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paeds 4th year > avulsion and luxation injuries > Flashcards

avulsion and luxation injuries Flashcards

1
Q

what is concussion to primary and permanent teeth?

A

> No abnormal loosening, bleeding or displacement but TTP

> oedema and haemorrhage in the PDL

> Quite often Primary tooth concussion injuries will not attend dentist

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2
Q

what is the management for concussion in primary and perm teeth?

A

> Check sensibility (unreliable in primary)

> IOPA

> Reassure, educate and analgesia advice

> soft diet for 1 week

> Good OH ( +0.2%Chlorhex swab/mw bd for 1 week)

> Monitor

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3
Q

what is subluxation in the primary/ perm dentition?

A

> Abnormal loosening, but no displacement

> Mobile, TTP, +/ - bleeding

> No abnormal radiological findings

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4
Q

what is the management of subluxation in a primary tooth ?

A

> Reassure and analgesia advice

> 1-2/52 soft diet

> Good OH

> Monitor

*Good OH consider Chlohexidene MW/swab

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5
Q

what is the management of subluxation in a perm tooth?

A

> Check sensibility (informs prognosis)

> Reassure and analgesia advice

> 1-2/52 soft diet

> Good OH

> Consider flexible splint (2/52) if very mobile/ tender or closed apex

> Monitor

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6
Q

when would you use a flexible/ physiological splint?

A

> if there is 1 tooth either side

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7
Q

when would you use a rigid splint?

A

> when there is over 1 tooth either side

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8
Q

what are example of direct splints?

A

> Composite and wire

> Composite and titanium trauma splint

> Orthodontic bracket and wire

> Foil -cement

> Composite/ acrylic

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9
Q

what are examples of indirect splints?

A

> Acrylic

> Thermoplastic

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10
Q

what is lateral luxation?

A

> displacement of the tooth in any lateral direction

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11
Q

what is the management of lateral luxation in primary teeth?

A

> No/minimal occlusal interference
- Spontaneous repositioning

> Severe
- Extraction
- Reposition and splint
- Risk (high)/benefit discussion pre treatment
- Consider stability/ splint placement / R/O etc

> 10-14/7 soft diet

> Good OH

> Monitor

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12
Q

what is extrusion in a primary tooth?

A

> partial displacement of tooth out of socket

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13
Q

what is treatment of exclusion based off?

A

> Degree of displacement

> Mobility

> Interference with occlusion

> Root formation

> Splint options (co-op)

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14
Q

what is the management of extrusion?

A

> If no occlusal interference conservative

> excess mobility or >3mm extract under LA

> 1-2/52 soft diet

> Good OH

> reassurance and analgesia advice

> Monitor

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15
Q

what is extrusive luxation?

A

> Lateral luxation-displacement other than axially, with comminution or fracture of alveolar plate

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16
Q

what is the treatment for extrusion and lateral luxation in a permeant tooth?

A

> Reposition (after cleansing of tooth surface)
- +/- LA
- Digital
- Orthodontic appliances (if digital fails)

> Splint
- Flexible
- Lateral 4/52
- Extrusive 2/52

> Pt instructions
+/- antibiotics
Monitor

17
Q

when a tooth has intruded what is important to assess?

A

> Important to assess degree of intrusion as informs treatment

> Age of patient

> History of previous position

> Other teeth

> Radiograph
- Compare cej, apices

> Previous dental treatment

> A large force is required to severely intrude teeth so be aware of the possibility of other injuries – adjacent teeth, head injury

18
Q

what is the treatment of an intruded primary tooth?

A

> Monitor for reeruption
- Usually within 6 months-1year

> 10-14/7 soft diet
Reassurance and analgesia advice
Good OH
Monitor

19
Q

what are the treatment aims and options for intrusion of a permanent tooth?

A

> Aims to maintain the tooth if possible

> Treatment options
- Monitor only +/- orthodontics later
- Monitor for up to 4 weeks if no movement -» Ortho
- Immediate orthodontic extrusion
- Surgical repositioning

> Consider pulp therapy and timing

20
Q

what are the 2 repositioning techniques?

A

> orthodontic

> surgical

21
Q

what is orthodontic repositioning?

A

> A removable appliance with a self-supporting spring or elastic module to apply vertical extrusive force through a bracket bonded onto the labial or incisal surface.

> UFA (sectional)

22
Q

what is surgical repositioning?

A

> LA (Sedation or GA may be required)

> Gentle movements with a flat plastic instrument/forceps

> If resistant, consider if a bony impaction is present and release this before repositioning the labial plate of bone and soft tissue closure and suturing.

> Splint 4/52

> benefits? = reduced number of visits, rapid access for RCT

23
Q

what is the IADT - dental traumaa guide guidelines for open and closed apex intrusions?

A

> open apex =
- monitor up to 4/52
- then orthodontic

> closed apex
- up to 3mm = monitor +/- ortho/ surgery
- 3-7mm = ortho/ surgery
- over 7mm = surgery

24
Q

what is the follow up management of intrusion in permanent teeth?

A

> Incomplete Apex
- Monitor
- If signs or symptoms of pulp death start RCT with apexification

> Closed Apex
- Elective pulp extirpation will be necessary for all intrusive luxation injuries on closed apex teeth
- Within 2 weeks of the injury
- Keep dressed with calcium hydroxide paste until any inflammatory resorption has stopped

25
Q

what are the indication to use antibiotics during trauma?

