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Published byAbbey Gaynes Modified over 9 years ago
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In the name of GOD
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Prevention and Management of Traumatic Injuries in the Primary and Permanent Dentition
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Etiology and Epidemiology Peak age in primary : 2-4 y Falls Contact sports: mouthgaurds Automobile accidents Seizure disorders Permanent teeth more crown fx / primary more luxation Maxillary central incisor Protruding incisor Child abuse in primary :50 % head and neck Injuries in various stages of healing, labial frena
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History Medical and dental History of dental injury : When,where,how First or not Tetanus prophylaxis Central nervous system : consciousness,disoriented,nauseated 24 h : every 2-3 h waking the child
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Non-complicated Crown Fracture Enamel fracture Enamel-dentin fracture
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Complicated Crown Fracture Enamel,dentin,pulp exposure
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Crown-root Fracture Multiple( pulp may or not be involved) Coronal fragment : attached to the gingiva,mobile Treatment Extraction of mobile fragments Do not insist on removing root fragments(damage to the tooth germ )
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Root Fracture Mobile tooth,displacing of coronal fragment
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Alveolar Fracture Mobile,displaced (tooth in the affected segment) Discotinuity in the surrounding area
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Concussion Tender to touch No mobility,no sulcus bleeding No abnormal changes in the X-ray Treatment Observation
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Subluxation Mobile,without displacement Sucus bleeding may or not Treatment Observation Careful bacterial control: Good oral hygiene
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Lateral Luxation Displaced laterally Crown usually in palatal direction
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Intrusion Apex labially (80%) PA X-ray Shorter,apical tip is seen: toward labial bone plate Elongated,apex tip isn’t seen : toward permanent tooth germ Hypoplasia in permanet tooth
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Extrusion Mobile,displacing out of the socket Treatment Left or Extarct
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Primary teeth Tooth out of the socket PA X-ray :ensure that the lost tooth is not intruded Treatment Must not be replant :damage to the developing tooth germ Replant : aspiration,retention,inflamatory resorption,abscess formation Hypoplasia,white or yellow brown opacity Esthetics,function loss Phonation disorder or tongue interposition: removable appliance
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Permanent Teeth Time out of socket Immediately reimplant by the first capable person
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Transport medium :Viaspan,Hanks Balanced salt solution (HBSS): EMT tooth saver Cool Milk > salin,water Saliva/patient’s mouth
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As soon as possible to dentist Office : HBSS/ moth rinse Doxycycline /penicillin V Splint
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Uncomplicated crown fracture Immediate treatment : none Refer to dentist: within 48 h
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Complicated crown fracture Immediate treatment : none,don’t place any medication on the bleeding pulp,stop bleeding with sterile cotton gauge Refer to dentist: as soon as possible,could wait 48 h if patient can tolerate cold and eat
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Root fracture Immediate treatment : none Refer to dentist: as soon as possible
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Concussion /Subluxation Immediate treatment : none Refer to dentist: within 48 h for evaluation
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Luxation Immediate treatment : move the tooth back Refer to dentist: as soon as possible
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Avulsion Immediate treatment : replace the tooth in its hole,restor in milk or saline Refer to dentist: immediately
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Education How to avoid injuries How to manage at the site of the injury Who are at the high risk? Severe maxillary overjet : orthodontic treatment before 11 Another injuries Young children Looking for all fragments
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Facegaurd Prefabricated/custom Not applicable to all activities Hit under the chin : no False security
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Mouthgaurd 100 y Amateur: Boxing, football, ice hocky,lacrosse Baseball.basketbal,soccer,school physical classes Promote the rules requiering the use of mouthgaurds
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Best fitted by dentist Cover all teeth in max arch except in mandibular prognatism Fix orthodontic appliances/congenital abnormalities: cleft Adequet thickness : min 3 mm over occlusal Retentive fit Speech consideration Material
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Custom-fabricated Mouth formed Thermoplastic Shell line stock
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