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BDS3 CLINICAL Paeds > Trauma III > Flashcards

Trauma III Flashcards

1
Q

What is avulsion

A

Displacement of the tooth from its socket in the alveolar bone due to trauma

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2
Q

When can successful healing occur

A

Successful healing can occur if there is only minimal damage to the pulp and the PDL

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3
Q

What are critical factors for replantation

A
  • Extra-alveolar dry time (EADT) - this is the time that the tooth is just in the air and not in any storage medium or the sockets
    • Extra-alveolar time (EAT) is the amount of time that the tooth is out of the mouth including time in any storage medium
    • Type of storage medium
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4
Q

If a patient attends with a tooth already replanted what should be done

A

• Do not remove it - leave it as it is and follow the instructions regarding splinting (depending on circumstance e.g if there is lots of debris)

Radiograph important to establish status of root development

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5
Q

What is the help advice for avulsion

A
  • Give advice over the phone
    • Hold by crown only
    • Wash in cold running water for up to 10 seconds only and put the plug in in case its dropped
    • Replace in the socket and let child bite on tissue
    • Or store in milk/saliva/normal saline
    • Seek immediate dental advice
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6
Q

What is the healing likelihood for implantation

A

○ If the EADT is <30 minutes then there is a chance of cemental/PDL healing
○ If the EADT is >30 minutes then it is likely that healing will be by ankylosis

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7
Q

What are the periodontal outcomes

A

regeneration
pdl/cemental healing
bony healing
uncontrolled infection

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8
Q

What are the pulpal outcomes

A

○ Regeneration (more likely with an open apex)
○ Controlled necrosis (elective disinfection)

	○ Uncontrolled infection
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9
Q

What is controlled necrosis

A

§ Where we know the tooth is going to become non vital and we take the live part of the tooth out before it dies and causes infection

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10
Q

What is uncontrolled infection

A

PDL is not healing at all and instead granulation tissue is made resulting in abscesses

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11
Q

What is the aim if the EAT <60 minutes

A

PDL healing

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12
Q

What is the procedure for EAT<60 minutes for an open apex

A
  • If the decision is made not to root treat the tooth then it must be closely monitored clinically and radiographically for signs of continued growth vs loss of vitality
    • If the tooth is found to be non vital then extirpate the pulp and refer to a paeds specialist
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13
Q

What is the review period for EAT <60minutes open apex

A

• Review interval is 2 weeks (splint removal), 4 weeks, 2 months, 3 months, 6 months then yearly

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14
Q

How is it easy to tell if there is regeneration on an open apex

A

• It is easy to tell if there is regeneration as the tooth can be compared to the contralateral side to see if there is a continuation of development

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15
Q

What is the procedure for EAT <60 min closed apex

A
  1. After replantation and splinting, remove the pulp ASAP (ideally day 0)
    1. Following extirpation and disinfection, place anti-biotic steroid paste as intra-canal medicament and leave in place for 2 weeks
    2. Remove the splint after 14 days
    3. At 2 weeks - clean and replace intracanal medicament with non setting calcium hydroxide
    4. Obturation with the gutta percha should take place within 4-6 weeks
    5. Refer to a specialist paeds team
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16
Q

When is the review for EAT <60 min closed apex

A

• Review 3 months, 6 months, 12 months then yearly

17
Q

What is the aim for EAT >60 min open apex

A
  • AIM: BONY HEALING

* Unlikely to get PDL healing

18
Q

What is the procedure for EAT >60 min closed apex

A
  1. The aim is for bony healing (by ankylosis) so scrub the root clean of dead PDL cells so the body does not have to do it itself
    1. Extra-oral endodontics can be carried out prior to replantation
    2. Replant tooth under LA
    3. Splint: 4 weeks flexible splint
    4. Consider antibiotic prescription
      • If extra-oral endodontics is not carried out then extirpate at 7-10 days and use non setting calcium hydroxide as the initial intra-canal medicament for 4 weeks prior to obturation with GP
19
Q

What is the procedure for EAT >60 min open apex

A
  • Unlikely to get PDL healing
    • Very small chance the pulp may still revascularize
    • Do not root tx unless signs of loss of vitality on follow up
    • Splint for 4 weeks using a flexible splint
    • Consider AB prescription
    • Check the tetanus status
    • Monitor closely for signs of necrosis vs continued root development
20
Q

What is the review for EAT closed apex

A

• Review at 3, 6, 12 months then yearly

21
Q

What is the review for EAT open apex

A

• Review interval: 2 weeks, 4 weeks (splint removal), 2 months, 3 months then 6 months yearly

22
Q

When do you not replant

A
  • Almost never
    • If very immature apex and the EAT>90 minutes (may still be best to replant)
    • Child is immunocompromised e.g as a result of active chemotherapy, immunosuppressant drugs
    • The child has other serious injuries and warrant preferential emergency treatment and/or intensive care being dealt with
    • Very immature lower incisors in young child finding it difficult to cope
    • Even as a temp space maintainer - the right choice is usually to replant especially when guiding the position of the adjacent erupting tooth
23
Q

How do you monitor avulsion

A

• Open apex teeth require close monitoring
• If pulpal necrosis is detected then pulp extirpation must be carried out as soon as possible to avoid inflammatory resorption
• Clinical tests should be done (trauma stamp)
Sensibility tests should be done (thermal and electrical
radiographs should be taken

24
Q

When should sensibility tests be done

A

○ At time of injury

○ 1 month, 2 months, 3 months, then 6 monthly for an average of 2 years

25
Q

Why should radiographs be taken to look for

A

○ Root development - width of canal and length
○ Comparison with other side
○ Internal and external inflammatory resorption

26
Q

What is the best practice for open apex pulpecotmy

A
  • Extirpate pulp and place CaOH for no longer than 4-6 weeks after identified as non-vital
    • Problems with CaOH apexification
    • MTA plug and heated GP obturation
27
Q

What is the 5 year pulpal survival for avulsion

A

open apex - 30%

closed apex - 0%

28
Q

What is the 5 year resorption for avulsion

A

frequent

29
Q

What is a dentoalveolar fracture

A
  • There is no displacement of teeth
    • They have not moved in their sockets
    • The damage is to alveolar bone
    • A flexible splint needs to be placed for 4 weeks
30
Q

What is the tx for dents-alveolar fractures

A
  • Give LA
    • Reposition - ‘apical lock’ may be present
    • Place a flexible splint for 4 weeks
    • Give antibiotics
31
Q

What is the follow up for dents-alveolar fractures

A

• Monitor clinically and radiographically
○ Check for root development (canal width and length) and compare with neighbouring unaffected tooth
○ Check for signs of inflammatory resorption
○ Follow up at 2 weeks, 4 weeks, 8 weeks, 4 months, 6 months, 1 year and 5 years
○ Risk of pulpal necrosis where the apex is closed is 50% at 5 years

32
Q

What is the advice for all dental injuries

A

○ Soft diet for 7 days
○ Avoid contact sport while splint in place
○ Careful OH with use of chlorhexidine gluconate mouthwash 0.1%

BDS3 CLINICAL Paeds (14 decks)

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