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Trauma in the Primary Dentition

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Trauma in the Primary Dentition

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    1. Trauma in the Primary Dentition

    2. Epidemiology (Permanent) Boys > Girls 9-11 year olds Maxillary central incisors Class I fractures Patients with increased overjet

    3. Epidemiology (Primary) Incidence - up to 30% Location - anterior teeth 71% maxillary central incisors Sex predilection - varies according to author and age.

    4. Incidence in Sports Soccer players are at increased risk of an orofacial injury than football players

    5. Incidence in Sports Basketball players’ risk is double that of a football player Due to faceguards and mouth protectors that are mandatory in football.

    6. Slam Dunking May cause serious dental injury Typical patient male 12 years old about 5 feet tall slam dunking on lowered backboard or raised take off area

    7. Mouthguards Aids in preventing condylar injuries Aids in preventing against dental-alveolar injuries

    8. Condylar Injuries

    9. Types of Mouthguards Stock Boil and bite Custom vacuum formed Custom pressure laminated

    10. Stock Mouthguards

    11. Stock Mouthguards

    12. Boil and Bite

    13. Custom Mouthguard - Vacuum

    14. Pressure Laminated

    15. Domestic Violence? 23% of patients with HNF injuries were victims of DV 94.4% of victimes of domestic violence had HNF injuries Patients with HNF injuries were 11.8 times more likely to be victims of DV Caution: preliminary study, small sample size; age 15 and older.

    16. Medical History Take a full medical history Pay particular attention to: drug sensitivities congenital or acquired cardiac problems coagulation disorders Determine tetanus coverage

    17. Neurological Assessment Obtain information re: loss of consciousness, neck or head pain, and numbness Ask about the event…. amnesia? Other signs: nausea, vomiting, drowsiness, blurred vision

    18. WHEN IN DOUBT… REFER TO ER!!!

    19. Tetanus Coverage Uncovered children - antitoxin (tetanus immune human globulin) Children with previous but dated coverage - toxoid booster Active immunization 3 injections of DPT during 1st year booster at 1 1/2 and 3 years booster at 6 YOA and every 4-5 years

    20. Reaction of the Tooth to Trauma Pulpal hyperemia Internal hemorrhage Calcific metamorphosis Internal resorption Peripheral root resorption Pulpal necrosis Ankylosis

    21. Pulpal Hyperemia May lead to infarction and necrosis

    22. Internal Hemorrhage Capillary rupture due to increased pressure Within 2-3 weeks

    23. Internal Resorption Due to osteoclastic action Institute endodontic tx. immediately "Pink spot" perforation may occur

    24. Calcific Metamorphosis

    25. Calcific Metamorphosis

    26. Calcific Metamorphosis

    27. Peripheral Root Resorption Due to damage of peridontal structures Usually in severe injuries with displacement of the tooth Types surface - normal PDL, small areas replacement - ankylosis inflammatory - granulation tissue, radiolucency

    28. Pulpal necrosis Due to severing of apical vessels or prolonged hyeremia and strangulation May not occur for several months

    29. Ankylosis PDL injury > inflammation > osteoclastic activity > fusion between bone and root surface

    30. Reaction of the Permanent Tooth Buds Hypocalcification/hypoplasia (Turner's tooth - due to trauma, infection, or both) Reparative dentin Dilaceration Sequelae of chronic infection

    31. Position of Primary Teeth

    32. Dilaceration/Turner’s Tooth

    33. Dilaceration

    34. Focal Hypoplasia & Hypocalcification

    36. Dental History How? When? Where? Was there a previous injury to area? Was there previous treatment to area? Unconsciousness, headache, amnesia, nausia? Bite disturbance?

    37. Soft Tissue Injuries Examine lacerations and contusions of the face, lips, and gingivae Remove any tooth fragments or debris embedded in the tissue Gently cleanse the area to aid in visual examination (topical anesthetic, soaked gauze sponges) Develop treatment plan

    38. Hard Tissue Injuries Examine teeth and alveolar process Note extent of crown fracture, if any Check for displaced or avused teeth Note amount of mobility Check for pulp exposures Examine adjacent/opposing teeth for injury

    39. Radiographic Examination X-ray injured tooth, adjacent teeth, and opposing teeth Evaluate proximity of fracture to pulp Estimate root development Look for root and alveolar fractures Note any periapical pathology Note previous treatment

    40. Other Diagnostic Tests Wait at leat 2 weeks Electrical and thermal tests may be unreliable in primary teeth If a tooth is incompletely erupted or is being orthodontically treated, the tooth may be normal even if there is little sensitivity to EPT - 20% of normals with 3/4 erupted teeth show no response to vitalometer

    41. Class I Primary (enamel fracture) Smooth enamel Check vitality in 6-8 weeks

    42. Class II Primary (dentin involved) Dycal Restore Check in 6-8 weeks

    43. Class III Primary (pulp involved) Formocresol pulpotomy, at least Restore Check in 6-8 weeks

    44. Class IV Primary (pulp necrotic) Formocresol pulpectomy, in absence of significant internal or external root resorption Extraction +/- space maintainer if endodontic treatment not possible

    45. Extraction and Space Maintainer

    46. Extraction and Space Maintainer

    47. Extraction and Space Maintainer

    48. Class V Primary (avulsion) Poor prognosis If within 30 minutes, replant, splint if necessary, soft diet, follow with primary endodontic treatment Space maintainer if endodontic treatment not possible

    49. Cleaning an Avulsed tooth Saline to remove foreign bodies and bacteria Flush alveolus with saline to remove coagulum; failure to do this increases chance of ankylosis Avoid scraping the root surface; this removes periodontal fibers and denudes the cementum

    50. What to Tell Parents Clean tooth under tap water Replant and maintain pressure for 5-10 minutes Bring child to office immediately If parent can't replant, put tooth into a cup of milk

    51. Replantation "Periodontal Healing of Replanted Dog Teeth Stored in Viaspan, Milk, and Hank's Balanced Salt Solution" Trope, Endod Dent Traumatol, Jan-Feb, 1993. Viaspan (a storage media used in organ transplants) and HBSS proved superior to milk for long term storage (>6 hrs) of avulsed teeth.

    52. Splinting .030 Stainless steel wire + Composite (old) .0175 Twist (Wildcat) + Composite Composite alone Avulsion: 7 days Root fractures: 1-3 months

    53. Splinting (not good.)

    54. Splinting

    55. Class VI Primary (root fracture) Extraction is almost always the treatment of choice

    56. Class VII Primary (displacement) Labial, lingual, extrusion - reposition tooth, compress alveolar bone, stabilize if necessary, check periodically Intruded primary tooth allow 2-4 months for eruption if ankylosis occurs, may luxate and check in 1 month, or remove

    57. Intrusion, Primary Teeth

    58. Lateral Luxation

    59. Lateral Luxation

    60. Lateral Luxation

    61. Class VIII Primary - Coronal/Root Fracture Extraction is usually the only option

    62. Class VIII Primary - Coronal/Root Fracture Radiograph day of trauma

    63. Class VIII Primary - Coronal/Root Fracture

    64. Class VIII Primary - Coronal/Root Fracture Radiograph one month later

    65. Class VIII Primary - Coronal/Root Fracture Tooth following extraction

    66. Combination Trauma Case 9 year 8 month male Bike accident yesterday History of asthma Taking Ritalin (nausia, dry mouth, BP changes)

    67. Combination Trauma Case

    68. Combination Trauma Case

    69. Just for Baseball Fans

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