Flashcards in Spring - Pedo Final Deck (152):
What percent of children in the US have special health care needs? And out of them, how many have trouble in life?
15% and then 60%
What is the definition of SHCN, special health care needs?
Those with “any physical, developmental, mental, sensory, behavioral, cogni5ve, or emo5onal impairment or limi5ng condi5on that requires medical management, health care interven5on, and/or use of specialized services or programs.”
What percentage of GP's and pedo dentists respectively each treat children with SHCN?
GP's 10% and Pedo's 95%
What are the purposes of the new patient exam with SHCN kids?
Goal is to establish the “Dental Home”
Iden5fy child as a pa5ent with SHCN prior to first visit
Schedule extra 5me
Obtain and record list of medical providers, consult when necessary
Never treat a stranger, especially in the case of pa5ents with SHCN
LISTEN, establish a rela5onship, reduce anxie5es, develop trust
What is protective stabilization?
Defined as “any manual method, physical or mechanical device, material, or equipment that immobilizes or reduces the ability of a patient to move his or her arms, legs, body, or head freely."
What is active immobolization vs passive immobilization?
Ac#ve immobiliza5on involves restraint by another person, such as the parent, den5st, or dental auxiliary.
Passive immobiliza5on u5lizes a restraining device.
What are the three indications for protective stabilization?
1. A pa5ent requires immediate diagnosis and/or limited treatment and cannot cooperate because of lack of maturity or mental or physical disability.
2. A pa5ent requires diagnosis or treatment and does not cooperate ader other behavior management techniques have failed.
3. The safety of the pa5ent, staff, parent, or prac55oner would be at risk without the use of protec5ve stabiliza5on.
What are the four contraindications for protective stabilization?
1. A coopera5ve nonsedated pa5ent.
2. Pa5ents who cannot be safely stabilized due to medical or physical condi5ons.
3. Pa5ents who have experienced previous physical or psychological trauma from protec5ve stabiliza5on (unless no other alterna5ves are available).
4. Nonsedated pa5ents with non-emergent treatment requiring lengthy appointments.
What are the Do's and Dont's of protective stabilization?
Protec5ve stabiliza5on must NOT be used as punishment Protec5ve stabiliza5on must NOT be used solely for convenience
Pa5ent record MUST display informed consent, indica5ons for use, type of stabiliza5on used, and dura5on of applica5on
Tightness and dura5on of stabiliza5on MUST be monitored and reassessed at regular intervals Stabiliza5on around the extremi5es or chest must NOT ac5vely restrict circula5on or respira5on
Stabiliza5on MUST be terminated as soon as possible in a pa5ent who is experiencing severe stress or hysterics to prevent possible physical or psychological trauma
What are the common disabilities or disorders you see with kids?
Down Syndrome (Trisomy 21)
Au5sm Spectrum Disorder
What defines mild intellectual disability?
A child with mild intellectual disability is one who, because of low intelligence, requires
special supports in the school environment.
What percent of mild intellectual disability patients will function acceptably as adults?
What defines moderate intellectual disability?
A child with moderate intellectual disability can be expected to master many voca5onal, leisure, and self-help skills within a suppor5ve environment with trained personnel who help them with problems with which they may not be able to cope on their own.
What defines severe intellectual disability?
A child with severe or profound intellectual disability may present a significant challenge and may be grouped in special educa5on programs or group homes.
Children with intellectual disability usually never have a higher incidence of poor oral hygiene, gingivi5s, malocclusion, and untreated caries. True or False?
False, they usually do.
As the severity of intellectual disability increases, typical oral signs of clenching, bruxing, drooling, pica, trauma, missing teeth, and self-injurious behaviors increase.
Providing dental treatment for a person with intellectual disability requires adjus5ng to social, intellectual, and emo5onal delays.
What are some tips to treating kids with intellectual disability?
Give the family a brief tour of the office before ajemp5ng treatment.
Be repe55ve; speak slowly and in simple terms.
Make sure explana5ons are understood by asking the pa5ent if there are any ques5ons. Give only one instruc5on at a 5me.
Ac5vely listen to the pa5ent.
Invite the parent/guardian into the operatory for assistance and to aid in communica5on. Keep appointments short and simple.
Schedule the pa5ent’s visit appropriately.
What is a learning disability in kids?
Defined as a neurological condi5on that interferes with the individual’s ability to store, process, or produce informa5on.
May affect a person’s ability to read, write, count, speak, or reason.
May affect memory, ajen5on, coordina5on, social skills, and emo5onal maturity.
