Trauma Management Flashcards
What is often the best option in emergency tx?
Observation
What are contraindications to observation in emergency tx?
Risk of aspiration, ingestion or occlusal interference
What is the home care advice after primary trauma?
Appropriate analgesia
Soft diet for 10-14 days
Brush teeth with soft toothbrush after every meal
Topical chlorhexidine gluconate 0.12% mouthrinse applied topically twice daily for one week
Warn re signs of infection
How is an enamel fracture managed?
Smooth sharp edges with small so flex disc
How is an enamel-dentine fracture managed?
Cover all exposed dentine with GIC/composite
Lost tooth structure can be restored immediately with composite or at a later visit
How is an enamel-dentine-pulp fracture managed?
Options:
Partial pulpotomy - LA, non-setting CaOH paste over pulp, thin layer of GI, then tooth restored with composite
Extract
How is a crown-root fracture managed?
Remove the loose fragment and determine if crown can be restored
If restorable:
- no pulp exposed: cover exposed dentine with GIC
-pulp exposed: pulpotomy or endo tx
If unrestorable:
- extract loose fragments
- don’ dig - don’t damage permanent successor
How should a root fracture be managed?
Coronal fragment not displaced - no tx
Coronal fragment displaced but not excessively mobile - leave coronal fragment to spontaneously reposition even if some occlusal interference
Coronal fragment displaced, excessively mobile and interfering with occlusion:
A - Extract only the loose coronal fragment
B - Reposition the loose coronal fragment and splint
How is concussion managed?
No tx
Observe and review
How is subluxation treated?
No tx
Observation and review
How is lateral luxation managed?
Minimal/no occlusal interference - allow to reposition spontaneously
Severe displacement - extract then reposition and splint
How is intrusion managed?
Allow to spontaneously reposition irrespective of direction of displacement
How can you find the direction of displacement in intrusion and why is it important to find the direction?
Use either a periapical or lateral premaxilla (extra-oral film)
Being able to assess the danger to the permanent tooth allows better counselling re prognosis
How is extrusion managed?
If not interfering with occlusion - leave for spontaneous repositioning
Excessive mobility or extruded >3mm - extract
How is avulsion managed?
Radiograph to confirm avulsion
Do not replant
Reposition segment
Stabilise with a flexible splint to the adjacent uninsured teeth for 4 weeks
Teeth may need to be extracted after alveolar stability has been achieved
