Paeds - trauma Flashcards
What are trauma stamps used for
We use this on clinic for long term trauma monitoring
What do you put at the top of a trauma stamp
what teeth you are examining
What does a trauma stamp cover
SCT MEEP R
Sinus Colour TTP Mobility EPT ECL Percussion note Radiograph
What do you write down in the corresponding box for a trauma stamp
For each category you need to put a plus/minus or tick in the box
You may also need to write down some description e.g. colour yellow etc
What is avulsion
tooth comes completely out of the socket
When can successful healing occur following avulsion
if there is only minimal damage to the pulp and the PDL
What are the critical factors for successful healing for avulsion
EADT
EAT
storage medium type
What does EADT stand for
Extra- alveolar dry time
What does EAT stand for
Extra-alveolar time
What is EADT
time the tooth is out of the mouth just in air e.g. lying on the ground (it is not in any type of storage medium and it is not back in the socket)
What is EAT
EAT is the amount of time the tooth is out of the mouth and dry including the time that it has been in any type of storage medium
What should you do if patient attends with tooth already reimplanted
Do not remove. Leave as is and follow instructions regarding splinting etc dependent on circumstance
Radiograph is important to establish status of root development
If a tooth comes out you want to put it straight back in its socket as this will give it the best prognosis. However, if there is a lot of debris and dirt etc you might feel that you would like to take it out and have a look at it and get rid of any large dirt or debris
Why is a radiograph important post avulsion
to establish root development - we want to know how much root is there, and is it a mature or immature tooth (open or closed apex
What is the advice to someone with an avulsed tooth
Hold by the crown only
Wash in cold running water (if there is obvious debris on the tooth - this can be done for up to 10 seconds)
Replace in the socket and get child to bite on tissue
OR store in milk/saliva/normal saline (if there is a lot of trauma you could potentially store it in the patient’s blood)
Seek immediate dental advice (the quicker you can get to a dentist the better)
How do you construct a splint
Cut and bend 0.3mm stainless steel wire
Apply composite resin to traumatised tooth and those adjacent
Sink the contoured, passive wire into the composite
Shape and cure the composite
Smooth rough composite and wire ends
Need to ensure that the wire remains passive as if the wire is active the teeth will be moved
What are other forms of splint other than composite and wire
vacuum formed
ortho brackets and wire
acrylic URA type splint
foil temporary splint cemented with kalzinol
Why are vacuum shield splints not as good
OH is often poor
What must be ensured with ortho bracket splints
its passive
What is good about an acrylic URA type splint
useful when there are few abutment teeth
When do you use a 2 week splint
Subluxation
Extrusion
Avulsion - open and closed apex <60 mins EADT
When do you use a flexible 4 week splint
Lateral luxation Apical/middle ⅓ root fracture Intrusion Dento-alveolar fractures Avulsion - closed apex >60 mins EADT
When do you use a 4 month splint
coronal ⅓ root fracture
Patient comes in with a tooth that shows increased mobility but no displacement
What type of injury is this, what type of splint will you use
subluxation
2 week flexible splint
patient shows with tooth displaced like this
what is the name of this? what splint will you use
extrusive luxation
2 week flexible splint
patient shows with this injury
what type of injury is it
what type of splint
lateral luxation
flexible 4 week splint
patients front tooths fallen out, theyre calling you crying
it fell out two hours ago and shes stuck in traffic coming to you, she’s put the tooth in her purse
she is 16 YO
what is this injury called, what will you do?
avulsion EADT time is more than 60 minutes closed apex PDL healing is unlikely so looking for bony healing do extra oral endo put it back under LA 4 week flexible splint
How do we classify crown fractures
enamel
enamel dentine
enamel dentine pulp
How do we classify crown root fractures
with or without pulp exposure
How do we classify root fractures
position - apical, middle or coronal third
displacement - are fragments displaced or undisplaced
what stage of root development - open or closed apex
What are the different periodontal healing outcomes after reimplantation post avulsion
Regeneration
PDL healing
Bony healing
Uncontrolled infection
When should a tooth not be reimplanted
if a child is immunocompromised
it is a decidious tooth
What should you do if there is concussion/subluxation of a primary tooth
observe
What should you do if there is lateral luxation for a primary tooth
if no occlusal interference then allow to position spontaneously
if there is occlusal interference then extract
What should you do if there is intrusion in a primary tooth
monitor re-eruption
if no re-eruption after 6 months consider extraction to avoid problems with eruption of permanent tooth
What should you do if there is extrusion with a primary tooth
extract
What should be done for primary tooth avulsion
radiograph to confirm avulsion
do not replant