Learning disabili5es may run in families, indica5ng a possible gene5c factor, and are some5mes confused with intellectual disabili5es, au5sm, deafness, and behavioral disorders.
They include condi5ons that have been referred to as perceptual handicaps, brain injury, minimal brain dysfunc5on, dyslexia, and developmental aphasia.
What percent of kids have a learning disability, and more in boys or girls?
(3-15% and 4x more prevalent in boys)
Most children with learning disabilities accept dental care and cause no unusual management problems for the dentist. True or False?
What are the odds of getting Trisomy 21?
1 in 691
What are the characteristics of Trisomy 21?
Trisomy 21 (1:691)
Cardiac anomalies, leukemia, respiratory infec5ons Underdeveloped midface, prognathic occlusal rela5onship Mouth breathing
Open bite, crowding
Appearance of macroglossia
Fissured lips and tongue
Delayed erup5on 5mes
Missing and malformed teeth
Low level of caries
High incidence of rapid, destruc5ve periodontal disease
What percent of down syndrome kids have cardiac anomalies?
What are the odds of being autistic?
1 in 68. Also more in boys, 10 fold increase in last 10 years.
What does the dental caries risk attribute to for autistic kids?
Dental caries risk due to behavioral and sensory issues affec5ng oral hygiene measures and dietary challenges.
What are some tips to treating autistic kids in your office?
Consider a “get to know you” visit
Have office forms filled out prior to appointment Schedule plenty of 5me
Ask Mom and Dad for help
Break down appointments into small tasks
Use familiar products
Periodic seda5on can be indicated
What causes cerebral palsy? And what are the characteristics of it?
Caused by insult, permanent damage to brain in the prenatal and perinatal periods
One of the primary handicapping condi5ons of childhood
s5ffness, or paralysis
Poor balance or irregular gait, and uncoordinated or involuntary movements Intellectual disability
Sensory deficits or dysfunc5ons
What are some tips to treating cerebral palsy kids?
Consider trea5ng a pa5ent who uses a wheelchair in the wheelchair
If pa5ent requires transfer to a dental chair, ask about preference for mode of transfer Stabilize the pa5ent’s head throughout all phases of dental treatment
Place, maintain pa5ent in midline of dental chair, with arms and legs close
Keep the pa5ent’s back slightly elevated to minimize difficul5es in swallowing
Determine pa5ent’s degree of comfort and assess the posi5on of the extremi5es
Use stabiliza5on judiciously to control flailing movements of the extremi5es
Consider mouth props, but consider gag and swallowing reflexes, and 5me
Minimize startle reflex reac5ons
Introduce intraoral s5muli slowly to avoid elici5ng a gag reflex or to make it less severe
Consider the use of the rubber dam
Work efficiently and quickly and minimize pa5ent 5me in the chair
Seda5on or general anesthesia may be an op5on for more complex pa5ents
What are the odds of having Asthma as a kid?
1 in 10
Asthma is the second leading cause of pediatric hospitalization and school absenteeism. True or False?
False, it is numero uno
What are the main asthma triggers?
Triggers: anxiety, exercise, respiratory infec5ons, allergens, cold air, smoke, pollu5on
What are the symptoms and characteristics of asthma patients?
labored or rapid breathing chest 5ghtness
gasping, inability to talk
Intermijent or Persistent
Mild, moderate or severe
Decreased saliva5on with prolonged use of B2 agonist inhaler
Increased risk of candidiasis with prolonged use of cor5costeroid inhaler
Increased caries risk
Airway related orofacial changes - high palatal vault, overjet, increased facial height
How do you treat asthma kids?
Consult with physician as necessary
Pa5ent should have an inhaler, but always stock in emergency kit Pre-dosing in moderate to severe cases prn
Avoid prolonged supine position, treat in more upright position
Postpone treatment in presence of respiratory infec5on
Minimize aerosolized dental materials such as acrylic
Nitrous oxide acceptable
Always prepare for uncontrolled asthma5c episode requiring interven5on
From the Utah survey, what percentage of special needs kids have all of their needed preventive dental care?
From the Utah survey, what percentage of special needs kids did not have all of their needed preventive dental care?
From the Utah survey, what percentage of special needs kids did not need other dental care?
From the Utah survey, what percentage of special needs kids got all needed other dental care taken care of?
From the Utah survey, what percentage of special needs kids had other unmet dental care needs?
Children with Down syndrome may show delays of up to 2 years. True or False?
Children can often get herpetic gingivostomatitis or herpes labialis before 6 months of age. True or False?
