Paediatrics Flashcards
Risks for paediatric trauma [6]
Increased overjet No lip closure Epilepsy Poor motor control Does contact/dangerous sports History of dental trauma Obesity
Primary/emergency management of paediatric trauma
Try and reimplant the tooth, or store in saline/milk Full history - What happened - MH - Other injuries - Where is the tooth/fragment E/O and I/O - Soft tissue injuries - Occlusion - TTP, EC, EPT, mobility - Xrays
Which radiographs are best for paediatric trauma [3]
PAs
Upper/lower standard occlusals
OPT
Types of tooth injury (paediatric trauma)
Concussion Subluxation Luxation - Intrusion - Extrusion - Lateral luxation - Avulsion Enamel infraction Uncomplicated enamel/dentine fracture Complicated fracture (involves pulp) Crown+root fracture Root fracture - Coronal third - Mid third - Apical third Alveolar fracture
What is a tooth concussion
Injury to tooth-supporting structures but the tooth hasn’t moved
- Pain and bleeding, sensitivity
- Monitor in 4 weeks and 1 year
What is a tooth subluxation injury and management
Injury/damage to tooth-supporting structures and some tooth mobility but no displacement of the tooth
- Pain, bleeding, sensitivity
- Splint for 2-4 weeks
- Review regularly for 1 year
What is a tooth luxation injury and types
The tooth has been displaced
Intrusion
- Tooth displaced in
- Severe injury, causing damage to PDL cells and neurovascular bundle
Extrusion
- Tooth displaced out of the socket a bit
- Might be mobile
- Damage to PDL cells
Lateral luxation
- Tooth displaced buccally or palatally so might not be mobile and have dull percussion
- Damage to PDL cells and neurovascular bundle
- Can get locked in bone
Avulsion
- Tooth falls out
- Death of PDL cells and neurovascular bundle
Intrusion injury permanent tooth management
Tooth displaced in. Need radiographs to see where it is (parallax, SLOB)
If immature apex
- Allow it to re-erupt for 2 weeks
- If no movement can use ortho or surgical extrusion
- Splint for 4-8 weeks (if marginal bone breakdown)
- Monitor to check pulp vitality. RCT + apical plug if pulp dies.
If mature apex
- <3mm intrusion, allow to re-erupt
- Ortho if this doesn’t work after 4 weeks
- > 7mm, surgically/ortho extrusion and RCT
- Splint for 4-8 weeks
Monitor and review regularly for 5 years
Extrusion injury permanent tooth management
Reposition and splint for 2-6 weeks (if marginal bone breakdown)
Monitor for 5 years and check pulp vitality
Lateral luxation injury and Permanent tooth management
Reposition and disengage from the bony lock
Splint for 4-8 weeks (if marginal bone breakdown)
Regular monitoring for 5 years to check pulp status
- If mature apex, it will likely lose vitality so do RCT
Avulsion injury - prognosis and patient instructions
Reimplant as soon as possible
- If <15 mins, good prognosis
- If exposed for <60 mins, guarded prognosis
- If exposed for >60 mins, poor prognosis
- PDL cells will have died
Hold the tooth by the crown, wash and store in milk/saline/reimplant and bite down.
Prognosis of dental trauma depends on ? [4]
Age of patient
Stage of tooth development
Type of injury
Any other injuries to the tooth
Types of pulp healing/responses after trauma [3]
- Complete healing - vital pulp
- Secondary dentine and pulp sclerosis/obliteration and loss of vitality
- Pulp necrosis, infection +/- inflammatory resorption
Types of tooth resorption
Internal resorption
- Will continue until the tooth is non-vital
- Starts from the pulp canal
External cervical resorption
- PDL cells are dead so inflammatory cells come to remove them and continue removing the tooth.
- Necrotic pulp so will continue until all the pulp/bacteria has been removed.
External replacement resorption
- Oc get activated by trauma and are in contact with the root surface bc dead PDL cells so remodelling the root into bone
- Will continue until all root is replaced, then the crown falls off
- Happens quicker in chidlren
General treatment after paediatric trauma
Xrays and images Reposition tooth Splint Regular monitoring \+/- RCT
Advantages of replanting avulsed teeth
Aesthetics
Avoid restorative work for a while
Psychological benefit
Preserve bone levels and gingival levels
Disadvantages of replanting avulsed teeth
Lots of monitoring and appointments
The tooth will need extraction eventually
Infraoccluded/external resorption = loss of verticle height and gingival contour
Risk of tooth necrosis, pain, infection
Discolouration
Contraindications of replanting avulsed teeth
Immunocompromised or severe heart condition
If have supernumerary teeth or severe anterior crowding
Can’t commit to multiple appointments e.g. learning disability
How to replant avulsed teeth (steps)
Xrays and emergency management
Gently clean tooth (handle from the crown) and keep in saline
- Measure root for future RCT
Analgesia/numb socket
Irrigate socket and remove debris e.g. any bone, blood clot
Insert the tooth into the socket but don’t force it in bc will shred PDL cells
Splint
Review
POIG
Antibiotics if worried about infection
- Amoxicillin or doxycycline (if older than 12)
Splinting after dental trauma (steps and types of splints)
Direct splints
- More hygienic
- Flexible so allow tooth and PDL to move like normal
- NiTi, orthodontic wires,
- Can composite bond or use ortho brackets
Indirect
- Would need to take imp
- Tooth can’t move, less hygienic, not fixed
Enamel infraction and permanent tooth management
Seal
Fluoride varnish
- Can use transillumination to diagnose
Uncomplicated enamel/dentine fracture and permanent tooth management
Xray
Restore bc exposed dentine will be sensitive and can get caries
- GIC, composite, crown
Review
Complicated tooth fracture and permanent tooth management
Xray Pulp cap if small exposure (<0.5mm, <24h) - use MTA, Biodentine, non-setting CaOH Or partial pulpotomy (remove the infected pulp, until no more bleeding/control the bleeding using pledgets) Or complete pulpectomy (RCT) - if bleeding doesn't stop - mature apex - symptoms - prolonged exposure/large exposure Restore (Crown, composite, temporary) Review
Crown and root fracture and permanent tooth management
Complicated - Crown lengthening procedure or ortho extrusion and restore
