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3. Paediatrics > Trauma 3 (Avulsions) > Flashcards

Trauma 3 (Avulsions) Flashcards

1
Q

What is avulsion?

A

tooth comes out socket
separation of pdl
exposure of root surface

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2
Q

What is the most important thing with avulsion?

A

Reimplantation into socket asap

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3
Q

When can successful healing occur in avulsion injuries?

A

If there is minimal damage to pulp and PDL

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4
Q

What are 3 critical factors in avulsion?

A

Extra-alveolar dry time (EADT)

Extra alveolar time (EAT)

type of storage medium

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5
Q

What is EADT?

A

Extra-alveolar dry time (EADT)

this is how long tooth is out mouth in air (on ground, on table, in hands etc)

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6
Q

What is EAT?

A

Extra alveolar time

this is how long tooth is out the mouth dry and then placed into storage medium

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7
Q

What is the type of storage medium?

A

This is what is used to transfer tooth to us - affects prognosis

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8
Q

What do we do if pt attends with tooth reimplanted?

A

leave it as is!! however if lots of debris then we may need to remove and clean any big parts of debris

take radiographs to establish open or closed apex

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9
Q

What advice to we give to emergency phone calls?

A

Find out what tooth has avulsed and if pt has any med conditions

HOLD TOOTH BY CROWN NOT ROOT (PART YOU NORMALLY SEE NOT BIT INSIDE THE GUMS)

IF ANY OBVIOUS DEBRIS THEN TURN UR COLD TAP ON FOR A FEW SECONDS THEN RUN TOOTH ROOT UNDER IT FOR MAXIMUM OF 10 SECONDS TO REMOVE ANY BIG DEBRIS

PLACE TOOTH BACK INTO SOCKET AND BITE ON TISSUE

IF ABOVE CANT BE DONE THEN PUT INTO STORAGE MEDIUM - MILK, SALIVA, BLOOD, SALINE

THEN GET TO US ASAP

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10
Q

What is the initial reimplantation decision based on?

A

we want to know if eadt is < or > than 30 mins

we have diff tx depending on how long its out mouth for

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11
Q

What are the healing outcomes periodontally for avulsion?

A

regeneration

PDL/Cemental healing

bony healing

uncontrolled healing

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12
Q

What is periodontal regeneration?

A

This occurs if tooth is put back in socket

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13
Q

When does cement/pdl healing occur?

A

This occurs if tooth isn’t put back in asap

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14
Q

What is bony healing?

A

This is when bone is fused right up to the tooth and resorption starts

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15
Q

What is uncontrolled healing?

A

this is when there is no healing, granulation tissue, infection and abscesses

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16
Q

What are some plural healing outcomes following avulsion?

A

Regeneration

Controlled necrosis - elective disinfection

Uncontrolled infection

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17
Q

What is the best plural outcome in avulsion injuries?

A

Regeneration

occurs more in open apex teeth - wider, lots of nerves and bvs compared to closed apex with less nerves and bvs

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18
Q

What is controlled necrosis?

A

This is when we know from studies that tooth will become nerrotic so we elect for end tx before death of tooth and initiation of infection

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19
Q

What is uncontrolled infection?

A

Pulp goes necrotic and will need end or xla

20
Q

What if the EAT < 60 mins?

A

Then there is a chance of cement/pdl healing

we would reimplant tooth under la

flexible splint for 2 weeks

consider antibiotics and tetanus

21
Q

When would we extirpate pulp when eat<60 mins

A

Day 0-10 unless open apex which has chance to revascularise so we can monitor for this

22
Q

What is the eat <60 mins in immature teeth with open apex?

A

We can decide to not root treat and instead monitor tooth clinically and radiographically for signs of continued growth or signs of loss of vitality

we can tell fast if revascularisation has occurred - radiographs to compare with adjacent tooth for root dev signs

23
Q

How often do we review avulsed teeth where eat<60 mins and immature teeth?

A

2 weeks, to remove splint, 4 weeks, 2 months, 6 months, yearly

if nv pulp then extirpate pulp and refer

24
Q

What if EAT<60 mins in mature teeth

A

Replant tooth into socket and splint for two weeks

we want to remove pulp- (day 0-10 if needed)

extirpate pulp and disinfect then place antibiotic steroid past as intra canal medicament - leave in for 2 weeks

then clean and replace with non setting calcium hydroxide

obturate gp with 4-6 weeks (max time for calcium hydroxide)

refer

25
Q

What is EAT>60 mins and closed apex?

A

PDL healing unlikely - we aim for bony healing by ankylosis so need to ensure we scrub out clean of dead pdl cells

26
Q

When we do end tx in closed apex tooth with eat>60 mins what can we do?

