Prevention of Dental Trauma II

1. Prevention of Dental Trauma II Libyan International Medical University 2nd Year 2nd Semester D Caroline Piske de A. Mohamed

2. Students at the end of this topic should be able to explain and discuss: • Secondary prevention of dental trauma • Tertiary prevention of dental trauma Objectives:

3. “A nine year old boy, while playing with a friend at school had his mouth injured ( 20 min passed). • His gingiva is moderately bleeding and his incisal and lateral right teeth are moving in a block. • He is anxious and concerned teacher has just arrived with the child to your clinic requesting for treatment”. Case for discussion

4. What is your line of action?????

5. Traumatized teeth should be • accurately diagnosed • treated quickly • treated appropriately Prompt intervention following accidental damage to teeth can have a secondary preventive effect by reducing the complications of trauma.

6. PSYCHOLOGICAL EFFECT!!

7. Be Calm, compassionate • Confident & • Reassuring.

8. Parent´s consentment

9. Trauma History

10. What was the cause of the trauma? • Falls in infancy • Child physical abuse • Falls and collisions • Sports and related injuries • Automobile accidents

11. How long has it happen?

12. What To Do And When • What to do and when to do it can be critical to saving the tooth or group of injured teeth as well as reducing stress and anxiety. There are some simple rules to follow. Dental injuries can be categorized into treatment needs as follows: • Immediate — Within 5 Minutes:A tooth completely avulsed (knocked out of socket) requires treatment immediately to have any chance of saving the tooth long term. • Urgent — Within 6 Hours:When a tooth is still in the mouth but has been moved, either in or out, or to one side or the other, this is considered an acute injury. • Less Urgent — Within 12 Hours: Injuries in which teeth are broken or chipped but not bodily moved from their original position. • See more at: http://www.deardoctor.com/articles/guide-to-dental-injuries/index.php#sthash.agXwbtm3.dpuf

13. WARNING: • If there has been a loss of consciousness from a head injury, even temporary, there may be a serious injury— send the child to the hospital.

14. Patient exam • General Health Physical Situation • Oral Situation Soft tissue – ripped - bleeding Teeth – chipped – fractured – dislodged – avulsed Bone – fracture

16. Treatment

17. Treatment depends on the injury • Irrigate mucose with saline • Care tissues injuries • Reposition teeth properly • Splint • Rx • Continuous follow up • Maybe RCT • Orthodontic treatment • Restore

19. What is the best treatment choice? • A) try again apecification with Ca OH2 • B) RCT • C) extraction- • D) Composite restoration/ extraction/ bridge/ implant

22. What is MTA?

23. Mineral Trioxide Aggregate (MTA) • MTA materials are considered calcium containing silicate cements. They promises to replace the time spent achieving an apical barrier with non-setting calcium hydroxide by creating a barrier in one appointment.

29. Case report • This 12years old boy came in after a playground accident where he hit his top teeth on the pavement. Four of the top teeth were severely or mildly broken. • Because the teeth were not loose, splinting was not necessary. The four broken teeth were restored using composite fillings. 

30. The development of both the acid-etch technique, dentine bonding agents, and composite or compomer technology, means that there is no excuse for leaving exposed dentine for any length of time in coronal fractures.

31. Traditional Apexificationwith calcium hydroxide is loosing popularity over MTA. However, it is a fairly predictable procedure. • Here is a case of a maxillary incisor in a ten year old patient treated with a dressing of calcium hydroxide and followed up for 20 months.

32. After the calcium hydroxide was removed the apical barrier was inspected through the scope.

33. The recognition that non-setting calcium hydroxide is capable of allowing continued root growth and apexification in non-vital immature teethhas made both treatment and long-term prognosis more predictable for these teeth.

