Paeds Flashcards
1
Q
What is a fissure sealant
A
- Material that is placed in the pits and fissure of teeth
- Prevent or arrest caries
- 50% of caries in school children was found occlusally
2
Q
How would you apply fissure sealant
A
- Clean tooth: dry brush
- Isolate: cotton wool rolls, dry guard
- Etch: 37% phosphoric acid used for 20 seconds
- Wash and dry: 15s
- Re-isolate
- Seal
- Check for defects
3
Q
What is PRR
A
- Preventative resin restoration/ Sealant restoration
- Caries in the fissure and pits
- Composite/GIC with the remaining fissure and pits
- Sealed
- If dentinal caries then conventional restoration
- Caries removal using 330 (small)
- Etch prime bond and seal, composite
- FS over it
4
Q
What’s the difference between permanent and primary molar
A
- Thinner enamel
- Thinner dentine comparatively
- Higher pulp horns
- More bulbous
- Roots more slender
- Roots flare out at cervix
5
Q
What is isthmus
A
- Central portion of the cavity preparation on the occlusal surface of a bicuspid or molar
6
Q
What are some non-verbal techniques
A
- Smile
- Body language
- Posture
- Pre-appoint video, letter, posters
7
Q
How can you measure dental anxiety
A
- Modified child dental anxiety scale: 6 questions 1-5 (age 8 and over)
- Frankl score: 1-4, 1 being negative
8
Q
What are some non-pharmacological behaviour techniques
A
- Graded exposure
- Enhanced control (stop and go)
- Acclimatisation
- Tell-show-do
- Behaviour shaping: reinforce the desired behaviour, ignore undesirable
- Modelling: direct observation of another patient
- Distraction technique (music, video)
9
Q
What is conscious sedation
A
- State of depression of CNS
- Verbal contact is maintained
- Loss of consciousness unlikely
- Retains their protective reflexes
10
Q
What kind of sedation for child under 12
A
- Inhalation nitrous oxide
- Over 12 IV midazolam can be used as basic
11
Q
What are the advantages of Nitrous oxide
A
- Colourless, slightly sweet smelling
- Anxiolysis
- Mild analgesia
- Hypnosis
- Rapid recovery
12
Q
What are the disadvantages of nitrous oxide
A
- Nausea/headaches
- Route of administration near operating site
- Environmental
13
Q
What are some contraindications for IHS
A
- COPD
- Infections with airways
- Operating site blocked by nasal hood
14
Q
How to assess caries clinically
A
- Dry the teeth and clean
- Tooth by tooth approach
- Opalescent enamel adjacent to stained fissure indicates dentinal involvement
- Stained pit without adjacent white opalescent enamel with no radiographic signs indicates enamel only
- Chalky white lesion is an enamel lesion
- White opalescent enamel at marginal ridge indicates proximal with dentine involvement.