Herpetic Gingivostomatitis only takes place in children. Usually under the age of 12. True or False?
False, can occur in adolescents and young adults.
What are the main medications associated with gingival overgrowth?
1. Calcium channel blockers
2. Phenytoin sodium
What three special needs diagnoses are frequently seen in Utah?
1. Trisomy 21, Down Syndrome
2. Cleft Lip and Palate
3. Craniofacial Syndromes
What is the average age for a baby with Down Syndrome to get their first tooth?
12-14 months, maybe 24 months
What is the average age for a baby with Down Syndrome to get all baby teeth by?
4-5 yrs, whereas normal is 2-3 years. Permanent incisors and 6 year molars may not erupt until 8-9 yrs of age.
What are the four main things to consider prior to dental procedures for sedating special needs kids?
1. Behavior/ communication
2. Airway obstruction
4. Atlantoaxial instability
What is the most common craniofacial anomaly?
Most common is cleft lip and/or palate
How many newborns are affected each year with cleft lip and/or palate?
1 in 750. Approximately one-half of these infants have associated malformations, either minor or major, occurring in conjunction with the cleft
What is the Utah average for cleft lip/palate newborns?
1 in 450. No change in rate during 13 years of surveillance.
When did the whole idea behind TEAMS attacking cleft palates first appear in literature?
According to the 1998 TEAM standard, which professionals make up the team?
Oral surgeon, Orthodontist, Speech pathologist
According to the 1998 TEAM standard, what four tools were used to treat patients?
1. CT and MRI
2. Cephalometric radiographs
3. Dental study models
What four things are vital to reduction of mortality from craniofacial operations?
1. Establishment of a dedicated surgical team
2. Frequent performance of operative procedures
3. Adequate support facilities
4. Longitudinal follow-up
What does the A, B, C, D, E, and F stand for in the Initial Clinical Assessments?
A - airway
B - breathing
C - circulation
E - exposure
F - feeding
What two syndromes are involved in complex craniofacial clefting?
2. Goldenhar's Syndrome
Referral for team evaluation and management of special needs children is only appropriate within the first few years of life. True or False?
False. The optimal time for the first evaluation is within the first few weeks of life and, whenever possible, within the first few days. However, referral for team evaluation and management is appropriate for patients at any age.
Care should be coordinated by the team but should be provided at the local level whenever possible; however, complex diagnostic and surgical procedures should be restricted to major centers with the appropriate facilities and experienced care providers. True or False?
What is esophageal atresia?
You don't have an intact communiciation in your esophagus (child can't feed, life threatening)
Why is spina bifida associated with latex sensitivity?
These patients because of frequent contact with medical professionals are at risk with latex sensitivity (spina bifida and latex sensitivity go hand in hand)
If you have a patient with a non-lethal condition, you are federally and professionally obligated to give that person a full life. True or False?
True. If a person has a lethal condition, this is a different story.
What orofacial characteristics are often associated special needs kids?
Maxillary (upper jaw) hypoplasia
Decreased anterior and posterior face height
Anterior open bite
Maxillary and mandibular planes rotate forward
What are the two main characteristics of down syndrome involving the teeth?
Oligodontia and Macrodontia
What are the three levels to dental care?
1. Primary (GP)
2. Secondary (Specialist)
3. Tertiary (subspecialist, in a facility with a tertiary care setting such as OR, anesthesiology)
What are two popular combinations with down syndrome patients?
Clefts and Ectodermal dysplasia
What three things does ectodermal dysplasia affect?
1. Hair (pilosebaceous complexes, anhydrosis)
2. Teeth (hypodontia) (conical, reduced VD)
3. Nails (sebacious complexes)
With what type of patients is bruxism common?
Neuro patients. Treatment is generally extraction.
Why would we test for alkaline phosphatase levels in pedo special needs patients?
Because of hypohphosphatasia, and early severe perio disease. Odontophosphotasia is an increase in a particular type of phosphate. Only involves the roots of teeth.
What does CPAP stand for and what does it do with special needs patients?
CPAP – continuous pressure alternating pressure -> provides positive pressure to open up the airway
- Good option unless the midface is so far back that the mask won’t fit
- If you put pressure on a growing bone then it goes back
What is the characteristic look of Gastroesophageal Reflux (GER)?
Cobble stoning. Bright red and pebbly appearance in the posterior pharyngeal wall) in the throat and erosion
- Score the tonsils
- Score the throat
What are the two components of Asthma?
2. Allergic reaction
In the study, what percentage of kids aged from 6 to 11 exhibited oral habits such as nail and object biting, sucking, tongue thrusting, or lip and cheek biting?
