Trauma Flashcards
trauma stamp (8)
sinus
colour
TTP
mobility
EPT
ethyl chloride
percussion note (dull / high)
radiograph
tooth trauma with:
- displacement
- single tooth mobility
- radiographic sign of root #
ROOT #
- if coronal fragment displaced; reposition & confirm radiographically
- stabilise for 4wks with passive flexible splint (cervical # may need up to 4mths)
- do not start pulp therapy but monitor pulp status up to 1yr
- in mature teeth if # is above alveolar crest consider XLA & post core crown
- other tx options inc: orthodontic / surgical extrusion, crown lengthening or XLA
tooth trauma with:
- displacement
- single tooth mobility
- NO radiographic sign of root #
EXTRUSION
- reposition under LA & splint for 2wks
- extra 4wks if # of marginal bone
- monitor pulp status
tooth trauma with:
- displacement
- NO single tooth mobility
- multiple teeth moving as a unit
ALVEOLAR #
- reposition segment & splint with passive flexible splint for 4wks
- suture gingival lacerations & do not start root tx
- monitor pulpal status at follow up visits
tooth trauma with:
- displacement
- NO single tooth mobility
- NO multiple teeth moving as a unit
(INTRUSION)
if INCOMPLETE root formation:
- allow for re eruption without intervention for 4wks
- if no re eruption then orthodontic repositioning
- monitor pulp status, RCT if required
if COMPLETE root formation:
- <3mm allow for re eruption
- if no eruption at 8wks then surgical reposition & splint
- 3-7mm reposition surgically / orthodontically
- >7mm surgical reposition
- pulp death is likely, initiate RCT at 2wks or when tooth position allows
- use corticosteroid antibiotic cream or CaOH as intra canal medicament to prevent external resorption
tooth trauma with:
- displacement
- NO single tooth mobility
- NO multiple teeth moving as a unit
(LATERAL LUXATION)
- reposition under LA & splint for 4wks using a passive & flexible splint
- additional splinting may be required if # of marginal bone / alveolar socket wall
- assess need for pulpal intervention at 2wks, therapy should be based on root formation
- if carrying out endo therapy use corticosteroid antibiotic or CaOH as an intracanal medicament to prevent external resorption
tooth trauma with:
- no displacement
- mobility
- TTP
SUBLUXATION
- no tx needed
- monitor pulp status for at least 1yr
tooth trauma with:
- no displacement
- mobility
- not TTP
- # either none or above gingival margin
- ENAMEL ONLY; depending on fragment size, bond fragment back on or restore with composite resin
- ENAMEL-DENTINE; if available bond fragment back on after rehydrating in saline for 20 mins or restore with GIC/composite resin. if exposed dentine is within 0.5mm of pulp (pink but no bleeding) place CaOH liner & restore with GIC
- ENAMEL-DENTINE-PULP; partial pulpotomy/pulp cap followed by bonding rehydrated fragment or GIC/ composite resin, if post required for crown retention then RCT first
tooth trauma with:
- no displacement
- mobility
- no TTP
- # below gingival margin (i.e. crown-root)
- NO PULP EXPOSURE;
stabilise mobile fragment, if not possible then XLA & cover with comp/GI. long term tx options inc: orthodontic extrusion of non mobile fragment +/- RCT, crown lengthening, XLA, auto transplantation, root submergence - PULP EXPOSURE;
stabilise or XLA mobile fragment
immature roots = carry out pulpectomy unless <1mm exposure & <24h then perform partial pulpotomy
mature roots = pulpectomy + GI/comp restoration
long term = RCT & permanent restoration
other management options: orthodontic/surgical extrusion, crown lengthening, xla, auto transplantation, root submergence
tooth trauma with:
- no displacement
- no mobility
CONCUSSION
- no tx usually needed
- monitor pulp status for at least 1yr
- if excessive mobility then splint for 2wks
emergency advice for over the phone when avulsion
- reassure pt
- hold tooth by crown & avoid touching the root
- if tooth is visibly dirty rinse it gently with milk / saline / pt saliva & avoid scrubbing
- if possible replant the tooth immediately back into the tooth socket & get pt to gently bite down onto tissue / napkin
- if replantation not possible you can store the tooth in milk / saliva / saline / hank’s balanced salt solution (if these mediums are unavailable leave in water as still better than leaving in the air
- take pt to see dentist ASAP & bring tooth
how to manage avulsion in clinic
- clean & soak tooth in saline to remove dead cells from root surface
- if tooth been out of mouth for >60mins then remove attached non viable soft tissue with gauze & consider carrying out root tx prior to reimplantation ( warn of akylosis) - give LA & irrigate socket with saline
- reposition any socket # with suitable instrument
- using gently pressure reimplant tooth & suture any gingival lacerations
- after examiming clinically take radiograph to esnure normal position of replanted tooth
- apply flexible splint for 2wks
- prescribe antibiotics (if o12 teracycline doxycycline 2x daily for 7 days or if u12then amoxicillin
- after 7-10 days start RCT; place CaOH for 4wks as intracanal medicament, or immediately after reimplantaion place antibiotic corticorsteroid past for 2 wkks then compete RCT
- 2wks follow iup, remove splint, clinical & radiographic contol
- clinical & radiographic control after 1 3 6 12 months
when dealing with avulsion what 2 things to consider:
a) open apex / immature root
b) post op advice
a) same steps as normal but avoid RCT unless there are clinical & radiographic evidence of pulp necrosis
aim is revascularisation of the pulp space
when dealing with avulsion what post op advice
- avoid contact sports
- soft diet for 2wks
- brush teeth after every meal the soft toothbrush
- use CHX 0.1% MW x2 daily for 7 days `
process of splinting
- take detailed medical dental & accident hx of trauma (safeguarding issues)
- examine head & neck for EO & IO bony & soft tissue injuries i.e. lacerations / haematoma and missing tooth fragments e.g. embedded in lip
- assess teeth with trauma & surrounding teeth (colour / mobility / tenderness)
- explain splinting process to parent / guardian
- +/- LA reposition fragment & any bony segments (for root # confirm position radiographically) & suture any gingival lacerations
- splint using appropriate wire 1 tooth either side of traumatised tooth
- give OHI, soft diet for 2wks, CHX MW 2wks & advise parent on discolouration of teeth & any pain
