IDENTIFYING URGENT DENTAL CARE

Transcription

1 IDENTIFYING URGENT DENTAL CARE Katie Kosten, DMD Director of Community Dentistry Assistant Professor Pediatric and Community Dentistry Southern Illinois University School of Dental Medicine

2 WELCOME!

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12 DISCLOSURE I do not receive any form of compensation from any source that directly affects, influences, or determines the content or my opinion of any aspect of this presentation.

13 ACKNOWLEDGEMENTS Diana Wilhold, BJC School Outreach and Development SIU School of Dental Medicine American Academy of Pediatric Dentistry Guidelines International Association of Dental Traumatology Guidelines McDonald and Avery s Dentistry for the Child and Adolescent 10 th edition by Jeffrey A. Dean

14 WHAT ARE TRUE DENTAL TRAUMA EMERGENCIES? All of these injuries are considered acute and need to be treated within a few hours. Avulsion Root fracture** Alveolar bone fracture Lateral luxation Extrusion** Images: dentaltraumaguide.org

15 WHEN DO CHILDREN EXPERIENCE TRAUMA? Toddler years Mid elementary years, with peak incidence between 8-10 THIS IS WHY YOU RE HERE! Adolescence

16 BABY TEETH OR PERMANENT TEETH? mamelons Trauma most often to front teeth (incisors) Average age of eruption for lower central incisors is 6-7 years (around 1 st grade) Average age of eruption for upper central incisors is 7-8 years (1 st or 2 nd grade) Generally: Larger Less white than baby teeth Mamelons

17 ACUTE DENTAL TRAUMA: PERMANENT TOOTH AVULSION Tooth is completely displaced out of the socket Socket may be empty or filled with a clot

18 ACUTE DENTAL TRAUMA: PERMANENT TOOTH AVULSION Prognosis for the dentist is dependent on: Root development (you can t do anything about this) Dry time (long dry time is a nogo) Wet storage time in PHYSIOLOGIC media (saliva, saline, milk, culture media) TAKE HOME POINT: REIMPLANT (in the proper orientation) ASAP!!

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20 Best option for avulsed tooth storage Shelf life of 24 months

21 AVULSION OF A PRIMARY (B ABY) TOOTH? DO NOT REIMPLANT! Why? Potential trauma to the permanent tooth that is still developing. Treatment is palliative: Soft food, OTC pain meds, good oral hygiene. Note: A primary tooth that is lost prematurely may actually delay the eruption of the permanent tooth.

22 ALVEOLAR FRACTURE: PERMANENT OR PRIMARY TEETH Fracture of the alveolar bone that may or may not include the socket Red flags: Several teeth moving as a unit Step up/down in plane of occlusion (bite plane) Requires repositioning of the mobile segment and flexible splint time of 4 weeks. Follow up treatment (root canal, possible extraction in primary teeth) often necessary, requires consistent monitoring at future visits

23 LATERAL LUXATION AND EXTRUSION Both require repositioning of the tooth Flexible splint will be placed by the dentist Encourage parent to check with dentist s comfort level of treating these cases before going to the office. Any pediatric dentist would be comfortable with treating these injuries. Lateral luxation Extrusion

24 15 YOF TRAUMA TO #8

25 TREATMENT FOR LATERAL LUXATION #8

26 CASE STUDY: ROOT FRACTURE 17 year old female

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28 HOW DID THIS HAPPEN? A. A. Basketball game B. B. Little brother threw a remote control at her during a fight C. C. Fell off of a mechanical bull D. D. Walked into a pole on the street while taking a selfie C. Fell off of a mechanical bull

29 POST OP What fracture??? Splint with flexible wire for four weeks Advise soft diet and OTC pain meds as necessary.

30 MONTHS LATER AFTER SEVERAL FAILED APPOINTMENTS Radiolucency visible at the fracture line Fistula present adjacent to #8 Root canal indicated

31 Don t panic, this is still the same tooth. The assistant forgot to flip them before I downloaded them. Patient did not return after RCT was completed, so we can only assume that no news is good news.

32 FRACTURES: TECHNIC ALLY NOT AN EMERGENCY (BUT GOING TO THE DENTIST ASAP IS STILL A GOOD IDEA)

33 WHAT S IN A TOOTH? Enamel: highly calcified outer layer, no innervation Dentin: still very calcified, communicates with pulp. Exposure will lead to potential sensitivity Pulp: living part of the tooth that connects systemically to the rest of the body Subject to infection, necrosis, inflammation, etc.

34 ENAMEL FRACTURES Little to no pain or sensitivity Fairly easy fix at the dentist Most often no local anesthetic is necessary to restore

35 ENAMEL-DENTIN FRACTURES Likely sensitivity to air, cold Fairly easy fix at the dentist Still, often no local anesthetic is necessary to restore

36 ENAMEL-DENTIN-PULP FRACTURES In most cases, sensitivity to air/cold or pain Restoration at the dentist must include treatment of the exposed pulp These teeth may exhibit changes in the future that need to be treated at a later date

37 OTHER TRAUMA TIDBITS

38 JAMES, AGE 3 History of trauma to #E (twice) Faceplanting into the coffee table at Great-Grandma s house Divebombing off the couch in the bowling alley Lots of bleeding, crying 4. Now what??

39 TREATMENT See, he s fine. Soft diet, palliative care, and monitor Discoloration alone is NOT an indicator for treatment. Spontaneous pain, swelling, or fistula development indicate need for treatment.

40 RUH ROH

41 PULPECTOMY (BABY ROOT CANAL)

42 ONE MONTH AFTER TREATMENT*

43 THERE S AN APP FOR THAT

44 QUESTIONS? THANK YOU!

45 REFERENCES _bars_girls_happy_fun jpg!d PG Traumatic Injuries in the Pediatric Dental Patient, S. Whitley DMD, February 2016