Paediatrics Flashcards
Trauma (6mins)
A parent with an 8-year-old child (Molly) attends an emergency appointment at your surgery.
Molly sustained dental trauma whilst playing on her trampoline. You have examined her and observed the injury in the photo provided.
You have taken the periapical radiograph provided. The child has just stepped out of the surgery for a moment
- Explain the nature of the child’s injury
- Explain, step by step in detail, what treatment is required for the child today only (the patient
is mildly anxious and the parent would like this information so that they can support their child through the treatment in the best way possible)
- Introduce yourself
- history : when/how did it happen , where and any fragments , any other symptoms and any LOC + tetanus status/ any MH
- Explain nature of trauma
~ enamel-dentine pulp fracture or complicated pulp fracture
~ the fracture involved all three layers of tooth including the nerve - Explain treatment
~ partial pulpotomy (open apex)
~ As this is a large exposure, the treatment of choice is called a pulpotomy which means partial removal of pulp tissue
~ This aims to keep undamaged pulp tissue alive
~ this is to allow the tooth to stay alive and continue to grow as the apex is still open meaning it allows blood in and give a chance for the tooth to survive - Explain baseline sensibility tests required
~ tests required to see how the nerves respond in the affected tooth and adj teeth
~ Required for long term monitoring
~ this involved testing the reaction of the tooth to cold stimuli and trying an electrode on the tooth to see pulp response - Explain that LA is required
~ inform parent that LA is required to keep patient numb and comfortable , this involves an injection into the gums - Explain the rubber dam is required
~ a rubber sheet isolating the tooth which acts as a mask
~ placed to protect airway and for moisture control - Explain the need for drilling + suction
~ drill will be used to to remove some of the pulp tissue , no pain is felt but may feel the vibration
~ aim is to leave healthy tissue
~ then cotton pledget will be used to control bleeding - Explain dressing
~ the tooth will be dressed with CaOH then with GIC or composite
~ explain that a white filling will be placed to regain aesthetics
Review pt in 1 week then 6-8 weeks
- Prognosis
1. good outcome = no future symptoms , tooth reponds to normal stimuli , no discolouration , continued development of tooth
2. Bad outcome = opposite of above
Nursing bottle caries (6 mins)
Concerned mother with 2-year-old in pain
Take a brief history then photo of decayed 52-62 provided
Explain diagnosis to parent, prevention and management options (GA)
- Introduce yourself and greet patient by name
- Take a brief history
~ pain history
~ if they take any analgesia
~ do they take a feeding bottle to bed?
~ what is in the feeding bottle? - Look at photos to identify pattern of decay
~ Usually it is upper incisors, Ds and lower canines
~ explain to pt diagnosis’s of nursing bottle caries
;
“ This happens when the child has a feeding cup with mild at night as the milk contains lactose which is a sugar. As the mild is held in the mouth, the sugar can feed the bacteria which start eating away the teeth causing decay, there is less salivary flow at night which can make it worse” - Give advice
~ Feeder cup should be replaced by bottle after 6 months so child doesn’t havr to suck
~ No feeding at night as reduced salivary flow and there is lactose in mild which is a sugar
~ No on demand breast feeding
~ No sweetened or soya mild unless medically advised
~ Milk and water only between meals
~ use sugar free variations of drinks/foods and medicine
~ Snack on safe snacks such as cheese, crackers, carrots and plain crisps
~ Toothbrushing instructions (smear , 1450 ppm) ; assist the child until 7 Y/O , brush twice once in morning and once at night , no drinks or food except water after brushing ; spit do not rinse ; high fluoride TP - Explain management
~ XLA of carious teeth under GA ( discuss GA risks and benefits) - if in pain - GIC remaining teeth and review - if no pain (acclimitasation)
- Fluoride varnish applications and supplements
- Ask about any questions
What would you discuss with parent of child with nursing bottle caries about GA?