15
Q
How to tell an arrested enamel lesion
A
- Feel smooth to probe
- Rough means lesion active
16
Q
How to tell dentine lesion is arrested or not
A
- Hardness of dentine
- Using caries excavator
- Harder lesions may be more shiny
- Colour isn’t a reliable indicator
17
Q
what techniques to assess caries in a child
A
- Radiograph bitewings (FGDP)
- Clinically
- Ortho separators for enamel only proximal lesion
18
Q
What is a triangle shaped radiolucency on mesial of maxillary molars
A
- Cusp of carabelli
19
Q
How to classify carious lesions in primary teeth
A
- Occlusal: initial (outer third, non cavitated), advanced (mid third, cavitation or dentine shadow)
- Proximal: initial (WSL, enamel only), advanced (enamel cavitation, dentine)
- Anterior: initial (WSL), advanced (cavitation or dentine shadow)
- Special cases: pulpal involvement (no clear band of dentine), arrested caries, unrestorable
20
Q
How to classify occlusal carious lesions in permanent teeth
A
21
Q
How to classify proximal carious lesions in permanent teeth
A
22
Q
How to classify anterior lesions in permanent teeth
A
23
Q
How to classify special cases in carious lesions in permanent teeth
A
24
Q
What is MIH
A
- Hypomineralisation of systemic origin, presenting as demarcated, qualitative defects of enamel of one to four first permanent molars (FPMs) frequently associated with affected incisors
- Poor quality of enamel, prone to breakdown, sensitivity
- Pain on toothbrushing
- High caries risk
- Enamel has abnormal etching and bonding pattern
- 12.5% of children uk
25
What is aetiology of MIH
- Unclear
- Disruption of amelogenesis process during early maturation or later secretory phase (late pregnancy – 3y)
- Possible causes: Respiratory tract infection, oxygen starvation, frequent childhood disease, use of antibiotics
26
What is clinical diagnosis of MIH
- White-creamy, yellow-brown, post-eruptive breakdown ,atypical caries
- Lesion larger than 1mm
- Check patients history of problems during prenatal and early age problems
27
How can you classify MIH
- Mild: demarcated opacities, no caries , no sensitivity
- Moderate: demarcated, post-eruptive breakdown on one to two surfaces no cuspal involvement, normal dentine sensitivity
- Severe: post eruptive enamel breakdown, crown destruction, caries, history of sensitivity, aesthetic concerns
28
What can you look at when assessing hypo mineralised teeth
- Enamel colour: white/cream, yellow, brown
- Location of defects, smooth surfaces, occlusal surface, cuspal involvement
- Sensitivity to brushing or temperature
- Atypically shaped restorations
- Any patient reported symptoms
29
What are the differentials for MIH
- Fluorosis: history of fluoride ingestion, symmetrical pattern, caries resistant teeth
- Enamel hypoplasia: quantitative defect, enamel lesions more smooth
- Amelogenesis imperfecta: hypoplastic/ hypo mature/ hypo mineralised, all teeth, both dentition, family link
- White spot lesion: white chalky, area of plaque
30
What are the clinical complications with MIH patients
- Post eruptive breakdown: pulp involvement
- Tooth sensitivity: poor ohi
- Local anaesthetic problem: may be related to chronic pulp inflammation
- Aesthetic
- Tooth loss
31
What are treatment for MIH patient
- **Enhanced prevention**: high fluoride tooth paste, tooth mousse, FS (GIC
- **LA** will be difficult (potential IHS, articaine, anaesthetic adjuncts)
- Molars:
- **Resin infiltration**: ICON (infiltrates enamel)
- **Restorations**: GIC, composite on sound enamel, remove all porous enamel
- **PMC**: severe damaged tooth, onlay
- **Incisors**: micro abrasion, bleaching, resin infiltration, restoration, veneers
32
How to assess a tooth for dental infection in primary teeth
- TTP (non-exfoliating)
- TTPalp (sinus or swelling)
- Mobility ( rocked with tweezers)
- Radiographic signs (including intra radicular radiolucency)
33
What are some factors to consider when assess risk of pain or infection in primary teeth
- Extent and site of lesion
- Time to exfoliation
- Number of other lesions
