A child in a clinic

7/29/2019 A child in a clinic

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A child of8yrs old come to your clinic with bleeding

margin around central incisor &the tooth is slightly

mobile.


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Psychological management.

History & chief complaint.

Examination.

Treatment


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How can I manage a child in my clinic ??!!!


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Fear !!True (Obj sub )

Not true (Unknown-strangers-parents)


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For successful management of patients with

dental trauma important to know

the history, circumstances of the injury

1. Personal

2. Medical

3. Dental


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* (When? Where? How? )

* Was there a period ofunconsciousness?

*Is there any disturbance in the bite?* Is there any reaction in the teeth to cold

and/or heat exposure?


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* Objective Examination

* Radiographic Examination


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1 . Extraoral Examination

2 . Intraoral Examination* Soft Tissue

* Dentition

3 . Clinical Tests

* Control Teeth * Percussion and Palpation* Pulp Vitality Tests * Selecting the Appropriate PulpTest

* Cold Tests * Heat Tests

* Electrical Pulp Testing * Blood Flow Determination

4.Periodontal Examination* Probing

* Mobility


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Periapical Lesions

Pulpal Lesions


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* Systemic disorders:

Disseminatedintravascular coagulation(DIC)

Hemophilia

Idiopathicthrombocytopenic purpura(ITP)

Scurvy ( Vitamin Cdeficiency)

* Dental Diseases

Gingivitis

Periodontitis

Trauma


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* is a serious disorder in which theproteins that control blood clottingbecome abnormally active.* This often occurs due toinflammation, infection, or cancer.

* Risk factors for DIC include:

- Blood transfusion reaction- Infection in the blood by bacteria

or fungus

- Recent surgery or anesthesia- Sepsis (a serious infection)- Severe tissue injury (as in burns

and head injury)


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Hemophilia is a hereditarybleeding disorder caused by alack of blood clotting factorVIII/IX. Without enough factorVIII/IX, the blood cannot clot

properly to stop bleeding.

* Risk factors for hemophiliainclude:

Family history of bleeding

Being male


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* Idiopathic thrombocytopenicpurpura

is ableeding disorder in which the

immune system destroysplatelets,

which are necessary for normalblood

clotting. Persons with the diseasehave

too few platelets in the blood.

* ITP is sometimes called immune

thrombocytopenic purpura.
http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A001304/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A001304/


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* Scurvy is a disease that

occurs when you have a

severe lack of vitamin C

(ascorbic acid) in diet. Itcauses general weakness,

anemia, gum disease,and skin hemorrhages.
http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A000560/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A000560/


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* It is common in children.usually causes gum tissueto swell, turn red andbleed easily.Gingivitis is

both preventable andtreatable with a regularroutine of brushing,flossing and professionaldental care. However, left

untreated, it caneventually advance tomore serious forms ofperiodontal disease.
http://www.perio.org/consumer/gum-disease-symptoms.htmhttp://www.perio.org/consumer/gum-disease-symptoms.htm


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* can affect young peoplewho are otherwise healthy.Localized aggressiveperiodontitis is found in

teenagers and young adultsand mainly affects the firstmolars and incisors. It ischaracterized by the severeloss of alveolar bone, and

ironically, patients generallyform very little dentalplaque or calculus.


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* may begin aroundpuberty and involve theentire mouth. It ismarked by inflammationof the gums and heavyaccumulations ofplaque and calculus.Eventually it can cause

the teeth to becomeloose.


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Classification:

Descriptive classification.

Ellis & davey classification.

Mod. Ellis & davey classification.


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* Fractures of teeth:

1. Infraction

2 . Crown fractureuncomplicated

3 . Crown fracture

complicated4 . Crown/root fracture

5 . Root fracture


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* Injuries involving the whole tooth:

1. Concussion

2 . Subluxation

3 . Displacment- Lateral luxation

- Intrusion

- Extrusion

4. Avulsion


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* Infraction

Diagnosis:craze lines apparent especially withtransillumination.