A

can do out the mouth extra oral ends prior to reimplantation

then we splint for 4 weeks with flexible splint

antibiotics and tetanus consideration

if we don’t do extra oral ends then extirpate at 7-10 days and use non setting calcium hydroxide as intra canal medicament for 4 weeks before gp obturation

27
Q

What do we do when eat>60 mins and open apex?

A

We won’t likely get pdl healing - only tiny chance of revascularation

BUT DONT ROOT TREAT UNLESS SIGNS OF LOSS OF VITALITY ON FOLLOW UP APPT

Splint flexible.4 weeks

review - 2 weeks, 4 weeks for splint removal, 8 weeks, 3mths, 6 months, yearly to monitor closely for necrosis signs v continued root development

28
Q

When do we not reimplant a tooth?

A

Almost never however if very immature apex and EAT>90mins then we are starting to reach borderline limits

if pt is immunocompromised - cancer, cardiac problems

if child has other serious injuries that require preferential tx or icu admittance

29
Q

Why may we not reimplant immature lower incisors?

A

they tend to only last 6 months - people won’t notice and the space will close however reimplant upper teeth to act as a space maintainer to guide position of adjacent erupting tooth

30
Q

How do we monitor avulsion injuries?

A

OPEN APEX - CLOSE MONITORING FOR SIGNS OF LOSS OF VITALITY

if plural necrosis occur then we must extirpate pulp to avoid inflammation response

clinical tests - trauma stamp

sensibility tests - thermal and electric (1 math, 2mnth, 3 math, 6mth, yearly)

radiographs - compare root canal with and length

31
Q

How do we do pulpetctomy on open apexed teeth?

A

extirpate pulp
place caoh for 4-6 weeks maximum
mta plug - 2mm from apex, 5-6mm
then heated gp backfilled because cones won’t fit wide canal

32
Q

What do we use a 2 week flexible splint for?

A

Subluxation

Avulsion - open and closed apex with EAT <60 mins

Extrusion

33
Q

What do we use a 4 week flexible splint for?

A

Luxation

Avulsion - open and closed apex >60 mins EAT >60

Apical, middle and 1/3 root fractures

Intrusion

Dento-alveolar fractures

34
Q

What gauge of SS do we use for flexible splint?

A

0.3mm SS adapted and moulded to shape

35
Q

Where does flexible splint lie?

A

It is placed on one abutment tooth either side of the trauma tooth for 2 weeks (or 4 in certain cases)

36
Q

What else can we use as a splint?

A

Vacuum formed splint - gum shield splint but OH is poor (can also use Essex retainer) - pts also don’t like taking it in and out as they worry about tooth movement

Ortho brackets and wire - must be PASSIVE because if active then teeth will move

Acrylic URA type splint - useful when few abutment teeth but not first choice as composite is

Foil temporary splint cemented with kalzinol - old fashioned

37
Q

Describe the splinting procedure

A
  1. cut 0.3mm SS round wire and bend around counter of teeth to ensure passive when in place
  2. cut wire to size
  3. acid etch teeth for 10 seconds then apply bond
  4. dry teeth - enamel will appear forsted
  5. apply bond and light cure
  6. apply comp resin to labial surfaces and position the wire then cure trauma tooth and adjacent teeth
  7. keep away from gingival margin and take flat plastic and mould comp around the wire and cure
  8. polish down any sharp wire edges and rough composite - keep wire away from gingivae to ensure good OH
  9. Leave splint for 2-4 weeks depending on injury
38
Q

What is a dento-alveolar fracture?

A

Displacement of teeth in socket - mobility but not individual teeth

damage to alveolar bone which holds teeth in

happens in blocks of 3-4 teeth or more

39
Q

What do dento-alveolar fractures happen in?

A

Blocks of 3-4 teeth

40
Q

How do we treat dent-alveaolr fractures?

A

We need to put fracture back into place and then splint for 4 weeks

41
Q

How do we treat dentoalvelar fractures? - procedure

A

LA

Reduce fracture to correct position (sometimes bone can get wedged and affect reduction so LA allows us to lift up over bit of bone and put the fracture back into place

splint for 4 weeks

42
Q

How do we monitor dentoalveolar fractures?

A

clinically and radiographically

check for root development - canal width and length comp to unaffected tooth

check for signs of inflammatory response

follow up - 2wks, 4 weeks, 7-8weeks, 4 myths, 6 myths, yearly for 5 years

43
Q

What is the follow up review procedure for dentoalveolar fractures?

A 
2 weeks
4 weeks
7-8 weeks
4 months
6 months 
yearly for 5 years
44
Q

What is the risk of pulpal necrosis?

A

50% at 5 years

45
Q

What is the advice for pts with dental injuries?

A

Soft diet for 7 days
avoid contact sports whilst splint in place
careful ahi
use of chlorohexidine gluconate mouthwash 0.1%

3. Paediatrics (10 decks)

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