” These teeth are severely decayed and we would not be able to restore them so XLA is the best options under GA as the child is very young and cannot understand what is happening so this is an issue with child cooperation”
” In GA the child is put to sleep so they are unconscious and will not remember the dental procedure, all GA is associated with some risks
Severe
1. Death ( 3 in a million)
2. brain damage
Common
1. pain
2. bleeding
3. sickness “
” Local anaesthesia will be applied to eliminate any pain , so the child might feel some facial numbness / tingling , when this wears off you can use painkillers which will help with the pain afterwards such as calpol”
Fluoride varnish (6 mins)
A parent, Mrs Ina Fleur, was seen by the dental nurse with her 2 year old child Sarah for application of fluoride varnish, but wants to ask you about it first
Have a discussion child with her and deal with any concerns
- Introduce yourself and greet patient by name
- Build a good rapport
“ I understand why you are concerned and i would like to reassure you by providing you with some evidence based information as this is what we are here to help for and explain “ - Evidence theme ; ‘ I am wondering why my child needs fluoride varnish’
- Prevention
~ prevention of tooth decay as F remineralises teeth and stop demineralisation , as it is antibacterial
~ there is evidence that F has additional benefit over daily brushing - Recommended for ALL
It is universal as it is not only recommended for high risk pts - Recommended that all children get FV applied at least twice a year
- This is by referring to SDCEP guidance + SIGN
- Harm theme ‘ I’ve heard that too much Fluoride can be harmful is that true? ‘
- Risk
~ low to minimal risk with use FV and brushing twice daily with F tooth paste - FV quantity is carefully controlled
- guidance regarding amount of F ( Smear/ pea)
- Side effects such as Flourosis / presents as mottling ( white/brown/ yellow) spots due to excessive F exposure (aesthetic POV)
- In term of FV , 2yo would have to swallow about 50 mg of F and the amount we place is 5.65 mg (11.3mg for over 6)
What are the contraindications of FV?
- Severe Asthma (hospitalised in the last 12 months)
- Allergy to colophany (sticking plaster) - can use colophany free FV
Instructions after applying FV
- Do not eat or drink for at least 30 mins
- No hard food or toothbrushing for 4 hours
- Avoid F supplements today
- Childsmile says do not brush that night
FV toxicity
- 5mg/kg - give calcium orally and observe
- 5-15mg/kg - give calcium orally and admit to hospital
- > 15mg/kg - admit to hospital immediately, cardiac monitoring and life support , IV calcium gluconate
Consenting and referral to GA (6mins)
- Introduce self and greet patient
- Explain process
~ It is a procedure done in a hospital where specific drugs are used to put child to sleep; these can be delivered using inhalation or IV
~ They will still need LA
~ Todays appointment is to provide info , next one is for assessment and then for the actual GA to be carried out
~ All required tx will be carried out under GA
~ other options include LA ( traumatising , more appointments ) ; under IS ( need older pt who is slightly anxious and able to cooperate) ; under IV ( need to be at least 12 Y/O )
~ after GA done ; vital signs monitored and pt drank and ate ; then can be discharged - Discuss risks
- Common minor risks
~ Headache
~ Nausea
~ Vomitting
~ Drowsiness
~ Sore throat
~ Sore nose and bleeding from intubation - Risks from treatment
~ Pain, bleeding , swelling , bruising , infection, loss of space and sitiches - Rare major risks
~ Brain damage
~ Death ( 3 in a million)
~ Malignant hyperpyrexia ( asl about FH)
- Discuss benefits
~ get them out of pain
~ all treatment is done in one visit
~ aim to make them pain free for at least 5 years - Discuss other options
~ Prevention only
~ Biological caries management
~ LA ± IS , IV , LA only - Discuss contraindications
~ Hypoxia
~ Sickle cell anaemia
~ Diabetes ( cannot fast)
~ Down’s syndrome
~ Malignant hyperpyrexia
~ CF or severe asthma
~ Cardiac and renal conditions
~ Epilepsy
~ Long QT syndrome - Referral
- Explain assessment appointment
~ For treatment planning and may change
~ Consent taken (written)
~ Expain process/risks/benefits
~ adult must escort child with no other children
~ Pre-op fasting ; 6 hours
~ ask if they would like to be referred for assessment
- Presenting to you is a 5-year old patient accompanied by their parent for a new patient assessment. They were registered at a dental practice before which is now closed. [6]
You carry out a regular assessment of the patients oral health which included taking bitewing radiographs which are provided below. The child says they have sensitive teeth when drinking cold Irn Bru.
