trauma guide Flashcards
subluxation in primary tooth
clinical findings
radiographic recommendations
treatment
follow up
clin: tooth is tender to touch, increased mob, not been displaced, gingival crevice bleeding
xray: PA and baseline establishment
treatment: no treatment, observation, cleaning (with soft brush and alcohol free 0.1-0.2% chlorhexidine gluconate mouth rinse applied topically 2 times a day for a week), soft diet, analgesic
follow up:
1 week, 6-8 week
xray when signs of pathosis
concussion in primary tooth
clinical findings
radiographic recommendations
treatment
follow up
clin: tooth is tender not been displaced, normal mobility
xray: none
treatment: no treatment, observation, cleaning (with soft brush and alcohol free 0.1-0.2% chlorhexidine gluconate mouth rinse applied topically 2 times a day for a week), soft diet
favourable outcome
asymptomatic
pulp healing with normal colour of crown, transient discolouration
no sign of pulp necrosis
continued root development in immature teeth
no disturbance to development/eruption of the permanent successor
unfavourable
symptomatic pulp necrosis and infection radiographic signs further root development of immature teeth negative impact on successor
lateral luxation in primary teeth
clinical findings
radiographic recommendations
treatment
follow up
clinical: tooth displaced palatally/lingually/labial
xray: PA for baseline (PDL space increased)
treatment:
if no occlusal interference & stable & displacement mild, tooth should be allowed to spontaneously reposition (physiologic) (happens in 6 months)
immediate repositioning: splint for 4 weeks using flexible splint attached to adjacent uninjured teeth
extract if (w LA): tooth pushed into tooth bud
occlusal interference,
excess mobility
follow up:
if left alone: 1 wk, 6-8 wk, 6 mo, 1y
if repositioned: 1 wk, 4 wk for splint removal, 8 wk, 6 mo, 1 yr
radiographic follow up when theres pathosis
extrusive luxation in primary teeth
when to extract
if to mobile or extruded >3mm
intrusion/intrusive luxation in primary teeth
clinical findings
radiographic recommendations
treatment
follow up
clinical findings: displaced through lateral bone plate, impinged on perm too bud, could completely disappear into socket
ask for history to ensure that its true intrusion
xray: PA for baseline, if apex is labial, tooth will appear short, if tooth towards perm tooth, apex cannot be visualised, tooth appear elongated (higher risk of injury to tooth germ)
treatment: tooth allowed to reposition (6mo-1y), observation, cleaning (with soft brush and alcohol-free 0.1-0.2% chlorhexidine gluconate mouth rinse applied topically 2 times a day for a week), soft diet
follow up: 1wl, 6-8 wk, 6mo, 1y
at 6y for severe intrusion to monitor eruption of perm
follow ups for luxation injuries
1w, 6-8w, 6mo, 1y
avulsion in primary teeth clinical findings radiographic recommendations treatment follow up
DO NOT reimplant due to perm tooth
locate the missing tooth
clinical findings: if not found, send to A&E
xray: PA to find it or baseline for assessment of perm tooth
treatment: soft diet, CHX cleaning
follow up: 6-8 wk, follow up at 6 y to monitor the eruption, only xray if pathological, bad if perm doesnt erupt
root fracture in primary teeth
clinical findings
radiographic recommendations
treatment
follow up
clinical finding: radio: PA at baseline treatment: if stable: leave and monitor if not: extract coronal segment and leave apical segment (roots close to perm) reposition and splint for 4 weeks
crown fractures in primary teeth: depends on pulp exposure
clinical findings
radiographic recommendations
treatment
follow up
enamel and enamel dentine
treatment: leave, smoothen sharp edges, composite restoration strip crown
pulp exposure
treatment: pulpotomy/pulpectomy extraction
crown-root fracture in primary teeth: depending on pulp exposure
clinical findings
radiographic recommendations
treatment
follow up
without pulp involvement: fragment removal, cover dentine w GIC
extract
with pulp:
fragment removal, RCT
extraction
alveolar fracture in primary teeth
clinical findings
radiographic recommendations
treatment
follow up
treatment: give LA/sedation, manual reposition, stabilise with flexible splint for 4 weeks, monitor teeth in fracture line
do you do sensitivity tests in children?
not reliable in children
what is the OHE instructions for parents
support tooth in brushing, cotton ball cleaning w chlorhex
what happens when theres a grey tooth discolouration
haemorrage one or 2 weeks before, if it gradually disappears/lightens, we dont treat. only treat when theres other signs and symptoms
Lateral luxation in perm tooth
Clinical findings
X-ray
Treatment and
Follow-up
Tooth-is displaced, usually assoc fracture of alveolar bone percussion likely give high metallic sound.