What were the five conclusions from the Sucking habits in Saudi children study?
1. Sucking habits were found in nearly half of 3- to 5-year-old Saudi children with dummy sucking as the dominant type.
2. We found no significant effect of gender difference, child birth rank, or family income on the prevalence of sucking habits.
3. Parents’ educational level is positively related to dummy-sucking habit with no appreciable effect on digit-sucking.
4. Prevalence of digit and dummy-sucking was the lowest among children who have good opportunity for breastfeeding.
5. A significant relationship was found between persistent sucking habits and malocclusion in the form of distal molar and class II canine relationship, increased overjet, and anterior open bite. Posterior crossbite is no more common in sucking habits than in children without these habits.
What is the effect of hypertrophic adenoids and tonsils on the development of posterior crossbite and oral habits?
The presence of crossbite was high in children with severe airway obstruction, particularly in those with hypertrophied adenoids and tonsils. On the contrary, most of the children with a posterior crossbite did not have a history of pacifier or finger sucking.
What did the study on dental arch diameters and relationships to oral habits conclude?
In most cases, dummy use and mouth breathing were associated with a reduction in the intercanine distance in the maxillary arch. A dummy habit leads to a reduction in maxillary arch width, and mouth breathing causes a reduction in the size of both arches.
What is the etiology of bruxism?
The etiology of bruxism includes habit, emotional stress (response to anxiety, tension, anger, or pain), parasomnias, neurologic abnormalities, tooth malocclusion, and, rarely, a medication side-effect.
The etiology of bruxism is usually identified fairly quickly. True or False?
False, it is often unknown
For children younger than 8 years, treatment is usually not required for bruxism. True or False?
There is an improvement of bruxism after tonsil and adenoid surgery. True or False?
What are the four main causes of bruxism?
1. High anxiety level
4. Oral habits
What are the main four therapeutic approaches for bruxism?
1. Oclusal adjustment of dentition
2. Interocclusal appliances
3. Behavior modification
The relationship between oral habits and unfavorable dental and facial development is cause and effect rather than associational. True or False?
False, that is backwards
Habits of sufficient frequency, duration, and intensity may be associated with dentoalveolar or skeletal deformations such as increased overjet, reduced overbite, posterior crossbite, or long facial height. True or False?
With sucking habits, the magnitude of force is more important than duration. True or False?
False, duration is more important, with resting pressure form lips, cheeks, and tongue having the greatest impact on tooth position.
What five things has prolonged nonnutritive sucking habits been associated with?
1. Decreased maxillary arch width
2. Increased overjet
3. Decreased overbite
4. Anterior open bite
5. Posterior crossbite
It is recommended to provide parents with guidance to help their children to stop sucking habits by what age or younger?
Evidence indicates that juvenile bruxism has far-reaching effects into adulthood. True or False?
False, it is self-limiting and does not persist in adults
What are some treatment modalities for kids with physchiatric disorders, traumatic brain injuries, etc, to avoid mouth and tooth damage?
Lip bumpers, occlusal bite appliances, protective padding, and extractions.
Research says that mouth breathing may contribute to the development of increased facial height, anterior open bite, increased overjet, and narrow palate, but it is not the sole or even the major cause of these conditions. True or False?
What five things can obstructive sleep apnea syndrome be associated with?
1. narrow maxilla
3. low tongue position
4. vertical growth
5. open bite
What are the four main specialists that oral habit problems are referred to?
3. Myofunctional therapists
The use of an appliance to manage oral habits is indicated only when the child wants to stop the habit and would benefit from a reminder. True or False?
What part of the skull dictates how the face grows for the most part?
What type of disease are children with clefts more susceptible to?
What is the common vaccine worried about with tooth injuries?
A force strong enough to fracture, intrude, or avulse a tooth is also strong enough to result in cervical spine or intracranial injury. True or False?
What is a class I crown fracture?
Simple involving little or no dentin
What is a class II crown fracture?
Involving considerable dentin but no pulp
What is a class III crown fracture?
Extensive fracture of crown with exposure of dental pulp
What is a class IV crown fracture?
Loss of entire crown
According to Ellis and Davey's classification for tooth fractures, what is Class I through Class IX?
I = enamel only
II = dentin but no pulp
III = dentin and pulp
IV = tooth becomes non-vital
V = avulsion
VI = fracture of root without loss of crown
VII = displacement of tooth with neither crown or root fracture
VIII = displacement and crown fractureWha
IX = traumatic injuries of primary teeth
What is the treatment order (#1-9) for a broken tooth?
