Paediatric Trauma Flashcards
What is an enamel fracture?
This is where there is loss of enamel, no mobility, sensibility and TTP testing normal
we take 1 parallel PA
Tx for enamel fracture?
Do nothing/accpet
Smooth off edges
Flowable/composite
Rebond fragment
Follow up for enamel fracture?
6-8 weeks
1 year
What is enamel dentine fracture?
This is where there is loss of enamel + dentine, no mobility, sensibility and TTP testing normal
we take 1 parallel PA
Tx for ED fracture?
Account for fragment
rehydrate in saline for 20 mins
rebond
GIC over exposed dentine and comp restoration
If 0.5mm from pulp, liner, restore
Follow up for ED fracture?
6-8 weeks
1 year
What is EDP fracture?
Enamel dentine pulp fracture - pulp is involved, not TTP, no mobility, normal sensibility but sensitive to stimulus due to pulp exposure
Tx for EDP fracture?
<1mm and 24 hrs = pulp cap
> 1mm >24hrs partial/full pulpotomy and restore
or if NV or bleeding wont stop then pulectomy
Follow up for EDP fracture?
6-8 weeks
3 months
6 months
1 year
What is a complicated crown root fracture?
This is where there is fracture of crown and root which involves pulp and as a result there is a mobile fracture, tooth is TTP, pos response and MOBILE FRAGMENT
XEAYS - 1 PARALLEL PA 2X OTHER
Tx for complicated crown root fracture?
temporise by bonding mobile fragment to adjacent non mobile
then tx:
- remove fragment and restore (pulp exposure will depend on size and time –> may need RCT)
Surgical/ortho extrusion of non mobile fragment and restore
RCT
XLA
Decoronate
Follow up for complicated crown root fracture?
1 week
6-8 weeks
3 months
6 months
1 year
yearly for 5
what is an uncomplicated crown root fracture?
This is where there is fracture of crown and root which DOES NOT INVOLVE THE pulp and as a result there is a mobile fracture, tooth is TTP, pos response and MOBILE FRAGMENT
XEAYS - 1 PARALLEL PA 2X OTHER
What is the tx for uncomplicated crown root fracture?
Temp = stabilise mobile fragment
remove fragment and restore (cover exposed dentine with GUC)
RCT if needed
Surgical/rotho extrusion
XLA
Decorate for implant
What is a root fracture?
This is where the root fractures at either:
apical 1/3rd
mid 1/3rd
coronal 1/rd
best prognosis if apical 1/3rd
coronal segment may be mobile and displaced, may be TTP, may have bleeding, pulp test may be negative
Tx for root fracture?
Reposition any displacements and check with PA
Stabilise with passive flexible splint for 4 weeks (up to 4 months for coronal fracture)
no endo at emergency visit but can initiate 7-10 days later or in primary teeth monitor
in mature teeth may need to remove mobile coronal fragment and consider post and core
What types of healing in root fracture?
CALCIFIED TISSUE HEALING
CT HEALING
BONE + CT HEALING
NON HEALING
What is a concussion injury?
This is where both supporting structures are injured and the tooth is TTP but no mobility. no displacement or mobility
What is tx for concussion injury?
Nothing - reassure pt monitor pulp for 1 year
What is follow up for concussion?
4 weeks
6/8 weeks
1 year
What is a subluxation injury?
This is where there is injury to tooth supporting structure, there is mobility, bleeding TTP, but no displacement
may be non vital
What is tx for subluxation?
No tx needed usually
for pt comfort or if excess mobility then splint for 2 weeks with passive flexible splint
monitor for 1 yerar
Recall for subluxation?
2 weeks - splint
3 months
6 months
1 year
What is extrusive luxation?
This is where tooth is displaced out socket, there is partial or total seperation of PDL, tooth appears elongated, increased mobility, negative pulp test
INC PDL SPACE APICALLY AND LATERALLY
TOOTH NOT IN SOCKET, LOOKS LONGER INICISALLY
How do we tx extrusive lunation?
reposition gently by pushing it back into socket under LA
stabilise with passive flexible splint 2 weeks
monitor pulp
if necctoridc endo
Recall for extrusive lunation?
2 weeks (splint)
4 weeks
2 months
3 months
6 months
1 year
yearly for 5
What is lateral luxation?
this is where tooth displaced buccal/palatally and there is tear and crush injury to PDL, tooth immobile, ankylotic, widened PDL space
How do we tx lateral luxation?
reposition and splint - 4 weeks
monitor pulp
Recall for lateral luxation?
2 weeks
4 weeks
2 months
3 months
6 months
1 year
yearly for 5
What is intrusive luxation?
Tooth driven into alveolar process and there is crush injury to PDL, immobile, ankylotic, likely negative
PDL not visible
ACJ apical
What is tx for intrusion?
Immature :
up to 7mm = spontaneous (if not after 4 weeks then ortho or there will be ankylosis)
> 7mm = ortho or surgical
Mature:
< or equal to 3mm = spontaneous
3-7mmm = ortho
>7m surgical
splint 4 weeks passivee flexible
Recall for intrusive luxcation?
2 weeks
4 weeks
2 months
3 months
6 months
1 year
yearly for 5 years
do we prescribe antibiotics?
PDL exposed in avulsion and contaminated by oral cavity, environment or storage medium so recommended to prevent infection by prescribing amoxicillin or pen V
Advice afterr avulsion?
avoid playing in contact sports
maintain soft diet for 2 weeks
brush teeth with soft brush after each meal
CHX 0.18% mouth rinse twice day for 2 weeks
Follow up for avulsion
2 weeks
4 weeks
2 months
3 months
6 months
year
yearly for 5 years