The patient has a clear medical history and is not dentally anxious. The parent says that the child brushes by themselves with whatever toothpaste is available at home.
Using the above information explain the child’s caries risk to the parent, provide the parent with preventative advice and give appropriate management options.
~ Introduce youself
~ Caries risk
* high risk
* Explain caries risk ; “ due to clinical evidence of decay present in the mouth, current diet and toothbrushing habits , your child is at higher risk for future decay”
- Explain aetiology ; “ high sugar diet with poor brushing routine results in plaque collecting around the teeth. mouth bacteria feed on sugars and produce acid resulting in break down of the tooth layers, bacteria travel deep in the tooth resulting in a hole with symptoms as bacteria has reached the pulp of the tooth”
- Explain risk of having decay ; “ dental decay causes pain during eating or drinking cold/sweet food , which if not treated early can develop into a more advanced decay / severe pain and infection , leading to tooth loss if left untreated”
- Explains importance of prevention
“ Bad habits continue into adulthood. All of this can be treated early with adjusting daily habits to promote good oral health to prevent decay from happening”
~ Prevention
* “ Avoid sweetened milk and juices which contain sugars , use plain water or milk between meals , use sugar free alternatives , and limits sweet and acidic food/drinks to meal times only”
- Snack on healthier snacks such as fresh fruit and vegetables , breadsticks, cheese
- Tooth brushing advice ( twice a day for two minutes , pea-sized amount , brush all surfaces , spit do not rinse , supervise until the age of 7 ) - demonstrate to parent and then let parent demonstrate on child
~ Management
1. FV - 4 times a year
- FS - applying a resin-based sealer to biting surfaces of adult molars and certain baby teeth (palatal of upper incisors / D’s and Es )
- Hall crowns ; placing a silver cap on decayed baby molar teeth to prevent the decay from being exposed to the oral environment which can help stop the decay progression / symptomatic relief
- SDF - applying a silver and F based paste to decayed areas which will stop decay progression but may leave brown/black stain on teeth. this only affects the baby teeth
- Selective caries removal ; with or without LA , removing part of the decay and dressing the tooth
- Attending your practice is a 10-year old patient with their mother. The mother complains to you that she was not happy with her child’s previous dentist who they saw a few days ago, and would like to register her son at your practice. [12]
You carry out an examination of the child, which reveals the following findings: - child has no presenting complaint and they have a clear medical history. - no restorations. - 16 transient sensitivity to cold air, 36 lingering sensitivity to cold air but non-TTP. - clinical findings: 16 + 36 occlusal caries; retained upper C’s in good condition with non-palpable upper 3’s; lower lip ~1cm width round fluctuant bluish/translucent benign asymptomatic lesion which appeared last week. - radiographic findings: congenitally absent upper 3’s; bitewing of 16 shows early caries limited to enamel only; periapical of 36 shows deep occlusal caries with associated periapical radiolucency.
Given the above information, explain the diagnoses and management of the conditions to the mother. Afterwards, the actor will prompt you for further information.
Actor script
Actor should maintain a frustrated tone.
Actor is not interested at the moment in hearing risks and benefits for management options.
When all treatment options provided = “I am really unhappy with how the previous dentist never took x-rays or advised us on treatment. I am considering legal action against him. What do you suggest?”