A

> Contamination

> Additional injury to soft tissues or other injuries

> Significant surgical intervention

> Medical condition rendering more prone to infections

> Always for reimplantation in permanent teeth

26
Q

what type of antibiotics are used for trauma injuries?

A

> First line amoxicillin or penicillin based unless CI/ allergy

  • > 12 yrs doxycycline based as alternative
27
Q

what is the management of avulsion at the site of injury?

A

> offer advice over the telephone

> Plan A =
- Re-implant immediately
- Contaminated -rinse in milk or saline or saliva
- Avoiding handling of the root surface
- Hold tooth in place by biting on folded handkerchief or napkin
- Attend dental surgeon immediately

> Plan B =
- If re-implantation not possible store in suitable storage medium - in order of preference:
- Cold fresh milk
- Hank’s Balanced Salt Solution
- Saliva (buccal sulcus or spit in a cup)

ATTEND DENTIST IMMEDIATELY

28
Q

what history would you need to take for avulsion?

A

> Avoid unnecessary delay before re-implantation

> During examination place in suitable storage medium if not currently in one

> Thorough medical, dental and accident history

29
Q

what are the treatment options for a patient who’s experienced avulsion if not already reimplanted?

A

> LA if patient co-operation allows

> Reimplant ASAP!
- Keep pt calm
- Prepare socket
- No unnecessary manipulation
- If clot present gently irrigate with saline in syringe and use suction to remove clot
- Avoid curettage
- Reposition any bone fragments

> Handling Tooth
- Don’t touch root
- If contaminated wash in normal saline

> Push tooth gently into socket

> If obstructed by alveolar bone fragments gently use blunt instrument to reposition bone

> Check position

> Splint (if already reimplanted start here (after History and Exam)
- Flexible splint for 2 weeks
- Check occlusion
- +/- sutures

> Advise soft diet, good oral hygiene (soft tooth brush and chlorhexidine mouth rinse), avoid contact sports

> Follow-up

30
Q

what does the IADT advise for avulsion in open apex teeth?

A

> Reimplanted prior to Clinic attendance
- Antibiotics +/ - tetanus
- Splint 2 wks
- Flexible
- Avoid contact sports
- Avoid RCT unless signs

> EODT <60 mins
- Reimplant
- Antibiotics +/ - tetanus
- Splint 2 wks
- Flexible
- Avoid contact sports
- Avoid RCT unless signs

> EODT >60 mins (or non-physiologic media)
- Reimplant
- Antibiotics +/- tetanus
- Splint 2 wks
- Flexible
- Avoid contact sports
- Avoid RCT unless signs

31
Q

what does the IADT advise for avulsion in closed apex teeth?

A

> Reimplanted prior to Clinic attendance
- Antibiotics +/ - tetanus
- Splint 2 wks
- Flexible
- Avoid contact sports
- RCT within 2 wks
Calcium Hydroxide 1mth

> EODT <60 mins
- Reimplant
- Antibiotics +/ - tetanus
- Splint 2 wks
- Flexible
- Avoid contact sports
- RCT within 2 wks
Calcium Hydroxide 1mth

> EODT >60 mins (or non-physiologic media)
- Reimplant
- Antibiotics +/- tetanus
- Splint 2 wks
- Flexible
- Avoid contact sports
- RCT within 2 wks
Calcium Hydroxide 1mth

32
Q

when do you not reimplant a tooth?

A

> Primary teeth

> Other injuries
- Where other injures are severe and require preferential emergency treatment

> Medical history
- Depressed immunity eg. Acute lymphoblastic anaemia
- If in doubt liaise with physician

> Immature permanent tooth with short wide open apex and prolonged extra-oral time
- Replacement resorption is inevitable

> Gross contamination/ long time out

> Grossly carious tooth

> Severe periodontal disease

> Patient choice

33
Q

what is the follow up management for avulsion?

A

> Ideally review within 48 hrs
- Check splint and modify if necessary
- Reinforce OH and soft diet

> Review 2 weeks
- Radiograph prior to splint removal
- Commence RCT if indicated
- Remove splint

34
Q

what is a critical survival factor for avulsion trauma?

A

> Periodontal ligament survival is critical factor

> Dry storage time is most important factor
Wet time less critical
Contamination of root adverse effect
Handling root adverse effect

35
Q

what decreases inflammatory resorptions in avulsion?

A

Prompt RCT decreases inflammatory resorption

36
Q

what are examples of injuries to supporting bone?

A

> Comminution of alveolar socket wall

> Fracture of alveolar socket wall

> Fracture of mandibular or maxillary alveolar process

> Fracture of mandible or maxilla

37
Q

what is a clinical appearance of an alveolar fracture?

A

> Mobility of several teeth ‘en bloc’

> Displacement, Occlusal interference, TTP

> take radiographs

38
Q

what is the treatment for an alveolar fracture?

A

> Debridement

> LA/GA Reposition

> Soft tissue repair

> Flexible Splint 4/52

> Soft diet

> Antibiotics

> Good OH

> Monitor

paeds 4th year (12 decks)

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