Paediatric dental trauma Flashcards
ILO 2.9a,b: competently place calcium hydroxide in a permanent incisor tooth with an open apex and place a flexible stent on a traumatised tooth in a simulated setting
what are some risk factors of traumatic dental injuries (TDI)?
- oral factors: overjet >=6mm, imcompetent lips (don’t fully cover teeth)
- medical history: epilepsy, cerebral palsy, visual/hearing impairment, ADHD
- sports: contact (boxing, rugby), non-contact (horse riding, cycling), equipment (cricket, hocket)
- other: past experience of TDI, bullying, neglect or abuse
what are fracture injuries? give examples
injuries when dental hard tissues are fractured
* enamel fracture (uncomplicated)
* enamel dentine fracture (uncomplicated)
* enamel dentine fracture with pulp exposure (complicated)
* crown root fracture +/- pulp exposure (complicated / uncomplicated)
* root fracture
* alveolar fracture
what are displacement injuries? give examples
when the periodontal ligament is injured
* concussion
* subluxation
* lateral luxation
* intrusion
* extrusion
* avulsion
how do you assess a TDI?
- take a history - injury (when, where, how), medical history (may affect treatment - bleeding disorder, immunocompromised), dental history (previous TDI? anxious? cooperative?)
- extraoral exam
- intraoral exam
what acts as a base record that you can compare to other teeth?
trauma stamp
give some simple post-operative advice for TDIs?
- do not bite on traumatised teeth for 1-2 weeks
- soft diet
- meticulous oral hygiene
- analgesia
- who to call if problems arise
what is an uncomplicated crown fracture?
- fractures involving only the enamel
- fractures involving the enamel and dentine
what is a complicated fracture?
fractures involving enamel and dentine, exposing the pulp
how would you approach first aid for enamel dentine fractures?
- account for missing fragment - may be embedded in soft tissue or inhaled
- if immediate treatment not possible, apply a composite resin bandage to cover exposed dentine to protect tooth and minimise bacterial ingress in tubules
- definitive restoration at later appointment
what ways can you manage an enamel fracture?
- smooth fracture margins
- if tooth fragment available, reattach fragment
- if tooth fragment not available, composite resin restoration
what ways can you manage an enamel-dentine fracture?
- if tooth fragment available, reattach fragment
- if tooth fragment not available, composite resin restoration
what ways can you manage an enamel-dentine fracture with pulp exposure?
- pulpotomy (Cvek/partial or coronal) and restoration
- pulpectomy and restoration if irreversibly damaged
what can pulp survical be affected by in a TDI?
- presence of periodontal ligament injury
- extent and degree of exposed dentine
- apical status - immature / mature
what is a pulpotomy and its aim? what are the advantages of it?
Cvek/partial or coronal pulpotomy aims to preserve pulp by removing inflamed pulp and leaving healthy, vital pulp to aid healing
* allows continued growth and hard tissue deposition in an immature tooth
* strengthens dentine walls of the root
* reduces risk of cervical fracture
* high success rate
how do you carry out a partial pulpotomy?
- administer LA and place dental dam
- clean and irrigate the area with saline then disinfect with sodium hypochlorite
- remove 1-3mm of exposed pulp with round diamond bur - expect to see some bleeding
- place saline soaked cotton wool pellet over exposure until haemostasis is achieved - if no bleeding or cannot arrest within 1-2mins, proceed to full coronal pulpotomy
- apply non-setting calcium hydroxide (paste/powder)then layer GIC then restore with composite resin or reattach fragment
what is the use of calcium hydroxide?
- high pH (alkaline) which decreases bacterial load
- induces calcific barrier formation
- negative effect on dentine strength so increased risk of root facture
how do you carry out a coronal pulpotomy?
- begin with **partial pulpotomy **
- assess for haemostasis after application of saline soaked cotton wool pellet
- if necrotic or hyperaemic, remove ALL coronal pulp
- place non-setting calcium hydroxide in the pulp chamber
- seal with GIC lining and coronal resoration/tooth fragment reattachment
what are the options of treatment for an immature incisor with an open apex?
- calcium hydroxide placed in canal to induce hard-tissue barrier to form (apexification)
- bioceramic (e.g. MTA and BioDentine) placed at apex of tooth to create a cement barrier so gutta percha can be placed
- regenerative endodontic technique (RET) to encourage hard tissue formation at apex
how would you treat non-vital immature incisors with MTA and thermoplastic gutta percha?
- an endodontic file is placed in the root canal to obtain correct working length
- MTA plug is placed at the apex using specially designed carriers
- thermoplastic gutta percha flows into the canal via a gun and is packed (3rd visit)
- MTA sets in damp environments and takes time to harden (2nd visit)
1st visit - composite resin bandage
what is an avulsed tooth?
tooth that is completely lost from the socket and is an emergency situation
what are the critical factors that a viable PDL relies on when managing avulsed teeth?
- extra-alveolar dry time (EADT) - how long the tooth is dry
- extra-alveolar time (EAT) - how long the tooth is out of the socket (wet or dry)
- storage medium
when is the PDL mostly viable, viable but compromised, and non-viable?
- PDL mostly viable: replanted immediately or very shortly after
- PDL viable but compromised: kept in milk/saline and total dry time <60mins
- PDL non-viable: dry time >60mins regardless of what happens after
what emergency advise is given when a tooth is avulsed?
- ensure it is a permanent tooth
- hold by the crown - don’t damage or contaminate PDL cells
- encourage individual to place tooth immediately back into socket - if dirty, rinse gently in milk, saline or patient’s saliva and replant
- bite on gauze/handkerchief to hold in place once replanted
- seek immediate dental advice
what are the best storage mediums for avulsed teeth?
- milk
- HBSS - Hank’s balanced salt solution
- saliva
- saline
- water
