Trauma Guidelines Primary Dentition - International Association of Dental Traumatology 2020 Flashcards
What are the clinical findings for an enamel only fracture
fracture involved enamel only
What are the radiographs indicated for enamel only fracture
- none
- if TTP, consider x-ray to rule out luxation or root fracture
What is the tx for enamel only fracture
smooth sharp edges
comp restoration if desirable
When should we follow up enamel only fracture
none required
What are the favourable outcomes of enamel only fractures
- asymptomatic
- pulp healing
- continued root development in immature teeth
What are signs of pulp healing
- no colour change of crowns
- no sign of pulpal necrosis or infection
What are the unfavourable outcomes of enamel only fracture
- symptomatic
- crown discolouerd
- signs of pulpal necrosis/infection
- no further root development in immature teeth
What are signs of pulp necrosis/infection
- sinus tract
- gingival swelling
- abscess
- increased mobility
- persistant dark grey discolouration with signs of infection
- no further root development in immature teeth
What is the general aftercare for all injuries
- watch out when eating, dont want to further traumatise tooth
- encourage healing by good OH using soft brush or cotton swab and use CHX mouthwash - two times daily for a week
What are the clinical considerations for enamel dentine fratcure with no pulp exposure
- locate missing tooth fragment
- risk of it being imbedded or aspirated
- fracture with no pulp exposrue
What radiographs do we take for enamel dentine fracture with no pulp exposure
baseline xray option
take xray of soft tissues if unaccounted for
if TTP, rule out luxation and root fracture
What is the treatment for enamel dentine fracture with no pulp exposure
cover exposed dentine with GI/comp
can restore lost tooth structure with comp
What is the follow up for enamel dentine fracture with no pulp exposure
- 6-8 wks
- only follow up with x-ray if signs of pulp necrosis and/or infection
What are the favourable outcomes of enamel dentine fracture with no pulp exposure
- asymptomatic
- pulp healing
- continued root development
What are the unfavourable outcomes of enamel dentine fracture with no pulp exposure
- symptomatic
- crown discoloured
- signs of pulp necrosis/infection
- no further root development
What are the clinical considerations of complicated crown fracture (enamel dentine pulp)
- exposed pulp
- locate missing tooth fragment
What radiographs do you want for a complicated crown fracture
- PA or occlusal for diagnosis and baseline
- screen for signs of displacement and root injury
- take x-ray soft tissue if concerned about embedding
What is the tx for complicated crown fracture
- aim to preserve pulp
- if not then pulpectomy (not really mentioned in IADT guidelines) or XLA
Why should we aim to preserve pulp in complicated fractures
to encourage normal root growth known as apexogenesis
What ways can we preserve pulp
- pulp cap
- partial pulpotomy
- coronal pulpotomy
When can we do a pulp cap
When pulp exposure within 24h and <1mm exposure
How do we do a pulp cap
cover exposure with setting caoh
cover with gi
cover with comp
What is the procedure for partial pulpotomy - briefly
- dam
- remove 2mm pulp and arrest haemorrhage with saline
- NScaoh placed
- cover with GI
- cover with comp
When is partial pulpotomy indicated
exposure >1mm
>24h