Download - A child in a clinic
-
7/29/2019 A child in a clinic
1/55
-
7/29/2019 A child in a clinic
2/55
A child of8yrs old come to your clinic with bleeding
margin around central incisor &the tooth is slightly
mobile.
-
7/29/2019 A child in a clinic
3/55
Psychological management.
History & chief complaint.
Examination.
Treatment
-
7/29/2019 A child in a clinic
4/55
How can I manage a child in my clinic ??!!!
-
7/29/2019 A child in a clinic
5/55
Fear !!True (Obj sub )
Not true (Unknown-strangers-parents)
-
7/29/2019 A child in a clinic
6/55
For successful management of patients with
dental trauma important to know
the history, circumstances of the injury
1. Personal
2. Medical
3. Dental
-
7/29/2019 A child in a clinic
7/55
* (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?
-
7/29/2019 A child in a clinic
8/55
* Objective Examination
* Radiographic Examination
-
7/29/2019 A child in a clinic
9/55
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
-
7/29/2019 A child in a clinic
10/55
-
7/29/2019 A child in a clinic
11/55
-
7/29/2019 A child in a clinic
12/55
-
7/29/2019 A child in a clinic
13/55
Periapical Lesions
Pulpal Lesions
-
7/29/2019 A child in a clinic
14/55
-
7/29/2019 A child in a clinic
15/55
* Systemic disorders:
Disseminatedintravascular coagulation(DIC)
Hemophilia
Idiopathicthrombocytopenic purpura(ITP)
Scurvy ( Vitamin Cdeficiency)
* Dental Diseases
Gingivitis
Periodontitis
Trauma
-
7/29/2019 A child in a clinic
16/55
-
7/29/2019 A child in a clinic
17/55
* 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)
-
7/29/2019 A child in a clinic
18/55
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
-
7/29/2019 A child in a clinic
19/55
* 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/ -
7/29/2019 A child in a clinic
20/55
* 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/ -
7/29/2019 A child in a clinic
21/55
-
7/29/2019 A child in a clinic
22/55
* 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 -
7/29/2019 A child in a clinic
23/55
* 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.
-
7/29/2019 A child in a clinic
24/55
* 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.
-
7/29/2019 A child in a clinic
25/55
Classification:
Descriptive classification.
Ellis & davey classification.
Mod. Ellis & davey classification.
-
7/29/2019 A child in a clinic
26/55
* Fractures of teeth:
1. Infraction
2 . Crown fractureuncomplicated
3 . Crown fracture
complicated4 . Crown/root fracture
5 . Root fracture
-
7/29/2019 A child in a clinic
27/55
* Injuries involving the whole tooth:
1. Concussion
2 . Subluxation
3 . Displacment- Lateral luxation
- Intrusion
- Extrusion
4. Avulsion
-
7/29/2019 A child in a clinic
28/55
* Infraction
Diagnosis:craze lines apparent especially withtransillumination.
Treatment : to maintain structural integrity and pulp vitality.
prognosis: Complications are unusual.
-
7/29/2019 A child in a clinic
29/55
* 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.
-
7/29/2019 A child in a clinic
30/55
* 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.
-
7/29/2019 A child in a clinic
31/55
* 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.
-
7/29/2019 A child in a clinic
32/55
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.
-
7/29/2019 A child in a clinic
33/55
* Injuries involving the whole tooth:
1 . Concussion
2 . Subluxation
3 . Displacment- Lateral luxation
- Intrusion
- Extrusion
4 . Avulsion
-
7/29/2019 A child in a clinic
34/55
* 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.
-
7/29/2019 A child in a clinic
35/55
* 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.
-
7/29/2019 A child in a clinic
36/55
* 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.
-
7/29/2019 A child in a clinic
37/55
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.
-
7/29/2019 A child in a clinic
38/55
* 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.
-
7/29/2019 A child in a clinic
39/55
* 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.
-
7/29/2019 A child in a clinic
40/55
* 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.
-
7/29/2019 A child in a clinic
41/55
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
-
7/29/2019 A child in a clinic
42/55
-
7/29/2019 A child in a clinic
43/55
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.
-
7/29/2019 A child in a clinic
44/55
* 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.
-
7/29/2019 A child in a clinic
45/55
* Pulpal Hyperemia The color change may be evident for several weeks
after the accident and is often indicative of a poor
prognosis.
-
7/29/2019 A child in a clinic
46/55
* 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.
-
7/29/2019 A child in a clinic
47/55
* 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.
-
7/29/2019 A child in a clinic
48/55
* 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.
-
7/29/2019 A child in a clinic
49/55
* External Resorption The pulp may not become involved.
Usually the resorption continues until gross areas of
the root have been destroyed.
-
7/29/2019 A child in a clinic
50/55
* 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.
-
7/29/2019 A child in a clinic
51/55
* 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.
-
7/29/2019 A child in a clinic
52/55
1. Hypocalcification and hypoplasia
2. Reparative dentin production
3. Dilaceration
-
7/29/2019 A child in a clinic
53/55
* 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.
-
7/29/2019 A child in a clinic
54/55
* Reparative Dentin Production
-
7/29/2019 A child in a clinic
55/55
* 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.