- Cooperation of child and patient (preventative measures, attend appointments)
34
What factors to consider in a caries risk assessment
- Clinical evidence of previous disease (DMFT)
- Dietary habits
- Socio-economic status (increased risk usually with DMFT)
- Use of fluoride
- Plaque control
- Saliva
- Medical history
35
How would you plan your treatment
- Pain
- Explain caries prevention and management
- Preventative treatment on permanent first before primary
- Explain to child and career: number of appointments and duration
- Obtain valid consent
- Referral (pre-cooperative, uncooperative)
36
Tell me about pulpal pathology in primary
- Most common reason for pain
- Vital pulp can cope with some bacterial ingress
- Eventually vital (perfused) pulp will turn into non-vital and necrotic pulp
- Reversible, irreversible, dental abscess/periradicular periodontitis
37
Tell me about reversible pulpitis in children
- Provoked by stimulus (cold, sweet)
- Doesn’t linger
- Difficult to localise
- Doesn’t affect sleep
- Not TTP
- Management of carious lesion alone may resolve problem
38
Tell me about irreversible pulpitis in children
- Spontaneous
- Lingers
- Difficult to localise
- Keeps awake at night
- Worsened by heat and alleviated by cold
- Not TTP
- Pulp therapy (primary: pulpotomy) or XLA
39
Tell me about dental abscess/ apical periodontitis in children
- Pain spontaneous
- Localised
- Keep awake at night
- Increased mobility
- TTP
- Sinus or swelling or radiographic evidence
- Necrotic pulp needs to be sorted even if chronic
- Pulpectomy/RCT/XLA
40
What to do with reversible pulpitis
- Restore (proximal hall technique, selective caries rem and composite) (permanent- stepwise technique)
- Or place temporary dressing and restore later (uncertain diagnosis) review again 3-7 days
41
What to do with irreversible pulpitis
- Pre-cooperative: try dress with sub-lining of cortico-steroid antibiotic paste (under temp dressing or if cooperative enough direct onto pulp), **pain relief** . Refer (XLA or treatment)
- Cooperative: primary(XLA or pulp therapy)
42
What to do for dental abscess treatment
- **Antibiotic if systemic** (spreading infection, systemic)
- **Pain relief** if indicated.
- Pre cooperative: refer for XLA (primary) or RCT/XLA (permanent), while waiting local measure to bring under control maybe, pain relief
- Cooperative: primary( XLA or pulpectomy) or RCT/XLA (permanent)
43
What is the toothpaste amount
- Smear under 3
- Over 3 pea
44
What is the standard prevention advice for children
- Give toothbrushing advice: yearly, 1000-1500ppm, supervise till ready, spit don’t rinse
- Demonstrate brushing
- Diet advice: yearly, sugar attacks, water, no food after brushing , snacking healthier, feeding bottle
- Place sealant: all molars after eruption, resin based (GIC for uncoop),
- Check existing sealants: top up worn
- Apply sodium fluoride varnish: (5%), 2xyear, 2 years and over
45
What are the enhanced prevention for increased risk children
- Demonstrate brushing: at every visit
- Diet advice: every visit, potential diet sheet
- Enhanced Fluoride: 1350-1500ppm under 10, 2800ppm 10-16 (limited period)
- Consider GIC sealant on partially erupted molars
- Fissure seal: upper b, Ds, Es, 6,7 (if possible)
- Fluoride varnish applied 4x year (children aged over 2)
- Utilise community or home support
46
What considerations do you make for varnish
- Severe asthma (hospitalised)
- Allergy in last 12 months or allergy to sticking plaster
- Allergy to colophony in varnish ( use different varnish or mouthwash instead)
47
What are the caries managing techniques in **primary teeth**
- Seal with Hall technique
- Fissure seal
- Selective caries removal and resto
- Pulpotomy
- Site specific prevention
- Non restorative cavity control (no caries removal, cavity cleansable)
- Complete caries removal and resto
- Extraction
48
What to do in carious tooth close to exfoliation (no pain) or caries arrested
- Non restorative cavity control
- Site specific prevention
49