Actor should not specifically say “I want to file a complaint”
~ Introduce yourself
~ Mention we have 4 problems to deal with ;
1. Caries in two teeth
* caries in 16 require a simple filling (explain)
* 36 has deeper decay reaching the inside of the tooth to the nerve and blood supply , causing infection in the roots and bone
* management of 36 ; do nothing , rct , XLA , monitoring will lead to symptoms to develop and infection to get worse ,
* Best option is to take the tooth out as the second molar could drift and take the space of the first molar , this will require further investigations and consenting for risks which i can go through today if you want
- congenitally absent 3s
* I am unable to clinically feel the canine which should e possible by the age 10-11 and on the x-ray it shows they are not present
* The baby canine is still present which is good , however a referral to an orthodontist would be the best option here
* Orthodontist might accept the existing baby teeth and manage this with restorative options
* or the use of removable braces and later down the line potential for fixed braces to reposition premolars and make them look like canines
* Some of the treatment not involving moving teeth will likely be done here - mucocele
* There is a soft fluid-filed swelling on the lower lip which is not abnormal. Pssibly related to biting lower lip which causes salivary gland fluid to build up causing this appearance. Tends to go away over time. Treatment involves monitoring over time or incision and surgical removal of mucocele and salivary gland associated. I can go through risks of having this done if you want . it might still reappear after removal
~ managament of complaint
* I am sorry that you feel this way
* “ every dentist will have their own method of planning treatment and preferred management of conditions. The plan provided here may be different to the one suggested by the previous dentist”
* “ I cannot comment on how you were treated because I do not know all the details nor is it my role to investigate this”
* “ if possible , you can return to your old dentist and discuss this with them. they should be open to having a discussion regarding your child’s treatment”
~ Any questions?
Tx options for each type of caries in children?
- Occlusal non cavitated
- Occlusal cavitated
- Approximal (early into dentine)
- Approximal ( advanced )
- Anterior cavitated
- Gross without pain or sepsis
- Gross with Sinus / PA pathology
- Occlusal non cavitated
~ Fissure seal
~ complete removal and restore
~ parial removal and restore
~ Prevention alone - Occlusal cavitated
~ Seal with Hall crown
~ Complete removal and restore 9needs cooperation)
~ Partial removal and restore
~ Prevention alone
~ Make lesion self cleansing and prevention - Approximal (early into dentine)
~ Seal with hall crown
~ complete removal and restore
~ partial removal and restore
~ prevention alone - Approximal ( advanced )
~ Seal with Hall crown
~ Complete removal and restore 9needs cooperation)
~ Partial removal and restore
~ Prevention alone
~ Make lesion self cleansing and prevention - Anterior cavitated
~ Complete removal and restore
~ Partial removal and restore
~ Prevention alone - Gross without pain or sepsis
~ XLA
~ prevention - Gross with Sinus / PA pathology
~ XLA
~ Pulp therapy in pts with good cooperation
Attending your practice is an 8 year old child accompanied by their parent. The parent is complaining that their child is being teased at school due to the appearance of their teeth, and mentions their child struggles with drinking cold drinks.
On examination, the following clinical photographs were taken. The lower permanent molars are sound and do not have an abnormal presentation.
Inform the parent of the condition present along with the possible aetiology. Explain to the parent this condition, any further information regarding the management of their child’s dentition and the treatment options available.
~ introduction
~ Reassure and calm patient
~ Aetiology of MIH
* Explain to parent the condition present occurs where there has been a fault in the development of certain teeth, causing them to appear a different colour as the enamel is softer, most commonly found in 1-4 molars often associated with incisors
* The most commonly affected teeth start forming throughout pregnancy, exact cause of the fault in development is not known but it is associated with prenatal , natal and post natal periods of life up to 2 years after
~ Ask relevant questions
1. did you suffer from gestational diabetes or any illnesses during the 3rd trimester of pregnancy
2. were there any abnormalities during childbirth, such as premature birth or prolonged delivery?
3. did the child suffer from any diseases or medical conditions during the first 2 years of life? like chicken pox, rubella, measles or was on any medication?
