Paeds IAssocDT Flashcards
what need to check during trauma to tooth specificly? 6x
6- ging bleeding, mobility+ ppd, TTP/TOP, occl interference, pulp sensibility** ; displacement?
which injury needed or which dont need Radiographs needed?
yes except for concussion and enamel # [1* tooth] and e. infraction [adult, unless suspect other prblms]
mx of intrusive luxation of permanent tooth vs 1*
Immature teeth: Re-eruption spontaneously-> 4 wks no m/m-> Ortho reposition
If s/s -ENDO
Mature teeth:
<3mm-no tx
If no m/m in 8wk, reposit
3-7mm - reposi Surg/Ort +splint for 4wk
>7mm, reposit surg
1* => Extract if into t.bud //No tx, re-erupts usu 6/12 to 1 yr
7future tx options:- of both complicated c-ROOT # [mature tooth] and uncomplicated c-ROOT # mature tooth.
Mature teeth:
RCT FUTURE TX OPTIONS: 1) Orthodontic extrusion non-mobile fgmt, f/by
rest.(may need period. re-contouring surgery after extrusion)
2) Surgical extrusion
3)RCT and restoration if the pulp- necrotic and infected
4) Root submergence
5) Intentional replantation
6) Autotransplantation
7) Extraction
tx options:- complicated cRWN # and c-ROOT # PRIMARY TOOTH
Complicated crown # [e,d,p]
1) partial pulpo + gic/cr under LA use non-staining CaSilicate/MTA
2) no tx and refer specialist
CRWN-ROOT #
LA to remove mobile frgmt and check restorability
1) Restorable + NO PULP exposed : GIC/CR
2) Restorable + PULP exposed : PARTIAL PULPOTOMY + GIC/CR
3)UNRESTORABLE: Extraction tooth/ ALL loose frgmt and leave the firm part ones in situ
root # mature vs 1* tooth
LA+ flexi. Splint 4WKs and 4months if cervical #
Mature teeth where the cervical fracture
line is located above the alveolar crest and
coronal fragment is very mobile, removal
of the coronal fragment, followed by RCT and a
post-retained crown will likely be required. FUTURE TX OPTIONS:
1) orthodontic extrusion of the apical segment, crown
lengthening surgery 2) surgical extrusion or
3) extraction may be required as future
treatment options (similar to those for
crown-root fractures) 4) root submergence 5) RCT if only symptomatic and not because no response to sensibility test
vs
1* dentition
IF not displaced, NO TX IF DISPLACED but NOT excessively mobile then allow SPontaneous reposition even with some occlusal interference
IF SEVERE Mobility 1) Exo and leave firm frgmt to resorb 2) LA+ flexi. Splint 4WKs
mx of lateral luxation 1* tooth vs permanent tooth
Not interfering with Occl. let it spontaneously reposition by itself, USU within 6 months// 2.LA + Xn if risk of ingestion/ aspiration
OR 3. LA+Reposition+ flexi. Splint 4wk
OR
4Occl adjs
vs permanent tooth
LA+Reposition+ flexi. Splint for 4WK
- 2wk endo Evaluation+ EPT
1) apexification/ apexog. if s/s
2) RCT if complete root formation
OR URA for ortho repositioning
mx of extrusive luxation 1* vs Permanent teeth
Not interfering with Occl. let it spontaneously reposition by itself, USU within 6 months// ExcesS mobile or >3mm extrusion, Xn under LA (dpd on compliance+ root formation*)
vs
LA+Reposition+ flexi. Splint 2WK
If Alv Bone #
4wk”
warning to parents-post luxation trauma to primary tooth [6x possible sequalae to permanent teeth]
POSSIBLE TRAUMA TO PERMANENT SUCESSORS
*Discolouration/ hypoplastic defect(Turner’s tooth)
* Dilaceration(crown/root)
* Arrested development->
* Failure to erupt
* Root duplication[ intrusive luxation]
Traumatic division of cervical loop resulting in formation of 2 separate roots, radiographically mesial+
distal root seen
* Odontome-like formation
7 Post-operative instructions for the patient who has undergone endodontic treatment/trauma injury should include the following:
1 Pain Management: Advise the adult to take 400mg [200mg if 12-17y/o] ibuprofen every 6 hours, with the first dose taken before the loss of local anesthesia. This is to manage any post-operative discomfort. If severe pain persists, they may take 1000mg of paracetamol [10- 15 mg/kg per dose]between doses of ibuprofen due to its synergistic effect. If allergic to NSAID, 60mg of codeine+ PCM can be considered.
2 Diet: Recommend a soft diet initially to prevent any undue pressure on the affected tooth. Caution the patient against chewing on the side of the treated tooth
3 Oral Hygiene: Instruct the patient to maintain good oral hygiene with gentle brushing and flossing. If it is sensitive, apply CPP-ACP. They may also rinse with CHX to promote healing.
4 Activity: Suggest the patient avoid contact sports.
5 Swelling: Inform the patient that some swelling is normal, but if it worsens or does not subside, they should contact the clinic.
6 Follow-Up: Remind the patient of the importance of attending any scheduled follow-up appointments to monitor healing and to complete any additional necessary treatment, such as permanent restoration.
7 Signs of Concern: Advise the patient to contact the clinic if they experience signs of infection, such as increased pain, swelling, increased mobility, or the development of a fistula, a raised temperature, or an allergic reaction to the medication.
f/up for enamel infraction Permanent teeth + primary teeth fractures
no f/up
f/up for enamel # Permanent teeth
same as….# vs primary teeth enamel #
after 6-8 wk
after 1 y
uncomplicated crown fractures involving enamel and dentine
vs NO f/up
f/up for uncomplicated crown fractures involving enamel and dentine-Permanent teeth
same as….#
vs primary teeth uncomplicated Enamel-dentin fractures
after 6-8 wk
after 1 y
enamel # Permanent teeth
SAME as well
f/up for complicated crown fractures-Permanent teeth
vs primary teeth
after 6-8 wk/2mo
after 3 mo
after 6 mo
after 1 y
VS
-1 wk
-6-8 wk/2mo
-1 y
uncomplicated crown-root fractures and complicated crown-root fractures f/up-Permanent teeth
vs
Crown-root fractures in primary teeth
after 1 wk
after 6-8 wk//2mo
after 3 mo
after 6 mo
after 1 y
then yearly for at least 5 ys
vs
1 wk
-6-8 wk
-1 y- similar to complicated crown #1*teeth