**Active caries** and **unrestorable primary** and not causing pain
- XLA
- Non restorative cavity control
- Avoid extraction first visit
50
Anterior tooth initial lesion primary
- Site specific prevention (if lesion progress change strategy)
51
Anterior tooth advanced primary
- Selective caries removal and resto
- Complete caries removal and resto
- Unable to do first two: non restorative cavity control
52
Molar occlusal primary initial
- FS
- Site specific prevention
53
Molar occlusal advanced primary
- Selective caries removal
- Hall technique (secondary option)
- Complete caries removal: high risk of pulp exposure
54
Molar proximal initial lesion primary
- Site specific prevention (if caries is arrested)
- Sealant/ infiltration
55
Molar proximal advanced lesion, primary
- Hall technique
- Selective caries removal (unable to do first option)
56
Caries where there is no clear separation between dentine and pulp (primary)
- Discuss with parent about uncertain prognosis
- Consider sealing under hall technique (not close to exfoliating)
57
What are the benefits of the hall technique
- Avoid iatrogenic damage
- Minimally invasive
58
Tooth is close to exfoliation and no pain
- Site specific prevention
- Non -restorative cavity control
- Ds 9-11 exfoliates
- Es 10-12 exfoliates
59
What to do with arrested caries
- Confirm it is arrested
- Site specific prevention
- Non restorative cavity control
- Appear black
60
How to manage initial occlusal lesion permanent
- Seal with FS (should be maintained
61
How to manage moderate occlusal lesion permanent
- Selective caries removal and resto
- Complete caries removal and resto
62
How to manage extensive occlusal lesion permanent
- Stepwise caries removal (restore with permanent after 6-12months)
63
How to manage initial proximal lesion permanent
- Site specific prevention
- Resin infiltration
64
How to manage moderate proximal lesion permanent
- Selective caries removal
- Complete caries removal
65
How to manage extensive proximal lesion permanent
- Step wise caries removal (restore with permanent after 6-12months)
66
How to manage initial anterior lesion permanent
- Site specific prevention
67
How to manage advanced anterior lesion permanent
- Complete caries removal
- Can do selective caries removal (if there is space)
68
What to do with first permanent molar with poor prognosis
- Ortho assessment and extract
- Panoramic
- Pain: extract
- Consider keeping free of symptoms: temporising using hall technique
69
What is site-specific prevention
- Make them fully aware
- Effective brushing
- Diet advice
- 4x fluoride varnish
- Monitor progression of lesion
- Plaque score monitor
- After 3 months not arrested – change treatment
70
What is hall technique
- Place spacers
- Find correct size SSC
- Add GIC cement to SSC
- Seat and bite on cotton wool
- Remove excess and floss
71
Resin infiltration on proximal surface
- Spacer
- Isolate tooth with rubber damn ideally
- Protect adjacent tooth not being etched
- Etch
- Apply resin sealant
- Alternative method is using ICON method (filles pores)
72
What is selective caries removal
- LA may not be necessary
- ART in primary
- Gian access to carious tissue (high speed if indicated)
- Slow handpiece or excavator to remove superficial caries
- Clear cavity walls to hard scratch dentine
- Cavity depth to good level (very close to pulp leave soft, some space leave leathery/firm dentine)
- Be aware of pulp chamber anatomy
- Remove unsupported enamel
- Place restoration
- Fissure seal rest
73
What is atraumatic restorative technique
- Hand instrumentation
- Good for anxious technique
74
What is the stepwise caries removal technique
- Risk of pulpal exposre
- Allows reactionary dentine to be laid and next step 6-12 months after
- Remove all superficial caries until soft dentine
- Place resto (coloured makes it easier to remove)
- Place permanent after
75
What is nonrestorative cavity control
- Make cavity cleansable
- Use high speed to open up
76
What is the pulpotomy technique
- LA and rubber dam
- Access cavity
- Remove coronal pulp
