IADT Dental trauma Guidelines Flashcards
What first aid advice should you give if a parent called your practice and said their child lost their tooth?
Keep the patient calm.
* Find the tooth and pick it up by the crown (the white part). Avoid touching the root.
* If the tooth is dirty, wash it briefly (max 10 seconds) under cold running water and
reposition it. Try to encourage the patient/guardian to replant the tooth. Once the
tooth is back in place, bite on a handkerchief to hold it in position.
* If this is not possible, or for other reasons when replantation of the avulsed tooth is
not possible (e.g. an unconscious patient), place the tooth in a glass of milk or
another suitable storage medium and bring with the patient to the emergency clinic.
The tooth can also be transported in the mouth, keeping it inside the lip or cheek if
the patient is conscious. If the patient is very young, he/she could swallow the tooth
– therefor it is advisable to get the patient to spit in a container and place the tooth
in it. Avoid storage in water!
* If there is access at the place of accident to special storage or transport media (e.g.
tissue culture/transport medium, Hanks balanced storage medium (HBSS or saline)
such media can preferably be used.
* Seek emergency dental treatment immediately.
What is the txt for an avulsed permanent tooth with closed apex?
Tooth has been replanted before pts arrival at clinic
- Leave the tooth in place.
- Clean the area with water spray, saline or chlorhexidine.
- Suture gingival lacerations, if present.
- Verify normal position of the replanted tooth both clinically and radiographically.
- Apply a flexible splint for up to 2 weeks
- Administer systemic antibiotics.
- Check tetanus protection .
- Give patient instructions
- Initiate root canal treatment 7–10 days after replantation and before splint removal
- Follow up 4w, 3m,6m, 1y, 1y for 5yrs
What is the txt option of an avulsed tooth with closed apex that has been kept in a physiological storage medium or osmolality balanced med and/or stored dry and E/O dry time <60mins?
- Clean the root surface and apical foramen with a stream of saline and soak the tooth in saline
thereby removing contamination and dead cells from the root surface. - Administer local anesthesia.
- Irrigate the socket with saline.
- Examine the alveolar socket. If there is a fracture of the socket wall, reposition it with a suitable
instrument. - Replant the tooth slowly with slight digital pressure. Do not use force.
- Suture gingival lacerations, if present.
- Verify normal position of the replanted tooth both clinically and radiographically.
- Apply a flexible splint for up to 2 weeks, keep away from the gingiva.
- Administer systemic antibiotics
- Check tetanus protection
- Give patient instructions
- Initiate root canal treatment 7–10 days after replantation and before splint removal
- Follow up 4w, 3m,6m, 1y, 1yfor 5yrs
What is the txt option of avulsed tooth with closed apex and dry time longer 60mins or other reasons suggest non viable cells?
Remove attached non‐viable soft tissue carefully e.g. with gauze. The best way to this has not
yet been decided (See Future areas of research).
* Root canal treatment to the tooth can be carried out prior to replantation or later (See
Endodontic considerations).
* In cases of delayed replantation, root canal treatment should be done either on the tooth prior
to replantation, or it can be done 7–10 days later like in other replantation situations (See
Endodontic considerations).
* Administer local anesthesia.
* Irrigate the socket with saline.
* Examine the alveolar socket. If there is a fracture of the socket wall, reposition it with a suitable
instrument.
* Replant the tooth.
* Suture gingival lacerations, if present.
* Verify normal position of the replanted tooth clinically and radiographically.
* Stabilize the tooth for 4 weeks using a flexible splint
* Administration of systemic antibiotics
* Check tetanus protection
* Give patient instructions
- follow up 4w, 3m, 6m, 1y, 1y for 5yrs
Why does delayed replantation of an avulsed tooth has poor long term prognosis? Why do you replant the tooth?
- PDL necrotic and not expected to heal
- Replantation restores aesthetic , function and or psychological reason but also maintains alveolar bone contour
- Eventual outcome is ankylosis and resorption of root and tooth eventually lost
What is the txt options of an avulsed tooth with open apex that has be replanted before pts arrival on clinc?
Leave the tooth in place.
* Clean the area with water spray, saline or chlorhexidine.
* Suture gingival lacerations, if present.
* Verify normal position of the replanted tooth both clinically and radiographically.
