Paediatric Trauma in Primary Dentition Flashcards
(43 cards)
What is an enamel fracture?
Fracture of only enamel.
What is an enamel-dentine fracture?
Fracture involved enamel and dentine but not the pulp.
What is a complicated tooth fracture?
Fracture involves enamel, dentine and the pulp is exposed.
What is a crown-root fracture?
Fracture involves enamel, dentine and root, the pulp may nor may not be involved.
What is a root fracture?
Injury to the tooth where the root has fractured.
What is concussion?
Tooth tender to touch but has not been displaced.
Normal mobility and no bleeding into the gingival sulcus.
What is subluxation?
Tooth tender to touch, has increased mobility but not been displaced.
What is lateral luxation?
Tooth displaced usually in a palate-lingual or labial direction.
What is intrusion?
Tooth displaced through the labial bone plate, or it can impinge on the permanent tooth bud.
What is extrusion?
Partial displacement of tooth out its socket.
What is avulsion?
Tooth displaced completely out of the socket.
What is alveolar fracture?
Fracture involves the alveolar bone and may extend to the adjacent bone.
What are the 8 aspects of the trauma stamp?
Mobility
Colour
TTP
Sinus
Percussion note
EPT
Ethyl Chloride
Radiograph
What special investigations might you want to do?
Trauma stamp
Radiographs- PA, anterior occlusal, OPT, lateral pre-maxilla.
What are the paediatric trauma guidelines called?
International Association of Dental Traumatology guidelines
When might you undertake a Cvek Pulpotomy?
Partial pulpotomy
Might be done in an enamel-dentine-pulp fracture in a primary tooth.
Describe the procedure of a Cvek Pulpotomy.
- Local anaesthetic administration
- Isolation with dental dam
- Remove 1−3 mm of coronal pulp tissue (sterile excavator/high speed bur and copious irrigation)
- Irrigate wound surface with sterile saline or Ferric Sulphate depending on if it is a primary or permanent tooth and dry with a cotton pellet
- If haemostasis achieved place non-setting calcium hydroxide paste or calcium hydroxide powder mixed with sterile water over pulp exposure and use a sterile cotton pellet to apply pressure and adapt the medicament to the cavity. If haemostasis not achieved, remove more pulp until haemostasis is achieved but if haemostasis is not possible, proceed to a coronal pulpotomy
- Place non-setting calcium hydroxide paste, or calcium hydroxide powder mixed with sterile water, over the exposure and use a sterile cotton pellet to apply pressure and adapt the medicament to the cavity before covering with a layer of glass ionomer
- Restore tooth with composite resin/re-attach fractured tooth fragment, if available/appropriate
- Regular clinical and radiographic review1
If a partial pulpotomy has not been sufficient to achieve haemostasis, what would you do?
Carry out cervical pulpotomy.
Involves removing the entire coronal pulp.
What treatment would you do for an enamel fracture?
Smooth off edges
No follow up required
What treatment would you do for an enamel-dentine fracture?
Account for missing fragment
Baseline radiograph is optional but take a soft tissue radiograph if fragment cannot be accounted for.
Cover exposed dentine with GI or composite.
Review clinically 6-8 weeks later.
What treatment would you do for an enamel-dentine-pulp fracture?
Account for missing fragment.
Take PA size 0 sensor or AMO size 2 sensor.
Cvek pulpotomy first, then move to full pulpotomy if haemostasis cannot be achieved.
Follow up
- Clinically- 1 week, 6-8 weeks, 1 year.
Radiographically- 1 year.
What treatment would you do for a crown-root fracture?
Determine location of any missing fragments.
PA or AMO radiographs.
Remove loose fragments and determine restorability.
Pulp not exposed- remove all loose fragments and restore with GI or composite.
Pulp exposed- perform Cvek pulpotomy or RCT depending on stage of development.
If unrestorable- remove loose fragments and leave it or remove whole tooth.
Follow up
- Clinically- 1 week, 6-8 weeks, 1 year.
- Radiographically- 1 year.
What treatment would you do for a root fracture?
PA or AMO.
If loose fragment is not displaced- no treatment.
If loose fragment is displaced but not excessively mobile- leave coronal fragment to spontaneously reposition.
If coronal fragment is displaced, excessively mobile and interfering with occlusion
- Extract loose fragment and leave rest in place.
- Gently reposition the loose coronal fragment and splint for 4 weeks.
Follow up
- 1 week, 4 weeks, 8 weeks, 1 year.
- Radiographic follow up is only indicated if clinical symptoms arise.
What symptoms would suggest failure of treatment?
Colour change in crown
Symptomatic
SInus tract
Gingival swelling
Increased mobility
Peri-radicular radiolucency
No further root development in immature teeth