- Irrigate with saline
- Identify the canals
- If still bleeding place pledget with ferric sulphate
- If bleeding doesn’t stop: pulpectomy
- Remove cotton wool and place MTA in chamber
- Fill cavity with ZOE and PMC
77
What questions to see if child protection referral needed
1) Has there been a delay in seeking dental advice with no good explanation
2) Does history change over time or not explain the injury
3) When you examine the child are there unexplained injuries
4) Are you concerned about the child’s behaviour and interaction with parent/carer
78
Tell me about GA
- Complete loss of consciousness
- Contraindicated: allergic to drug, comorbidities
79
What is the difference between deciduous and permanent molar
1) Smaller crown
2) Thinner enamel and dentine
3) Pulp horns more pronounced
80
What are some pulp therapy methods in deciduous teeth
- Indirect pulp cap
- Direct pulp cap ( success rate unreliable)
- Partial pulpotomy
- Pulpotomy
- Pulpectomy
81
Tell me about indirect pulp capping
- Placement of CaOH
- Stimulate tertiary dentine
82
Tell me about indications for partial pulpotomy
- Traumatic injury (involving pulp)
- Traumatic Exposure due to procedure error (no decay around the exposed area)
- Remove 2mm of pulp at exposure site, stop bleeding with wet cotton pledget
- Non setting CaOH
- Setting calcium hydroxide
- Seal with GIC and restore with composite
83
Why use ferric sulphate
- Forms a ferric ion complex
- Seals blood vessels
- Induction of reparative dentine
84
What is a two visit pulpotomy
- Desensitising pulp therapy
- Inadequate anaesthesia
- Remove as much coronal as you can
- Place ledermix or odontopaste
85
Tell me about pulpectomy
- LA and rubber dam
- Remove roof
- Remove coronal pulp
- Identify canals
- EWL 2mm short of apex
- Insert small files (no larger than 30)
- Irrigation
- If infection (exudate present) dress canal and temporise
- Obturate using resorbable paste (idoform paste vitapex)
- Definitive resto and ideally PFC
86
What are some features of immature apex
- Wide open
- Shorter root
- Thin dentine walls
- Good blood supply so pulp can heal better
87
What is apexogenosis and apexification
- Apexogenesis: vital teeth, radicular pulp intact
- Apexification: induce a natural barrier (calcified barrier), non-vital tooth
- Placement of artificial barrier at apex
88
Why use CaOH at the apex
- High pH
- Formation of cementum like structure at apex
- Disadvantage: multiple appt, weakens dentine wall and root fracture
- Repeat medication every 3 months for 18 months (no barrier MTA plug)
89
Talk about MTA as a apex plug
- Artificial barrier
- Biocompatible
- Good seal
- Radiopaque
90
What is regenerative endo
- Stimulate blood flow into previous necrotic radicular canal
- Places plug half way up tooth
- Presence of blood regenerates pulp and apexogenosis continues
91
What is the tooth development process
- Bud
- Cap
- Bell
- Dentinogenesis and amelogenesis
- Crown formation
92
What ages is deciduous dentition
- 6m – 5y
93
What ages is the mixed dentition
- 6y -12y
94
When do maxillary permanent incisors erupt
- Central 7-8
- Lateral 8-9
95
When does maxillary and mandibular canines erupt
- Mandibular 9-10
- Maxillary 11-12
96
When does mandibular incisors erupt
- Central 6-7
- Lateral 7-8
97
When does maxillary premolars erupt
- First premolar(4): 10-11
- Second premolar(5): 10-12
98
When does mandibular premolars erupt
- First premolar(4): 10-12
- Second premolar(5): 11-12
99
When does mandibular molars erupt
- First molar (6): 6-7
- Second molar(7): 11-13
- Third molar(8): 17-21
100
When does the maxillary molars erupt
- First molar (6): 6-7
- Second molar(7): 12-13
- Third molar(8): 17-21
101
Tell me about primary teeth eruption and shedding
102
Radiographic frequency for high risk child
- 6 months posterior bitewing
- FGDP
103
Radiographic frequency for moderate risk
- Yearly bitewings
- FGDP
104
What is guidance for radiographs in low risk children
- Primary dentition 12-18months
- Permanent 2y
- FGDP
105
What would your recall intervals be?