* Apply a flexible splint for up to 2 weeks
* Administer systemic antibiotics
* Check tetanus protection
* Give patient instructions
* The goal for replanting still‐developing (immature) teeth in children is to allow for possible
revascularization of the pulp space. If that does not occur, root canal treatment may be
recommended
- Follow up 4w, 3m, 6, 1y , 1y for 5yrs
What is the txt for avulsed tooth with open apex that has been kept in physiological storage medium or osmolality balanced medium and/or stored dry and E/O <60mins?
If contaminated, clean the root surface and apical foramen with a stream of saline.
* Topical application of antibiotics has been shown to enhance chances for revascularization of
the pulp and can be considered if available (See Antibiotics).
* Administer local anesthesia.
* Examine the alveolar socket.
* If there is a fracture of the socket wall, reposition it with a suitable instrument.
* Remove the coagulum in the socket and replant the tooth slowly with slight digital pressure.
* Suture gingival lacerations, especially in the cervical area.
* Verify normal position of the replanted tooth clinically and radiographically.
- Apply a flexible
splint for up to 2 weeks
* Administer systemic antibiotics
* Check tetanus protection
* Give patient instructions
* The goal for replanting still‐developing (immature) teeth in children is to allow for possible
revascularization of the pulp space. The risk of infection related root resorption should be
weighed up against the chances of revascularization. Such resorption is very rapid in teeth of
children. If revascularization does not occur, root canal treatment may be recommended
- Follow up 4w, 3m, 6m, 1y, 1yr 5yrs
What is the txt option of avulsed tooth with dry time >60mins or other reasons suggesting non viable cells?
Remove attached non‐viable soft tissue carefully e.g. with gauze. The best way to this has not
yet been decided
* Root canal treatment to the tooth can be carried out prior to replantation or later
* Administer local anesthesia.
* Remove the coagulum from the socket with a stream of saline. Examine the alveolar socket. If
there is a fracture of the socket wall, reposition it with a suitable instrument.
* Replant the tooth slowly with slight digital pressure. Suture gingival laceration. Verify normal
position of the replanted tooth clinically and radiographically.
* Stabilize the tooth for 4 weeks using a flexible splint
* Administer systemic antibiotics
* Check tetanus protection (
* Give patient instructions
- Follow up 4w, 3m, 6m ,1y, 1yfor 5yrs
What topical and systemic AB can be given to pts and why are they done?
Topical (immature teeth)
- Experimental studies shown positive effects on periodontal and pulpal healing
- Doxycycline 1mg per 20ml saline for 5 min soak
Systemic
- Pen V 500mg x4 a day 12-17
- Pen V 250mg X4 a day 6-11
Why may a child need tetanus cover if avulsed tooth?
- Refer pt to physician for eval of need for tetanus booster if avulsed tooth contacted soil or tetanus coverage if uncertain
Why do you splint replanted teeth?
- Maintain repos tooth in correct pos, provide pt comfort and improve function
- Periodontal healing and pulpal healing promoted if tooth given chance for slight motion and splinting time not too long
- Place on buccal surfaces of max teeth to enable lingual access for endo and avoid occlusal interference
What pt instructions do you give for avulsed tooth that has been repplanted?
- Pt compliance with follow up vists and home care required for healing
- Avoid contct sports
- Soft diet 2 weeks then normal function ASAP
- Brush teethw ith soft toothbrush after each meal
- 0.1% CH twice a day 1 week
What endodontic considerations is there for an avulsed tooth?
- If closed apex RCT 7-10 replantation
- CaOH as intra canal medication for up to 1 month (antimicrobial)
- Or can use ledermix which is anti-inflam corticosteroid with anti-clastic properties and left 2 weeks
- Do not use CaOH and ledermix together
What is a favourable outcome of avulsed tooth with open and closed apex ?
Closed apex
- Asymp
- Norm mob
- Norm percussion sound
- No radio evi resorption or periradicular osteitis
- Lamina dura norm
Open apex
- Asymp
- Norm mob
- Norm percussion sound
- radio evi of arrested or continued root formation and eruption
- Pulp canal obliteration expected
What is pulp canal obliteration ?
- Hard tissue deposited on the internal walls of pulp canal leaving it narrowed and restricted
- May show a yellow discolouration of clinical crown
What is an unfavourable outcome of avulsed tooth for open or closed apex?
Open and Closed apex
- Symptomatic
- Excessive or no mobility (ankylosis) with high pitched percussion sound
- radio evi of resoprtion (inflam, infection related, ankylosis)
- Infrapos of crown when ankylosis occurs (leading to distrubance in alveolar and facial growth over short, med and long term)