1. Soft tissue
2. Pulp therapy
7. Medication (Tylenol at night, Ibu during day)
9. Record treatment and rationale
You should always restore a crown fracture on the first visit in order to prevent future complications. True or False?
False, tooth might be traumatized. A temporary cover of dentin can be accomplished easily without to much additional trauma to tooth, this is often the treatment of choice. Often the temporary resin can be left on, when final restoration is finished.
What is pulpal hyperemia?
A trauma of even a so-called minor nature is immediately followed by pulpal hyperemia. Difficult to determine the initial pulpal response and in predicting the long-range reaction of the pulp, congestion of blood in the pulp chamber can often be seen in exam, color often appears reddish
What is internal hemorrhage
Hyperemia and increased pressure may cause the rupture of capillaries and the escape of red blood cells, with subsequent breakdown and pigment formation. The extravasated blood may be reabsorbed before gaining access to the dentinal tubules, in which case little if any color change will be noticeable and what does appear will be temporary.
More severe case, there is pigment formation in dentinal tubules. The change in color is evident within 2 to 3 weeks after the injury, and although the reaction is reversible to a degree, the crown of the injured tooth retains some of the discoloration for an indefinite period.
Pulp may remain vital, if color change remains dark-grey likelihood of vitality is low.
Discoloration that becomes evident for the first time months or years after an accident, however, is evidence of a necrotic pulp. True or False?
According to the study, what percent of dark grey teeth that had been pulpectomized ended up being necrotic?
What is calcific metamorphosis of the dental pulp?
A frequently observed reaction to trauma is the partial or complete obliteration of the pulp chamber and canal.
The crowns of teeth that have undergone this reaction may have a yellowish, opaque color. Primary teeth demonstrating calcific metamorphosis will usually undergo normal root resorption
Permanent teeth will often be retained indefinitely. However, a permanent tooth showing signs of calcific changes as a result of trauma should be regarded as a potential focus of infection.
What is internal resorption?
- Destructive process thought to be caused by odontoclastic action
- May be observed radiographically in the pulp chamber or canal within a few
weeks or months following injury
- Destructive action may progress slowly or rapidly
- If caught soon enough, it may be able to be stopped with endodontic procedures
- Is associated with a pink spot
What is external root resorption?
• Trauma with damage to the periodontal structures may cause external root resorption.
• The reaction starts from outside, the pulp may not become involved
• Resorption usually continues unabated until root structure is gone
• Usually seen in severe trauma which there has been some degree of displacement of tooth
What are the characteristics of pulpal necrosis?
• Little relationship exists between the type of injury to the tooth and the reaction of the pulp tissue and surrounding tissues
• A severe blow causing displacement may sever the apical vessels.
• A less severe blow that doesn’t cause displacement can also cause damage to apical vessels which may eventually cause pulpal necrosis
• A tooth injury that causes coronal fracture as opposed to displacement has a better pulpal prognosis.
• Injured teeth with pulpal necrosis often are asymptomatic and radiograph initially
• Some teeth do not recover and external and internal resorption may occur and therefore need to be WATCHED!!!
In a less severe type of injury, the hyperemia and slowing of blood flow through the pulpal tissue may cause eventual necrosis of the pulp. In some cases the necrosis may not occur until several months after the injury.
How is a necrotic pulp treated on a primary tooth?
- A necrotic pulp in an anterior primary tooth may be successfully treated if no extensive root resorption or bone loss has occurred.
- Trauma to the periapical tissues during canal instrumentation must be carefully avoided. After the canal has been properly prepared via a facial access in this example, it is filled with slow-setting zinc oxide–eugenol. The canal walls are first lined with a thin mix of the canal-filling material. A thicker mix should then be placed in the pulp chamber. Over this is placed a pledget of cotton, and the material is forced into the canal with a small amalgam plugger.
What are the characteristics of Ankylosis?
• Another reaction observed after trauma to anterior primary and permanent teeth is Ankylosis
• A condition caused by injury to the PDL and subsequent inflammation which is associated with invasion of osteoclastic cells.
• This results in irregularly resorbed areas on the PDL surface
• This causes a mechanical lock or fusion between alveolar bone and the root surface
• Adjacent teeth continue to erupt, whereas the ankylosed tooth remains fixed in relation to surrounding structures.
How do you treat primary and permanent ankylosed teeth respectively?