34. Do you know what you need to do if you or your child knocks out a tooth? 

35. Not the best choice...

36. You can call your dentist and he should guide you.

37. If a child broke his / her teeth, clean face and mouth and go to the dentist with the teeth pieces that may be reattached. Dental trauma, how to proceed?Instructions for patients: Dr Caroline Mohamed

38. If your child hit his/her tooth and it became mobil, wash her face and mouth and put a clean wet cloth on her mouth tighting slightly the mucose-gingivae around the tooth for 15 minutes to stop bleeding. • Go to your dentist fast. He may splint the teeth for a while. Dr Caroline Mohamed

39. If your children had his/her permanent tooth falled down: • Clean his/her face and mouth, • Take the tooth by its crown (the white part of the tooth), • Dont touch the teeth´s root, • If it fell down on soil wash with saliva or milkdon´t scrub it! • Try to reimplant in the tooth socket and go to the dentist immediately. • The sooner you seek treatment, the better the prognosis Dr Caroline Mohamed

40. Dr Caroline Mohamed

41. Or put the tooth inside the child´s saliva spilted in a cup, milk (normal temperature), saline and go to the dentist fast. • Don´t put inside water, don´t scrub the tooth root. Dr Caroline Mohamed

42. Go to the dentist fast! Dr Caroline Mohamed

43. Emdogain Gel. • The avulsed tooth if stored correctly and replanted soon after injury may be retained as a functioning member of the dentition with a healthy periodontal ligament for life. • Even the avulsed tooth with an extraalveolar dry time of greater than 60 min, which has had its necrotic periodontal ligament removed, may grow a new periodontal ligament with the help of Emdogain Gel.

44. Emdogain Gel • Emdogaingel is an enamel matrix protein of porcine origin. • Why is Emdogain Gel used? • EmdogainGel is used to help rebuild the lost tissues related to periodontitis. It may also be used to repair and cover exposed roots due to gum recession. • How does Emdogain Gel work? • Emdogain Gel is a revolutionary product that allows your body to rebuild the natural attachment that is required to support your teeth.

45. Such advances in the field of dental traumatology enable the clinician to retain teeth which would previously have been extracted. • These advances in the diagnosis, treatment, and prognosis of dental traumatic injuries have been most significant over the last 25 years and current knowledge is essential to treat appropriately (Welbury 2001).

46. “Battered child”- severe physical child abuse

47. The dentists role in child protection • The incidence of orofacial injuries in children who have been physically abused is in excess of 65%. • In all types of abuse, the incidence of orofacial injuries which are visible to the dental practitioner is of the order of 35%. • The dental practitioner may be the first professional to see or suspect abuse. • ( Injuries may take the form of contusions (bruises) and ecchymoses, abrasions and lacerations, burns, bites or dental trauma.)

48. DIAGNOSIS: Physical Abuse • Like other forms of abuse, physical findings alone are not usually diagnostic of physical abuse. • Any time there is a lack of history, a history that changes over time, or a history that does not make sense when compared to the injury, the diagnosis of physical abuse is indicated.

49. In addition, there are some constellations of injury that are often associated with intentional injury, including: • Infants may present as "shaken" infants. The finding may include retinal hemorrhages, subdural hemorrhages, rib fractures and/or metaphyseal fractures. Infants who have been shaken may or may not have associated other injuries. • Toddlers may present with scald burns, such as a scald pattern on the buttocks and/or feet with a "doughnut hole" spared area on the buttocks. • Older children may present with bruises or fractures mainly in the face a resulting from excessive corporal punishment. These may be pattern injuries and resemble the outline of the striking object. Bruises commonly occur on the buttocks and extremities.

50. The following eleven points should be considered by the dentist whenever doubts or suspicions are aroused: • Could the injury have been caused accidentally and if so how? • Does the explanation for the injury fit the age and the clinical findings? • If the explanation of cause is consistent with the injury, is this itself within normally acceptable limits of behaviour? • If there has been any delay seeking advice, are there good reasons for this? • Does the story of the accident vary? • The nature of the relationship between parents and child. • The child’s reaction to other people. • The child’s reaction to any medical or dental examination. • The general demeanour of the child. • Any comments made by the child and/or parents that cause concern about the child’s upbringing or life-style. • History of previous injury.