IADT guidelines Flashcards
Primary tooth
Enamel only
No radiographs
- Smooth sharp edge
- Give advice re care;
-advise caution when eating to avoid traumatising tooth
-clean affected area with chx 0.2% mouthrinse, twice daily for 1 week
*apply using cotton swab or soft brush
No follow-up necessary
Potential complications:
-Symptomatic (painful)
-Crown discoloration
-Pulp necrosis and infection
-Swelling +/- sinus tract
-Increased mobility
-usually the tooth remains asymptomatic and healthy root development continues
Primary tooth
Enamel-Dentine
Confirm location of fragment first; ask in history, clinical examination +/- radiograph
*usually falls outside of mouth but take ST radiograph if suspected to be embedded
1.Cover exposed dentine with GI or composite
2.Restore missing tooth tissue in composite (now or at later visit)
3.Give care advise;
-same as enamel only
-advise parents to bring child back immediately if any unfavourable signs develop (pain, swelling, discoloration, mobility)
Follow up:
-6-8 weeks (clinical only)
-Only take radiograph if signs of pathology present (ie. Discoloration, increased mobility, swelling)
-If treatment is required, refer to secondary care/paed specialist
Primary tooth
Exposed pulp
Periapical radiograph (or occlusal)
*to aid diagnosis and establish a baseline
ST radiograph if suspected to be embedded
- Partial pulpotomy if small exposure (full pulpotomy if large exposure)
-cover exposed pulp with non-setting CaOH cement
-cover that in GI
-restore in composite
2.Provide care advice;
-same as before
-same advice to parent to bring child in in the event of pathology
Follow up:
Clinical: 1w then 6-8w then 1y
Radiographic: 1y post-tx
*only take another radiograph if there are signs of pathology (as previously discussed)
Primary tooth
Crown-root
Take a periapical radiograph
- Remove any loose fragments
- Assess restorability: yes or no
- Restore as necessary
OR
Leave any firm root fragment in-situ or extract entire tooth
*depends on child co-operation - Give care advice:
-same as before
Follow up: (if tooth is retained)
Clinical: 1w then 6-8w then 1yr
Radiographic: 1yr post tx
*any other radiographs only in event of pathology development
Primary tooth
Root fracture
Periapical radiograph
- Determine displacement
-none = no treatment
-displaced w/o excessive mobility = no treatment (allow to spontaneously re-position, even if there is minor occlusal interference)
-displaced w/ excessive mobility = option A or B
A: extract only loose coronal fragment, leaving apical fragment to resorb
B: gently reposition coronal fragment and (if unstable) splint for 4 weeks
Follow up depends on tx provided:
No displacement:
Clinical: 1w then 6-8w then 1yr
Displacement + splint:
Clinical: 1w then 4w (splint removal) then 8w then 1yr
Extraction:
Clinical: after 1yr
In all three cases, where there is concern of a likely unfavourable outcome:
review every Yr until permenant erupts
Primary tooth
Alveolar fracture
Usually presents as; mobility and dislocation of the segment with several teeth moving together + occlusal interference
- Periapical radiograph +/- lateral radiograph (to identify relationship between maxilla/mandible if the segment is displaced in a labial direction)
- Reposition segment (under LA) and splint for 4 weeks to adjacent uninjured teeth
- Advice re care:
-same as before
Follow up:
Clinical: 1w then 4w (splint removal) then 8w then 1yr then again at 6yrs (to monitor eruption of permanents)
Radiographic: 4w and 1yr (to assess impact on primary and permanent tooth germs)
*more may be needed based on findings
If the fracture line is across the primary tooth apex(s) - an abcess can develop and will present as a radiolucency
Any further treatment is done in specialist care
Would you sensibility test primary teeth?
No.
In primary teeth this test is unreliable
What should be recorded in the primary tooth trauma
Color, mobility, displacement, occlusal interference, tenderness to manual pressure
Discoloration management
-Discoloration may disappear over time (weeks or months)
-Discoloration itself is not reason enough to treat even if it persists
-Discoloration + signs of infection = root canal treatment
Radiograph exposure in children
Try to minimise it. That’s why they’re rare in the guidelines unless there is clinical pathology present
ALARA principle and why
As low as reasonably achievable
Children are higher risk for developing cancer from Radiographic exposure due to radiosensitivity of tissues and longer life expectancy
The two types of injury to a tooth
Hard tissue (fracture)
Periodontal injury (luxation)
*important to test adjacent teeth as several may be affected from trauma. Not just tooth in question
The two types of trauma injuries to primary teeth with greatest associated complications in the permanent dentition
Avulsion and Intrusion *and alveolar fracture
(A.I)
*it’s very important to make the parents aware of the complications following injury. Otherwise, they’re going to leave and come back pissed off to fuck because their kid has fucked up teeth now
Avulsed primary tooth
Should not be reimplanted
Primary teeth
Uncooperative child
Observation is usually most appropriate treatment *unless there is a risk of aspiration, ingestion or severe occlusal interference
+ analgesic advice (ibuprofen + paractamol)
+ rapid referral (next few days) to child specialist
Delay extraction on initial/acute presentation is a reasonable strategy to reduce associated post-dental-treatment anxiety
Primary dentition
Cooperative child
The aim is to maintain the primary dentition and reduce chance of complications
Discussion of future visits and treatment to minimise impact of trauma on the permanent dentition is essential
Copy and pasted
For crown and crown-root fractures involving the pulp, root fractures, and luxation injuries, rapid referral within several days to a child-oriented team that has experience and expertise in the management of dental injuries in children is essential.
Splinting is used for alveolar bone fractures40, 61 and occasionally may be needed in cases of root fractures62 and lateral luxations.62
Antibiotics and tetanus immunisation in the primary trauma case
Antibiotics not recommended.
*However in the event of significant ST injury, its at the clinicians discretion
*concerned by child’s medical status warranting ab use? Contact child’s paediatrician
Tetanus booster ‘may be required’ where there is environmental contamination of the injury.
*when in doubt, refer to a medical practitioner within 48hrs
Primary
Concussion
Diagnosed by: tender to touch without displacement or mobility, no sulcular bleeding
No radiograph
Observe
Advice as normal
Follow up:
Clinical: 1w then 6-8w
*Radiographic only where pathology develops
Primary
Subluxation
Diagnosed by: tender to touch and increased mobility BUT no displacement, bleeding from gingival crevice may be present
Periapical
*normal or slightly widened pdl normal
No tx. Observation only
Advice as normal
Follow up:
Clinical: 1w then 6-8w
*follow up at 1yr intervals until permenant erupts IF concerned unfavourable outcome likely
*radiograph only in event of pathology
Luxation extrusion
Primary
Partial displacement
Tooth appears elongated
Periapical
Leave to spontaneously adjust if not interfering with occlusion
Extract if >3mm extrusion OR excessively mobile (under child expert team)
Normal advise
Lateral luxation
Primary
Screenshots
Intrusive luxation
Primary
Screenshots
Avulsion
Primary
Screenshots