- The ankylosed anterior primary tooth should be removed if there is evidence of its causing delayed or ectopic eruption of the permanent successor. If ankylosis of a permanent tooth occurs during active eruption, eventually a discrepancy between the position of this tooth and its adjacent ones will be obvious. The uninjured teeth will continue to erupt and may drift mesially, with a loss of arch length. Therefore either surgical repositioning or the removal of a permanent tooth that becomes ankylosed is often necessary, especially if the ankylosis occurs during the preteen or early teen years.
When bonding a composite resin restoration to a fracture, slight beveling of the fractured enamel margins is usually recommended with the feathered-edge technique to remove loose enamel rods and ensure a fresh surface for etching. True or False?
Calcium hydroxide is often put on exposed dentin of fractured teeth. True or False?
The exposed dentin may be protected with a layer of hard-setting calcium hydroxide, and etching should extend 2 or 3 mm beyond the fracture to allow an adequate surface for feather-edging of the resin restorative materials.
According to the study, what percent of the patients had changes to permanent teeth caused by previous injuries to primary dentition?
Generally the developing permanent tooth buds develop buccally to the root of the primary tooth. True or False?
False, lingually. With an intrusion, the intruded primary tooth generally remains labial to Permanent tooth bud.
If primary tooth intrudes on lingual area and displaces permanent tooth bud it should be removed. True or False?
True. Intruded primary teeth should be observed; no attempt should be made to reposition them after the accident. Most injuries of this type occur at an age when it would be difficult to construct a splint or a retaining appliance to stabilize the repositioned teeth.
What are the possible outcomes for an intruded primary tooth?
Primary anterior teeth intruded as a result of a blow may often re-erupt within 3 to 4 weeks after the injury.
During the first 6 months after the injury, however, the dentist often observes one or more of the reactions of the pulp and supporting tissues that have been mentioned previously in this chapter, the most common of which is pulpal necrosis. Even after re-eruption, a necrotic pulp can be treated if the tooth is sound in the alveolus and no pathologic root resorption is evident.
How do you treat primary teeth that have been displaced but not intruded?
Primary teeth that are displaced but not intruded should be repositioned by the dentist or parent as soon as possible after the accident, to prevent interference with occlusion. The prognosis for severely loosened primary teeth is poor. Frequently the teeth remain mobile and undergo rapid root resorption.
What did the study conclude regarding the prognosis of loosened teeth with teeth with root formation and completed and teeth with uncompleted root formation?
He concluded that the immediate and future prognosis for the pulp was more favorable if root formation was still incomplete at the time of the accident. Root resorption, which was observed in all three groups of loosened teeth, was most common in impaction cases. Teeth with complete root formation seemed to undergo resorption more frequently than those with incomplete root formation. However, when resorption did occur, it was more extensive and progressed more rapidly in teeth with incomplete root development.
Intruded permanent teeth have a poorer prognosis than primary teeth. The tendency for the injury to be followed by rapid root resorption, pulpal necrosis, ankylosis. True or False?
What is the treatment for a permanent tooth with closed apex and only intruded 3mm or less?
Treatment for permanent tooth with closed apex and only intruded 3mm or less is to let tooth erupt without intervention. WATCH, may need to pull down with orthodontics.
What is the treatment for a permanent tooth with closed apex and only intruded or extruded 7mm?
Reposition tooth surgically and stabilize for 4-8 weeks with a flexible splint.
Pulp will become necrotic, root canal treatment started 2-3 wk after stabilization, fill with Ca(OH) initially to stop external resorption.
How do you treat a permanent tooth that has intruded less than 7 mm with an open apex?
Allow it to erupt spontaneously If doesn’t erupt within 2-4 weeks orthodontically reposition.
How do you treat a permanent tooth that has intruded more than 7 mm with an open apex?
If Permanent tooth is intruded more than 7mm, surgically reposition tooth and stabilize with flexible wire for 4-8 weeks.
Endodontic therapy should be initiated with Ca(OH) monitor closely before initiating endodontic treatment
In immature permanent teeth that underwent spontaneous eruption after intrusion had the highest failure rate. True or False?
False, had the lowest.
Extrusive luxation of a permanent tooth usually results in pulpal necrosis. True or False? And how do you treat it?
True. Treatment is repositioning of tooth, splinting with a flexible splint, and initiation of Ca(OH) endodontic treatment.
The need for endodontic intervention is usually always warranted in cases of significant extrusion (more than 2 mm) of mature teeth. True or False?
Replantation of permanent teeth continues to be practiced and recommended, however, slow or rapid root resorption often occurs with even the most precise and careful technique. True or False?
What are the advantages to replantation?