~ Prevention
* The teeth affected are softer than the unaffected ones, this means they are more prone to sensitivity, breakdown and becoming decayed compared to healthy teeth. That is why it is important to maintain excellent oral hygiene for your child
* Avoid sweetened milk and juices which contain sugars, use plain water / milk between meals /sugar-free alternatives. Acidic or sugar-containing drinks strictly mealtimes only.
* Advice about snacks
* I understand it can often be difficult to get children to brush properly. We recommend supervision until the child is 7-years old. We can demonstrate brushing technique in front of a mirror using a special tablet that reveals missed spots, and the child will repeat what we do. Use a short scrubbing motion with the toothbrush angled 45o to the gum line to brush away plaque near the gum, brush the biting surface of each tooth making sure not to miss partially erupted teeth – can be done by
brushing from the side of the mouth.
~ Management
1. Tooth mousse - a toothpaste-like creme that you can buy in pharmacies , this can be put directly on top of sensitive teeth after brushing to help with symptoms
- FV - applying a small of bit of FV , 4 times a year , help strengthen the tooth and help with sensitivity
- FS - applying a resin based sealant to the biting surfaces of adult molars and back side of upper incisors to help protect them
Options for molars ;
- Restoring affected first molars with a filling over the softer surface to strengthen them and attempt to reduce symptoms , or we can place a silver cap , these are non invasive procedures but fillings are more prone to fall easily as the tooth surface is soft and the silver cap is considered not aesthetic
- Extracting the affected first molars
“ sometimes it may be advisable to take out the affected molars, with good timing and other factors, it is possible for the second molar to move forwards and take the space of the FPM. The child 8-years old so it may be possible - External vital bleaching
“ To deal with the discoloured front teeth we will initially take baseline photos of the teeth for recording purposes. One of the options involves providing special trays with bleach applied to it and seated on the teeth to wear overnight. This will change the shade of the tooth surrounding the defect and make it less visible - ICON resin infiltration
“ Another method is using a nail-varnish like chemical to pain over the tooth. This varnish contains resin which is absorbed into the white area of the tooth changing the properties of the white bits making it look like the surrounding teeth - Microabrasion bleaching
“ Another method is done in the clinic using a stronger acid to remove a very thin outer layer of the tooth. it is slightly more invasive but can improve the colour of the discoloured part of the tooth - Restorative options
This is to older children , but we can mask the discolouration by placing a filling or a veneer over the front teeth. May be a bit expensive and minimally invasive.
Upon taking a history, the parent is unable to provide detailed information regarding the onset of pain throughout a brief medical and dental history taking process. The parent is unable to clarify the cause of these injuries and is unable to explain how they managed their child’s pain.
You notice a bruise behind the child’s ear and on their earlobes. Photographs of the presentation are included below, with clinical examination revealing a mesial fracture in the upper right central permanent incisor which has shifted palatally.
Discuss with the parent:
a) any suspicions that arise from their child’s presentation;
b) the appropriate management for this case.
~ Introduce yourself
~ Discussion of suspicious presentation
* I am concerned with how the child has presented to clinic today. It is very unusual for a mouth injury to lack explanation for how it happened or how it was managed. Some injury sites are also highly suspicious of abuse, such as the bruised frenum/lip, at the earlobe or behind the ear. Also lacking of seeking treatment immediatey for the child’s injuries raises a high index of suspicion
* As a result of today’s findings, I will asl you for consent to pass my concerns to the safeguarding lead of the clinic. This is typically the policy which dental teams have in place for these suspicions, so it can be dealt with by the appropriate member of staff
* I will keep records of the findings today’s appointment on our system which will include specific description and diagrams of what I have deemed as suspicious
* After passing on this information to my colleague, they may contact a child protection advisor for further advice. This is an experienced member of NHS staff who works at the royal hospital of children who will guide us further if things need to be escalated. My colleague may also contact your GP or other professional responsible for the care of the child to see if concerns are shared