Treatment : to maintain structural integrity and pulp vitality.

prognosis: Complications are unusual.


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* Crown fracture

uncomplicated Diagnosis:loss of tooth structure.

Treatment : to maintain pulp vitality and restore normalesthetics and function.

General prognosis: depends on the injury to the Pdl andthe extent of dentin exposed.


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* Crown fracture

complicated Diagnosis:loss of tooth structure with pulp exposure.

Treatment :

Primary teeth: pulpotomy, pulpectomy, or extraction.

Permanent teeth: direct pulp capping, partial pulpotomy,full pulpotomy, and pulpectomy.

General prognosis: depend on injury to the periodontalligament, the age of the pulp exposure, extent of dentin

exposed, and stage of root development at the time of injury.


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* Crown/root fracture Diagnosis: a mobile coronal fragment attached to the gingiva.

a radiolucent oblique line.

Treatment

Primary teeth: extraction of coronal fragment. Permanent teeth: Reposition and stabilize the coronal

fragment.

General prognosis: Pulp necrosis in mature root. Pulpal

healing in immature root formation.


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Diagnosis: A mobile coronal fragment attached to the gingiva.

1or more radiolucent lines that separate the tooth fragments.

Treatment:

Primary teeth: the entire tooth should be removed.

Permanent teeth: remove the coronal fragment . If the pulp isexposed, pulp capping, pulpotomy, and root canal treatment.

General prognosis:Fractures extending significantly below thegingival margin may not be restorable.


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* Injuries involving the whole tooth:

1 . Concussion

2 . Subluxation

3 . Displacment- Lateral luxation

- Intrusion

- Extrusion

4 . Avulsion


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* Concussion

Diagnosis: tooth tender to pressure and percussionwithout mobility, or sulcular bleeding.

Treatment : to optimize healing of the periodontal

ligament and maintain pulp vitality.

General prognosis: For primary teeth, no pulpaltherapy is indicated. Permanent teeth may undergo

pulpal necrosis.


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* Subluxation Diagnosis: a mobile tooth without displacement.

Treatment :

Primary teeth: The tooth should be followed for pathology.

Permanent teeth: Stabilize the tooth and relieve anyocclusal interferences. For comfort, a flexible splint can be

used. Splint for no more than 2 weeks.

General prognosis: Permanent may undergo pulpal necrosis.The primary tooth should return to normal within 2 weeks.


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* Lateral luxation

Diagnosis: A tooth is displaced laterally .The tooth usually isnot mobile or tender to touch. Radiographic findings reveal

an increase in periodontal ligament space.

Treatment objectives:

Primary teeth: passive or spontaneous repositiong , orextraction.

Permanent teeth: Repositioning of the tooth is done withdigital pressure and little force. Splinting an additional 2 to 4

weeks may be needed with breakdown of marginal bone.


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General prognosis: Primary teeth requiringrepositioning have an increased risk of developing pulp

necrosis compared to teeth that are left to

spontaneously reposition.

In mature permanent teeth ,pulp necrosis and pulp

canal obliteration are common healing complications.


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* Intrusion Diagnosis: the tooth appears to be shortened or missing. The

tooth is not mobile or tender to touch.

Treatment :

Primary teeth : Extraction.

Permanent teeth: reposition passively, actively or surgicallyand then to stabilize the tooth with a splint for up to 4 weeks .

General prognosis: In primary teeth, 90% of intruded teeth willreerupt spontaneously in 2 to 6 months.

In permanent teeth ,pulp necrosis, pulp canal obliteration.


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* Extrusion Diagnosis: the tooth appears elongated and mobile.

Radiographic findings reveal an increased periodontal ligament

space apically.

Treatment objectives: Primary teeth: reposition spontaneously ,extraction.

Permanent teeth: to reposition and stabilize the tooth . Splint

for up to 2 weeks.

General prognosis : In permanent teeth, pulp necrosis.