1. Sometimes prolonged retention is achieved, especially when replanted rapidly
2. The replanted tooth serves as a space maintainer and often guides adjacent teeth into their proper position in the arch.
3. The replantation procedure also has psychological value.
Replantation should be viewed as a temporary treatment. True or False?
True. Sometimes can last 5-10 years, sometimes only months. Most common age is 7-9 years. 3 times more frequent in boys.
What is the most common age for an avulsion and are boys are girls more likely?
7-9 years, 3X more with boys
What did the study say about replanted teeth within 30 minutes?
90% showed no evidence of resorption 2 or more years later
What did the study say about replanted teeth more than 2 hours later?
95% had showed root resorption
Do you get a better outcome with a open or closed apex for a replanted tooth?
Open apex. With closed, pulpotomies and Ca(OH) should be done within a few days.
Primary teeth should be replanted when possible. True or False?
What should you tell parents when they call asking about what to do with their child's avulsed tooth?
1.Make sure no other injuries, neurologic, or other higher priority injuries;
2.Primary teeth are not replanted.
3.Keep patient calm.
4.Find tooth, pick up by crown, avoid touching the tooth.
5.If tooth is dirty, wash it briefly (10seconds) under cold running water and reposition it. Try to encourage patient/parent to replant tooth. Bite on a handkerchief to hold tooth in position.
6.If repositioning is impossible, place tooth in suitable storage medium.
7.Seek emergency dental treatment immediately, unless patient needs other medical help
In replanting teeth, the preservation of an intact and viable periodontal ligament is the most important factor in achieving healing without root resorption. True or False?
When a patient arrives to your office with a displaced tooth, what are the steps you should take?
If an evaluation of the socket area shows no evidence of alveolar fracture or severe soft-tissue injury, the tooth is intact, and only a few minutes have elapsed since the injury, the dentist should replant the tooth immediately. Under the conditions just described, every effort should be directed toward preserving a viable periodontal ligament. Trope correctly asserts that treatment should be directed at avoiding or minimizing the resultant inflammation that occurs as a direct result of the two main consequences of tooth avulsion: attachment damage and pulpal infection. If the tooth was cleanly avulsed, it can probably be replanted without local anesthetic, and obtaining the initial radiograph can also be delayed until the tooth is replaced in the socket and held with finger pressure. The minutes saved may contribute to a more successful replantation. If a clot is present in the socket, it will be displaced as the tooth is repositioned; the socket walls should not be scraped with an instrument. If the tooth does not slip back into position with relative ease when finger pressure is used, local anesthesia and a radiographic evaluation are indicated. Local anesthetic should also be administered when fractured and displaced alveolar bone must be repositioned before the tooth is replanted. Soft-tissue suturing may be delayed until the tooth has been replaced in the socket; however, the suturing should be performed to control hemorrhage before the tooth is stabilized with a bonded splint.
What are the good storage mediums for avulsed teeth?
1.Tooth must be kept moist, dehydration of tooth is damaging.
2.Hanks’ buffered saline- sometimes sold in stores.
3.Isotonic saline if available.
4.Pasteurized Cow’s milk is probably the most favorable medium that is easily available.
5.Tap water is not very good because is hypotonic and leads to cell lysis, but is better than dehydration.
How long is a splint usually put on after replanting a tooth?
7-14 days. More severe subluxation, teeth that have been laterally displaced fracturing the alveolar process, splint 4-6 weeks.
What are the eight criteria for an acceptable splint for a replanted tooth?
1.It should be easy to fabricate directly in the mouth without lengthy laboratory procedures.
2. It should be able to be placed passively without causing forces on the teeth.
3. It should not touch the gingival tissues, causing gingival irritation.
4. It should not interfere with normal occlusion.
5. It should be easily cleaned and allow for proper oral hygiene.
6. It should not traumatize the teeth or gingiva during application.
7. It should allow an approach for endodontic therapy. 8. It should be easily removed.
When should endo/pulpectomy be done on a replanted tooth?
The pulp should be extirpated before the splint is removed, however, and preferably within 1 week after the injury. A sterile, dry cotton pellet or one dampened with CMCP and blotted on sterile gauze may be sealed in the pulp chamber after debridement and irrigation. The canal should be filled approximately 2 weeks after the injury. When the canal is filled, calcium hydroxide paste is the material of choice.