- Child: 3,6,12
- Over 18: 3-24
- Nice guidelines
106
When to do BPE
- 12-17 full BPE
- 7-11: codes 0,1,2 (simplified BPE, central incisors and molar)
107
What to do in patient with gingivitis
- OHI
- Plaque scores
- Remove plaque retentive factors
108
What are the BPE codes management
109
What is the aetiology and epidemiology of trauma
- **Accidental**: slips, bikes, sports
- **Non accidental**: assault, physical
- More likely in overjet, inadequate, socio-economic status, males
110
What can happen in trauma to the crown
- Enamel infraction (crack)
- Enamel fracture
- Enamel dentine fracture
- Enamel dentine cementum
- Complicated crown fracture
111
What are the periodontal trauma things
- Concussion ( without loosening or displacement
- Subluxation
- Extrusive luxation
- Lateral luxation
- Intrusive luxation
- Avulsion
112
what are clinical tests for trauma
- Visual (colour)
- Sound (percussion sound)
- Thermal
- Electrical
- Radiographic
113
What are odontoblasts
- Cells the line the wall of the pulp
- Trauma stimulates odontoblasts to lay down dentine to protect the pulp
- Stem cells can differentiate into odontoblasts
114
What are the outcomes for pulp after trauma
- **Pulp survives**: survives dentine lay down by odontoblasts
- **Pulp canal obliteration**: pulp can go into overdrive, tooth will look yellow
- **Pulp necrosis**: tooth become dark and discoloured, infection go periapical
- **Inflammatory internal resorption**: transient (reversible) or permanent (non-reversible/progressive)
- **Replacement internal resorption**: after inflammation pulp chamber can lay down bone tissue instead of dentine
115
What are the outcomes of periodontal ligament after trauma
- **Normal healing**: PDL has good self healing
- **External resorption**: surface resorption, inflammatory resorption (no bone), replacement resorption (ankylosis)
116
What is ankylosis
- Fusion of tooth surface and bone
117
What are the factors that influence the survival of pulp after trauma
- Severity of damage to blood supply
- Area and time of exposure
- Stage of root development
118
Extra info about pulp
119
What is an infraction?
- Incomplete fracture of enamel
- Not TTP
- PA radiograph: no abnormalities
- Etch and seal with resin to prevent discolouration of crack
- No follow generally needed
120
What is enamel fracture
- Complete fracture: no exposed dentine
- No mobility, not TTP
- PA: rule out presence of root problem
- Tooth fragment can be rebounded or resto
- Follow up: 6-8weeks, 1 year
121
What extra oral examination to do for trauma
- Check if there are any injuries
- Facial injuries, lacerations, bruising
- Palpate facial bones: facial fracture
- Check if they got a head concussion
122
What is the trauma stamp (8)
- Colour
- Mobility
- Displacement
- TTP
- Percussion note
- Sinus
- Cold pulp test
- Electric pulp test
123
What is concussion of tooth
- Involves injury of the tooth supporting structure but no displacement or mobility
- **TTP**, not mobile, no change to occlusion
- No changes radiographically
- No treatment just monitor
- Follow up: 4 week, 1 year
124
What is subluxation
- Involves injury to the tooth supporting structure and increased mobility without displacement
- TTP, mobility, remains in sulcus, bleeding in sulcus, no changes to occlusion
- Radiograph: no significant abnormalities
- No treatment is required, flexible splint for 2 weeks
- Follow up: 2 weeks (remove splint), 3 months, 6months, 1 year
125
What is extrusive luxation
- Displacement of the tooth out of its socket
- Elongated appearance of tooth, mobility, TTP, changes to occlusion, negative response of tooth to vitality test
- Radiographic: tooth displaced, increased PDL space
- Management: LA, reposition with pressure, flexible splint (2 weeks) Mature apices RCT started 7-10 days
- Follow up: 2 weeks, 4 weeks, 6-8weeks, 6 months, 1y, yearly for 5years
126
What is lateral luxation
- Displacement of the tooth from the socket in lateral direction, usually associated with alveolar bone fracture
- Tooth displaced buccal/palatal with fractured alveolus. Immobile and negative to sensibility
- Radiograph: widened PDL
- Management: LA, reposition, flexible splint (4 weeks). Mature apices RCT in 7-10days
- Follow up: 2 weeks, 4 weeks, 6-8weeks, 12week, 6month, 1y, 5y
127
What is intrusive luxation
- Displacement in apical direction into alveolar bone
- Tooth intruded, immobile, negative to sensibility
- Radiograph: PDL may not be visible, tooth intruded
- Management: immature: mild-moderate: spontaneous eruption or reposition after 2-3weeks. Sever reposition straight away
- Mature: mild spontaneous eruption, otherwise reposition
- Once repositioned splint (4 weeks), mature RCT 7-10 days
- Follow up: 2 weeks, 4weeks, 6-8 weeks, 12 week, 6 month ,1y, 5y
128
Over the phone advice for avulsion
- Time is of the essence
- If you sure it permanent and no medical contraindication
- Locate the tooth (if unsure of location)
- Only handle it by the crown (“white part”) and avoid touching the root (“pointy bit”)
- If the tooth is dirty, wash it for a maximum of 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 you are unable to do this, place the tooth in a glass of milk and bring it with the patient to the emergency clinic (other suitable storage mediums include saliva or the patient’s buccal sulcus – do not store in water!)