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* Avulsion

Diagnosis: the tooth is not present in the socket. Treatment :

Primary teeth: should not be replanted.

Permanent teeth: to replant and stabilize the replanted tooth,

except when replanting is contra-indicated by:

1. the childs stage of dental development.

2. compromising medical condition.

3. compromised integrity of the avulsed tooth or supporting

tissues.


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General prognosis: The tooth has the bestprognosis if replanted immediately.

The best transportation media for avulsed teeth

include Viaspan, and cold milk,saliva (buccal

vestibule), physiologic saline, or water. In permanent avulsed teeth, pulp necrosis, root

resorption, and ankylosis. The risk of ankylosis

increases significantly with an extra oral dry time of

20 minutes


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Revascularization:An immature tooth has thepotential to establish revascularization when there

is a minimum of a 1.0 mm apical opening. It

appears that antibiotic treatment reduces

contamination of the root surface and/or pulp space,

thereby creating a biological environment that aids

revascularization.

On the other hand, a mature tooth has little or no

chance of revascularization.

Researchers have demonstrated that immature

teeth soaked in doxycycline solution have a greater

rate of pulp revascularization.


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* PDL management transitional therapy:When a tooth has been out of the oral cavity and in a dry

environment for greater than 60 minutes, the PDL has no

chance of survival. If such a tooth is replanted, it is likely to

undergo osseous replacement resorption and, overtime,the tooth will become ankylosed and ultimately will be lost.

To slow down this process, the remaining PDL should be

removed. Then teeth are soaked in fluoride before

replantation, it has been shown to reduce significantly

the,risk of resorption after a follow-up of 5 years.


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* Pulpal Hyperemia The color change may be evident for several weeks

after the accident and is often indicative of a poor

prognosis.


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* Internal Hemorrhage The change in color is evident within 2 to 3 weeks afterthe injury, and although the reaction is reversible to a

degree, the crown of the injured tooth retains some of

the discoloration for an indefinite period.


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* Dystrophic Calcification The radiograph may give the illusion of complete

obliteration.

The crowns of teeth may have a yellowish, opaque color.

Primary teeth will usually undergo normal root resorption,

Permanent teeth will often be retained indefinitely ,should

be regarded as a potential focus of infection.


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* Internal Resorption It may be observed radiographically in the pulp

chamber or canal within a few weeks or months

after an injury.

If evidence of internal resorption is detected early,the tooth may possibly be retained when endodontic

procedures are instituted.


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* External Resorption The pulp may not become involved.

Usually the resorption continues until gross areas of

the root have been destroyed.


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* Pulpal Necrosis Injured teeth with subsequent pulpal necrosis are commonly

asymptomatic, and the radiograph is essentially normal.

A necrotic pulp in an anterior primary tooth may be successfully

treated if no extensive root resorption or bone loss has

occurred .

The treatment technique is essentially the same as that for

permanent teeth.


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* Ankylosis Clinical evidence of ankylosis is a difference in the incisal

plane.The radiograph shows an interruption in the periodontal

membrane of the ankylosed tooth, and the continuous dentin

and alveolar bone can often be seen.

The ankylosed primary tooth should be removed.

Removal of a permanent tooth that becomes ankylosed is

often necessary, especially if the ankylosis occurs during early

teenage years.


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1. Hypocalcification and hypoplasia

2. Reparative dentin production

3. Dilaceration


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* Hypocalcification AndHypoplasia

There was evidence of destruction of the ameloblasts

before any enamel had been laid down, resulting inhypoplasia that clinically appeared as deep pitting.

Small hypoplastic defects may be restored by the resin-

bonding technique.


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* Reparative Dentin Production


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* Dilaceration The developed portion of the tooth is twisted or bent on

itself, and in this new position growth of the tooth

progresses.

The tooth was necrotic, the root had not resorbed, and

the apex of the root was exposed in the labial sulcus

and was associated with a draining sinus.

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A child in a clinic