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Paeds > Avulsion and Luxation Injuries > Flashcards

Avulsion and Luxation Injuries Flashcards

1
Q

Types of injuries?

A

 Concussion (primary and permenant teeth) /Subluxation
 Lateral/Extrusive luxation
 Intrusive luxation
 Avulsion
 Injury to supporting bone

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2
Q

Concussion what is it? primary and permenant teeth

A

(1º and perm) No abnormal loosening, bleeding or displacement but TTP

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3
Q

How to assess concussion? primary and permenant teeth

A

 Check sensibility
 IOPA

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4
Q

Treatment concussion? primary and permenant teeth

A

 Reassure and analgesia advice
 1/52 soft diet
 Good OH ( +0.2%Chlorhex swab/mw
bd for 1/52)
 Monitor

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5
Q

What is subluxation? primary teeth

A

(1º) Abnormal loosening, but no displacement

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6
Q

subluxation results of tests? primary

A

 Mobile, TTP, +bleeding
 No abnormal radiological findings/slightly

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7
Q

Treatment of subluxation? primary

A

 Reassure and analgesia advice
 1-2/52 soft diet
 Good OH
 Monitor
 *Good OH consider Chlohexidene MW/swab

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8
Q

Subluxation permenant teeth? findings?

A

 Abnormal loosening, but no displacement
 Mobile, TTP, +bleeding
 No abnormal radiological findings

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9
Q

what to assess for permenant tooth subluxation?

A

 Check sensibility (informs prognosis)

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10
Q

Treatment of permenant tooth subluxation?

A

 Reassure and analgesia advice
 1-2/52 soft diet
 Good OH
 Consider flexible splint (2/52) if very
mobile/ tender or closed apex
 Monitor

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11
Q

Types of splinting?

A

Flexible/physiological
Rigid

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12
Q

Flexible/physiological splinting

A

1 tooth either side

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13
Q

Rigid splinting

A

More than 1 tooth either side

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14
Q

Direct restorations for splinting?

A

Composite and wire
Composite and titanium trauma splint
Orthodontic bracket and wire
Foil -cement
Composite/ acrylic

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15
Q

Indirect restorations for splinting?

A

Acrylic
Thermoplastic

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16
Q

When to check outcome of splinting?

A

2 days

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17
Q

Lateral luxation in primary teeth what is it

A

Displacement of the tooth in any lateral direction

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18
Q

Findings

A

No/minimal occlusal interference
Spontaneous repositioning

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19
Q

Treatment for lateral luxation in primary teeth?

A

Severe
Extraction
Reposition and splint
Risk (high)/benefit discussion pre treatment
Consider stability/ splint placement / R/O etc

10-14/7 soft diet
Good OH
Monitor

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20
Q

Extrusion what is it primary teeth

A

Partial displacement of tooth out of socket

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21
Q

What is treatment of extrusion in primary teeth based on?

A

Degree of displacement
Mobility
Interference with occlusion
Root formation
Splint options (co-op)

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22
Q

What is treatment of extrusion in primary teeth?

A

If no occlusal interference conservative
XS mobility or >3mm extract under LA
1-2/52 soft diet
Good OH, reassurance and analgesia advice, Monitor

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23
Q

Extrusive/ lateral luxation is what

A

displacement other than axially, with comminution or fracture of alveolar plate

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24
Q

Treatment of extrusive/lateral luxation in permenant teeth?

A

Reposition (after cleansing of tooth surface)
+/- LA
Digital
Orthodontic appliances (if digital fails)
Splint
Flexible
Lateral 4/52
Extrusive 2/52
Pt instructions
+/- antibiotics
Monitor

25
Q

Intruded teeth is what?

A

A large force is required to severely intrude teeth so be aware of the possibility of other injuries – adjacent teeth, head injury

26
Q

What in intrusion important to assess?

A

degree of intrusion as informs treatment

27
Q

What factors to assess in intrusion of teeth?

A

Age of patient
History of previous position
Other teeth
Radiograph
Compare cej, apices
Previous dental treatment

28
Q

Treatment of intrusion in primary teeth?

A

Monitor for reeruption
Usually within 6 months-1year

10-14/7 soft diet
Reassurance and analgesia advice
Good OH
Monitor

29
Q

Aim in treatment of permenant teeth in intrusion cases?

A

To maintain the tooth if possible

30
Q

Treatment options for intrusion of permenant teeth?

A

Treatment options
Monitor only +/- orthodontics later
Monitor for up to 4 weeks if no movement -» Ortho
Immediate orthodontic extrusion
Surgical repositioning

Consider pulp therapy and timing

31
Q

What techniques are there for repositioning?

A

Orthodontic Repositioning
Surgical repositioning

32
Q

Orthodontic repositioning?

A

A removable appliance with a self-supporting spring or elastic module to apply vertical extrusive force through a bracket bonded onto the labial or incisal surface.
UFA (sectional)

33
Q

Surgical repositioning?

A

LA (Sedation or GA may be required)
Gentle movements with a flat plastic instrument/forceps
If resistant, consider if a bony impaction is present and release this before repositioning the labial plate of bone and soft tissue closure and suturing.
Splint 4/52

34
Q

IADT- Dental Trauma Guide Open apex?

A

Monitor up to 4/52
Then ortho

35
Q

IADT- Dental Trauma Guide closed apex?

A

Up to 3mm ?
monitor /-ortho /surgical
3-7mm

Ortho / surgical
>7mm surgical

36
Q

Follow up/management of incomplete apex?

A

Monitor
If signs or symptoms of pulp death start RCT with apexification

37
Q

Follow up/ management of closed apex?