X-ray: 1 parallel PA, 2 angled PA, 1 occlusal
Treatment: give LA then reposition for 4 weeks with splint, monitor pulp status
Fix aesthetics with partial dentures
Initiate rct early to prevent resorption
Prognosis depends on status of tooth: tooth w incomplete
Apex may have spontaneous
Revascularisation but apex complete tooth likely necrosis
Clinical & xray follow up: 2wk, 4wk, 8wk, 12wk, 6mo, 1yr, yearly for 5 years
Complications to look out for after trauma
Loss of vitality
Internal external root resorption
Pulpal necrosis & obliteration
Ankylosis/ replacement resorption
List order of how severe trauma can be
prognosis
1 intrusion
2 lateral luxation / extrusion
3 concussion/ subluxation
If you have combination shit then even worse
Intrusive luxation in perm tooth Clinical finding x-ray treatment follow up
Clinical finding: tooth displaced, immobile, percussion gives high metallic sound
xray: 1 parallel PA, 2 angled PA, 1 occlusal
Treatment:
in developing tooth, allow reeruption, if no re eruption in 4 weeks use ortho to pull it down
If pulp become necrotic then rct
In fully formed roots: if tooth intruded less than 3mm, allow reeruption. 3-7mm reposition surgical (prefered) or ortho. beyond 7mm reposition surgically
rct in 2 weeks cos tooth almost sure die
can use steroids in canal to reduce inflammation, if not use anitbiotics and CaOH
follow up: 2wk, 4wk, 8 wk, 12wk, 6 mo, 1y, yearly for 5 years
why do teeth kenna pulp canal obliteration
common in teeth with wide open apex trying to heal by laying down dentine, cause pulpal strangulation, lose vitality
extrusive luxation in perm tooth
Clinical finding
x-ray
treatment
follow up
clinical: elongated, mobile,
root fracture for perm tooth clinical x-ray treatment follow up
clinical descriptions:
coronal segment mobile, TTP, bleeding from sulcus
xray: 1 parallel PA, 2 angled PA, 1 occlusal, CBCT can be considered
treatment: coronal fragment should be repositioned as soon as possible, take PA, splint for 4 wks-4mo (cervical), monitor healing for a year, if necrosis happens, treat the necrotic part only (not the whole canal), but a bit hard to determine length.
follow up: 4 weeks, 6-8 weeks, 4 mo, 6mo, 1y, yearly for 5 years
dont RCT just because no pulp response. give it time
coronal 1/3 poorest prognosis, greater chance for oral bacteria and more movement
how to describe root fractures
single or multiple,
horizontal or vertical,
level
degree of separation
complicated fracture for perm tooth
clinical finding
xray
treatment
follow up
clinical finding: pulp sensitivity usually positive, pls find the fragment thanks later they aspirate need go A&E
xray: 1+2+occlusal maybe CBCT
treatment: if no pulp exposure, spint and stick back w GIC
if pulp exposed, partial pulpot for developing tooth and and full pulpot for fully formed root.
in the future can ortho, surgical, RCT etc
follow up: 1wk, 6-8wk, 3 mo, 6 mo, 1y, yearly at least 5 years
whats transient apical breakdown
in moderate injury to pulp or PDL, sometimes repair can happen and apex looks radiolucent cos increased blood supply to allow healing. can loss of sensitivity shortly also. DONT ANYHOW RCT just because sensibility test gg. monitor da radiographs
alveolar fracture in perm tooth
clinical finding
xray
treatment
follow up
clinical findings: mobility, usually multiple teeth
xray: 1+2+occlusal maybe CBCT
treatment: reposition with passive splint, suture any lacerations
follow up: 4 wk, 6-8 wk, 4mo, 6mo, 1y, yearly for 5 years
types of resorptions
replacement resorption: root resorpt replaced by bone
inflammatory resorption: infected pulp tissue act as constant stimulus for inflammation (need to do RCT early)
surface resorption: mild, limited to surface of cementum or dentine
tooth avulsion in perm teeth w closed apex
clinical finding
xray
treatment
follow up
clinical:
at site of accident: pick up the crown, rinse w saline or milk, try to stick back, but if cannot, put in milk
if patient comes in with tooth replanted: check if is correct, if not correct can change up to 48hr, give LA (no vasoconstrictor), reposition
if in saline or milk, wash gently, irrigate socket, put back, verify
systemic antibiotics, check tetanus
splint for 2 weeks. if got alveolar fracture then 4 weeks
if put back in 15min, PDL likely alive
if in medium for up to 1 hour, compromised but still can try
if more than 1 hour, GG will ankylosis but just at least got some aesthetics and function
endo within 2 weeks
tooth avulsion in perm teeth w open apex whats the difference?
clinical finding
xray
treatment
follow up
revascularisation can lead to further root development. if unlucky it never happen, inflammatory resorption and necrosis then do root canal.
expect pulp canal obliteration
what antibiotics to give when tooth is avulsed
amox, penicillin, tetracycline, doxycycline (not for patients under 12 later intrinsic discolouration)
types of intracanal medicament and and guidelines
CaOH for a month
corticosteroid/antibiotic mixture then need 6 weeks
4 post emergency advice
- avoid contact sports
- maintain soft diet for up to 2 weeks
- brush w soft tooth brush after every meal
- CHX 0.12% mouth rinse 2 weeks
open apex vs closed apex difference between recalls
open apex more frequent, need to see at 2 months cos later ankylosis need to discover early