Root canal treatment should be initiated 7 to 10 days after replantation. Early extirpation of the pulp may help to control the early onset of inflammatory root resorption. Filling the root canal with calcium hydroxide also controls and may even arrest external inflammatory root resorption. If the calcium hydroxide is placed in the canal too soon (before adequate healing of the periodontal ligament), however, it may stimulate replacement root resorption. Andreasen suggested that 2 weeks after replantation is the ideal time to fill the canal with calcium hydroxide. The use of calcium hydroxide as a root-canal–filling material was described previously in the discussion of apexification.
The calcium hydroxide material used to fill the root canal should be replaced every 3 to 6 months until a decision is made to fill the canal with gutta-percha. The optimum duration of the calcium hydroxide treatment is unknown, but generally calcium hydroxide should be kept in the canal for at least 6 months or until root end closure (apical plug) occurs beyond 1 year. In cases in which an adjacent tooth is still unerupted, calcium hydroxide treatment is recommended until eruption of the adjacent tooth. It is believed that eruption may stimulate or accelerate the resorptive process in a nearby replanted root.
How do oral electrical burns occur?
1. Childplacesfemaleendofa“live” extension chord into mouth
2. Childsucksorchewsonexposed or poorly insulated electrical wires
3. Electrolyte-richsalivaprovidesa short circuit between the chord terminals and mouth
coagulation tissue necrosis
How do you treat oral burns?
• Control of minor hemorrhage, possibility of spontaneous arterial hemorrhage can occur in first 3 wks
• Check immunization status
• Possibly give broad spectrum antibiotics
• Treatment of choice is prosthetic
appliance to prevent contracture of healing tissue and create normal- appearing commissure
When is direct pulp capping a traumatized tooth the best option?
If the patient is seen within an hour or two after the injury, if the vital exposure is small, and if sufficient crown remains to retain a temporary restoration to support the capping material and prevent the ingress of oral fluids, the treatment of choice is direct pulp capping.
But iff the final restoration of the tooth will require the use of the pulp chamber or pulp canal for retention, a pulpotomy or a pulpectomy is the treatment of choice.
How is direct pulp capping done on a fractured tooth?
•Thin layer of dentin-type material placed over exposed pulp
then sealed with a bonded restoration,
•Most important is to seal and protect pulp tissue from oral fluids
Calcium hydroxide and MTA are great
When is a pulpotomy on a traumatized tooth indicated?
If the pulp exposure in a traumatized, immature permanent (open apex) tooth is large, if even a small pulp exposure exists and the patient did not seek treatment until several hours or days after the injury, or if there is insufficient crown remaining to hold a temporary restoration, the immediate treatment of choice is a shallow pulpotomy or a conventional pulpotomy.
A SHALLOW or partial pulpotomy is preferable if coronal pulp inflammation is not widespread and if a deeper access opening is not needed to help retain the coronal restoration. Pulpotomy is also indicated for immature permanent teeth if necrotic pulp tissue is evident at the exposure site with inflammation of the underlying coronal tissue, but a conventional or cervical pulpotomy would be required. Yet another indication is trauma to a more mature permanent (closed apex) tooth that has caused both a pulp exposure and a root fracture. In addition, a shallow pulpotomy may be the treatment of choice for a complicated fracture of a tooth with a closed apex when definitive treatment can be provided soon after the injury
How is the pulpotomy performed for a fractured tooth?
• Exposure site should be conservatively enlarged,1-2 mm of coronal pulp tissue removed for shallow or all tissue in pulp chamber removed for conventional pulpotomy
• Clean with copious irrigation, control hemorrhage with wet cotton pellet
• Dressing of Calcium Hydroxide gently placed to fill chamber
• Fill last of chamber with hard setting material to seal
• Tooth, then can be restored with bonded material
What is apexogenesis?
In instances of complicated fractures of young permanent teeth with incomplete root growth and a vital pulp, the pulpotomy technique is the procedure of choice. The successful pulpotomy allows the pulp in the root canal to maintain its vitality and also allows the apical portion to continue to develop (apexogenesis).
What is apexification and what are the steps?
Instead of apical surgery, a less traumatic endodontic therapy called apexification has been found to be effective in the management of immature, necrotic permanent teeth. The apexification procedure should precede conventional root canal therapy in the management of teeth with irreversibly diseased pulps and open apices.
1. Under rubber dam access the tooth, with files clean out the canal, rinse with hydrogen peroxide and sodium hypochlorite, dry canal with paper points and cotton.
2. Either wait 4 days or this apt fill canal with thick paste of calcium hydroxide. Excess should not be pushed beyond apex. Seal canal opening with cotton pledget and ZOE
3. Let tooth sit for 6 months, determine if a “positive stop” has been created. If not retreat check in 2-3 months./ if yes fill with gutta-percha