA/Occlusal if tooth not found to make sure tooth not intruded and to check on perm tooth bud
Tx: None
P/O: care when eating, brush w/ 0.12% CHX 2x/day for 1wk
F/U:
- 6-8 wk
- 6 yr old to check on perm tooth eruption
- X-ray only when signs of pathoses, f/u every yr until perm teeth erupt if concerned
- tell parents to monitor for unfavorable outcomes