- Seek emergency dental treatment immediately
129
What is the definitive management of avulsion
- Depends on extra oral time and open or closed apex
- Dry time over 60mins: poor prognosis, still reimplant and advice patient
- Closed apex – re-implanted at scene
- Closed apex – dry time less than 60 min
- Closed apex – dry time over 60mins
130
Closed apex – re-implanted at scene
- Leave in place
- Irrigate
- Suture any laceration
- Verify normal position of tooth
- Apply flexible splint 2 weeks
- Prescribe systemic antibiotics
- Confirm tetanus status
- RCT after 7-10 days
- Open apex same management
131
Closed apex – dry time less than 60 min
- Clean root with saline
- Administer LA
- Irrigate socket with saline
- Reimplant
- Suture any gingival laceration
- Verify normal position of tooth clinically and radiographically
- Flexible splint 2 weeks
- Systemic antibiotics
- Check tetanus
- RCT after 7-10 days
132
Closed apex – dry time over 60mins
- Explain poor prognosis
- Remove PDL with gauze
- RCT can be initiated chairside
- Flexible splint 4 weeks
133
What is the follow up for avulsion
- 2 weeks, 4 weeks, 6-8 weeks, 12 week, 6 months, 1y, 5y
134
What to do in enamel dentine fracture (uncomplicated)
- Enamel dentine only
- No pulpal involvement, sensitive to cold air
- Radiographic: fracture
- Management: restored with composite
- Follow up: 6-8 week, 1 year
135
What to do enamel dentine pulp (complicated)
- Pulp exposure
- Tooth may be sensitive to hot and cold
- Radiograph: fracture
- Management: partial pulpotomy, closed apex and signs of devitalisation then RCT
- Follow up: 6-8 weeks, 12 weeks, 6 month, 1y
136
Crown root fracture with no pulpal involvement
- Enamel dentine and cementum
- Increased mobility with the fracture extending below gingival margin
- Radiograph: difficult to identify changes
- Management: emergency can splint, treatment: fragment removal and resto or gingivectomy, RCT
- Follow up: 1 week, 6-8week, 12 week, 6 months, 1y, 5y
137
What to do with crown root fracture with pulpal involvement
- Mobility, fracture below gingiva
- Radiographic: difficult to see changes
- Same as without exposure, immature apex try partial pulpotomy
- Follow up: 1 week, 6-8 weeks, 12 weeks, 6months, 1y, 5y
138
What to do in root fracture
- Dentine pulp and cementum
- Tooth mobile, bleeding from gingival sulcus
- Radiograph: fracture confined to root
- Management: LA, reposition, flexible splint (4 weeks if mid to apical third, 4 months if cervical third)
- Follow up: 4 weeks, 6-8 weeks, 4 months (splint removal), 6 months, 1y, 5y
139
What to do in alveolar fracture
- Alveolar bone may extend into adjacent bones
- Segment mobility, several teeth discoloured, changes to occlusion, soft tissue contusion
- Radiograph: fracture line
- Management: LA, reposition, rigid splint 4 weeks
- Follow up: 4 weeks, 6-8 weeks, 6 months, 1y, 5y