* We will arrange a follow up appointment for you to come back and see us for further management of both the trauma and to get an update of the child’s wellbeing
~ Management of Trauma
* assessment and radiograph
* LA
* Tooth repositioned with finger into socket , then splinted for 4 weeks
* reviewed at 2 weeks to initiate RCT , 4 weeks to remove splint
Hall crown and separator placement (12 mins)
Part 1 ; Place separator and remove a pre-placed separator , size a hall crown and select correct cement (LAzinol, Ultracal and Aquacem placed)
- Place separators between mesial and distal contacts
~ Floss to pieces of floss through the separator and pull tight between contacts of teeth - Leave in place for 3-7 days
- Remove with a blunt probe
- Sit child upright
- Place gauze swab to
protect airway
*Choose crown - aim to fit smallest size crown that will seat ( use sticky stick)
~ Can use BPE probe to meausure mesial and distal width of tooth and compare this to the crowns available
- Crown ideally should be subgingival or below margins of cavity
- Select the crown that covers all cusps and approached contact points with slight s do not fully seat crown)
- Dry the crown and fill with GIC
- Dry the tooth ( if cavity large place some GIC in cavity)
- Places crown with finger pressure , or by biting on it with gauze
- Remove excess cement
- get pt to bite down for 2-3 mins or fingure pressure
- Remove any remaining cement
- Floss between contacts
- Reassure child and parent
~ Explain that the crown should fit tightly and the gum will adjust by time
~ will get used to the feeling within 24h
~ Occlusion tends to adjust to given contacts bilaterally within weeks
~ Cement tastes like salt and vinegar crisps
What are the advantages of Hall crown and what are some faults associated with it?
- Advantages
1. Non invasive
2. Quick and easy
3. no caries removal or prep
4. biological caries management
Only can be used when there is no pulp involvement , contraindicated in pts with risk of infective endocarditis
- Faults
1. New/secondary caries
2. Crown might wear and can e lost
3. reversible pulpitis
4. irreversible pulpitis ; abscess
5. Tooth might be unrestorable when crown removed
Hall crown and separator placement (12 mins)
Part 2 : Child starts choking on hall crown - deal with the emergency appropriately
- ABCDE
- Are you choking , encourage to cough
- 5 back slaps between shoulder and blades ( child lying down or across knees)
- 5 abdominal thrusts between belly bottun and strenum
- Check ABCDE again
- BLS if not resolved (in case of LOC too )
- Call 999 and refer ti hospital ti check for rib fracture
** cannot do thrusts if child under 1 year **
If infant then put on leg and support jaw by forearm with their face facing down and do the back blows with other hand , for thrusts tilt up while still supporting jaws , then placed two fingers in middle of chest
MIH ( 12 mins)
pics of molars and radiographs
- Explain MIH to a dental student , and how to deal with an uncooperative child?
PART A - explaining MIH
1) What is molar incisor hypomineralisation
- hypominerlisation of systemic origin of 1-4 permanent molars , frequently associated with affected incisors
- Prevalence 10-20%
- hypominerlised means reduced mineral content due to disturbance in enamel formation
- hypoplastic as reduced enamel thickness
2) Pain mechanisms
1. dentine hypersensitivity - porous enamel activate pain fibres ( A and D)
2. periphernal sensitisation - pulpal inflammation leads to activation of C fibres
3. Central sensitisation due to continued nociceptive input
3) Pulp tissue in MIH have
- increased neural density
- increased immune cells
- increased vascularity
4) How is it caused?
- not enough evidence on how its caused, but it is believed that it develops during the 1st year as enamel matrix of FPM forms by 1 year
5) however it is important to enquire about 3 clinical periods through the mother
~ Pre natal
- general mother health during 3rd trimester (pre-eclampsia and gestational diabetes)
~ Natal
- hypoxia , hypocalcaemia , preterm birth , birth trauma
~ Post Natal
- prolonged breast feeding, Dioxins in breast milk
- Childhood infections ( Rubella, Chicken Pox, Measles)
- Socio-economic status
6) Symptoms
- loss of tooth substance
- sensitivity
- aesthetic concerns
7) Management
1.Molars
- Direct restorations
- SSC
- XLA (8.5-9.5 yrs)
- Incisors
- Microabrasion
- Resin infiltration
- Localised comp restoration
- Veneers
MIH ( 12 mins)
pics of molars and radiographs
- Explain MIH to a dental student , and how to deal with an uncooperative child?