A

Elective pulp extirpation will be necessary for all intrusive luxation injuries on closed apex teeth
Within 2 weeks of the injury
Keep dressed with calcium hydroxide paste until any inflammatory resorption has stopped

Any being monitored close follow-up

38
Q

Antiobiotics for intrusive luxation?

A

Indications
Contamination
Additional injury to soft tissues or other injuries
Significant surgical intervention
Medical condition rendering more prone to infections
Always for reimplantation in permanent teeth
Types
First line amoxicillin or penicillin based unless CI/ allergy
>12 yrs doxycycline based as alternative

39
Q

Avulsion in permenant teeth management at the site of injury
Plan A?

A

Offer advice over telephone

Plan A
Re-implant immediately
Contaminated -rinse in milk or saline or saliva
Avoiding handling of the root surface
Hold tooth in place by biting on folded handkerchief or napkin
Attend dental surgeon immediately

ATTEND DENTIST IMMEDIATELY

40
Q

Avulsion management at the site of injury plan B?

A

If re-implantation not possible store in suitable storage medium - in order of preference:
Cold fresh milk
Hank’s Balanced Salt Solution
Saliva (buccal sulcus or spit in a cup)

ATTEND DENTIST IMMEDIATELY

41
Q

What about the history for avulsion?

A

Avoid unnecessary delay before re-implantation
During examination place in suitable storage medium if not currently in one
Thorough medical, dental and accident history

42
Q

Treatment for avulsion

A

–LA if patient co-operation allows
–Reimplant ASAP!
Keep pt calm
Prepare socket
No unnecessary manipulation
If clot present gently irrigate with saline in syringe and use suction to remove clot
Avoid curettage
Reposition any bone fragments
–Handling Tooth
Don’t touch root
If contaminated wash in normal saline

43
Q

Treatment 2 for avulsion

A

Push tooth gently into socket
If obstructed by alveolar bone fragments gently use blunt instrument to reposition bone
Check position

Splint if already reimplanted start here (after History and Exam)
Flexible splint for 2 weeks
Check occlusion
+/- sutures
Advise soft diet, good oral hygiene (soft tooth brush and chlorhexidine mouth rinse), avoid contact sports
Follow-up

44
Q

What are the two schools of avulsion?

A

IADT and BSPD

45
Q

IADT

A

For avulsion injuries follow teaching in IADT ‘Dental Trauma Guide’

46
Q

Avulsion open apex teeth-
If reimplanted prior to clinical attendance ?

A

Antibiotics
+tetanus

Splint 2 wks
Flexible
Avoid contact sports

Avoid RCT unless signs

47
Q

Avulsion Open Apex Teeth

If extra oral dry time is less than 60 minutes

A

Reimplant
Antibiotics
+tetanus

Splint 2 wks
Flexible
Avoid contact sports

Avoid RCT unless signs

48
Q

Avulsion Open Apex Teeth

If extra oral dry time is more than 60 minutes
(or non-physiologic media)

A

Reimplant
Antibiotics
+tetanus
Splint 2 wks
Flexible
Avoid contact sports

Avoid RCT unless signs

49
Q

IADT Avulsion Closed Apex Teeth
If reimplanted prior to Clinic attendance?

A

Antibiotics
+tetanus

Splint 2 wks
Avoid contact sports

RCT within 2 wks
Calcium Hydroxide 1mth

50
Q

IADT Avulsion Closed Apex Teeth

A

Reimplant
Antibiotics
+tetanus

Splint 2 wks
Avoid contact sports

RCT within 2 wks
Calcium Hydroxide 1mth

51
Q

IADT Avulsion Closed Apex Teeth
If extra oral dry time is more than 60 minutes

A

Reimplant
Antibiotics
+tetanus

Splint 2 wks
Avoid contact sports

RCT within 2 wks
Calcium Hydroxide 1mth

52
Q

IADT Avulsion Closed Apex Teeth

If extra oral dry time >60 mins
(or non-physiologic media)

A

Reimplant
Antibiotics
+tetanus

Splint 2 wks
Avoid contact sports

RCT within 2 wks
Calcium Hydroxide 1mth

53
Q

When Not To Reimplant(Almost Never!)

A

Primary teeth

Other injuries
Where other injures are severe and require preferential emergency treatment

Medical history
Depressed immunity eg. Acute lymphoblastic anaemia
If in doubt liaise with physician

54
Q

When Not To Reimplant(Almost Never!) cont…

A

Immature permanent tooth with short wide open apex and prolonged extra-oral time
Replacement resorption is inevitable

Gross contamination/ long time out

Grossly carious tooth

Severe periodontal disease

Patient choice

55
Q

Follow-up Management

A

Ideally review within 48 hrs
Check splint and modify if necessary
Reinforce OH and soft diet

Review 2 weeks
Radiograph prior to splint removal
Commence RCT if indicated
Remove splint

56
Q

Avulsion outcome Summary

A

Periodontal ligament survival is critical factor
Dry storage time is most important factor
Wet time less critical
Contamination of root adverse effect
Handling root adverse effect
Prompt RCT decreases inflammatory resorption
Replacement resorption rate determines prognosis
Short term space maintainer should be considered
Long term survival questionable

57
Q

Injuries to supporting bone

A

Comminution of alveolar socket wall
Fracture of alveolar socket wall
Fracture of mandibular or maxillary alveolar process
Fracture of mandible or maxilla

58
Q

Aveolar fracture primary and permenant

A

Mobility of several teeth ‘en bloc’
Displacement, Occlusal interference, TTP

SI
IOPA, Occlusal
+/- OPT and/or CBCT

59
Q

Treatment of alveolar fracture primary

A

Debridement
LA/GA Reposition
Soft tissue repair
Flexible Splint 4/52
Soft diet
Antibiotics
Good OH
Monitor

Paeds (11 decks)

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