PART B - dealing with uncooperative child
1) Managing an uncooperative patient requires a structured approach with non pharmacological and pharmacological techniques
2) Non pharmacological techniques
- Tell Show Do
- Positive reinforcement
- Distraction technique - by talking / music / toys
- Modelling - through other pt with same age
- Desensitisation - gradual introduction to dental environment
3) Pharmacological
- Topical
- LA
- Inhalation sedation
- if very severe then GA
- Start with minimally invasive to build pt trust
A parent with an 18-month old child attends an emergency appointment at your surgery. The child has sustained dental trauma after falling onto the patio. Both parent and child are very distressed. [12]
The child is generally fit and well, with no medical conditions/problems. There is nothing in the history to indicate trauma affecting any other part of the body and you do not need to ask anything about this.
Show how, with the help of the parent, you would examine the small, distressed child.
Following this you will be given further instruction by the examiner.
Further instructions
The child has a subluxated upper primary central incisor. Explain the following to the patient:
a. the nature of the injury and treatment you will provide
b. what is required in the way of immediate aftercare
c. what the possible consequences following this injury are
~ Introduction
~ Reassure and calm mom
~ Knee-to-knee exam
* Inform parent that a knee to knee exam to be carried out and you’ll talk them through it
* Put child on knee facing you , and their legs around your waist
* Parent support child body and hold child’s hands
* Prepare light and mirror
* Support child head at all times when on knee
* Support child back to sitting position
Further info provided : subluxated upper primary incisor
~ Explanation of injury
the teeth has had a knock which made them mobile and sensitive on biting but has not moved from its own socket and suffered no fractures, the sensitivity will need a review at a later date
~ management
- Soft diet
- Analgesia
- CHX + CW
- brush as normal
~ Consequences on the primary dentition
- pain
- sinus/swelling
- discolouration
~ Consequences on the permanent dentition
- enamel defects
- dilaceration
- arrested development
- delayed eruption
- ectopic eruption
- odontome formation
- You are a dental student working in the emergency clinic. An 9-year old patient presents to you with their parent. The parent says their child has bumped their tooth. [6]
Below is a clinical photograph of the presentation.
Speaking to the examiner, describe how you will take a clinical trauma exam.
Following this, you will be given further instructions by the examiner.
Further information
The child has a suffered a lateral luxation of the immature upper right central incisor. The root is palpable in the buccal sulcus. Explain the following to the parent:
a) the nature of the injury and treatment you will provide
b) what is required in the way of immediate aftercare
c) what the possible consequences following this injury are
~ Trauma exam
* history of injury
* soft tissue checks for contusions, lacerations and abrasions
* hard tissue checks - displaced teeth, bone fractures
* Palpation
* mobility
* Percussion
* Pulp testing
* Rx
~ Nature of injury
* “ the teeth has had a knock which has displaced the root of the tooth into the bone , this has fractured the bit of bone that holds the tooth and locked the tooth in place , we can reposition the tooth today and review it to assess its response to healing. “
~ Management procedure
- “ we will numb the area , then the tooth will be repositioned and attach a metal wire to the tooth affected and adjacent teeth and secure the wire with a white material used for fillings ( composite) “ , this will be left for 4 weeks for healing to take place”
- We will ask that you come back in 2 weeks to assess healing and remove the splint in 2 weeks time. Further reviews at 8 weeks
~ Immediate aftercare
- avoid contact sports
- Good oh , especially around splinted teeth
- CHX mouth rinse
- Compliance with follow up visits
~ Ideal outcomes
- absence of symptoms
- continued development of teeth
- the chances for this tooth responding well is high as it is still yound (95%)
~ Unfavourable outcomes
- pain
- infected tooth
- tooth looking like its sinking into the gums
- if these symptoms appear , we will have to root treat the tooth
