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on Aug 07, 2012 Says :
well presented PPT on tooth avulsion.
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MANAGEMENT OF AVULSED TOOTH RAJENDRA BHATTA HIMAL DENTAL HOSPITAL
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MAN ALTHOUGH TRIES TO DOMINATE NATURE ….. BUT CANNOT CONQUER IT ACCIDENT DO HAPPEN……….
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INTRODUCTION DEFINITION PREVALENCE TREATMENT - OBJECTIVES - PRE HOSPITAL CARE - TRANSPORT MEDIA - HOSPITAL CARE - EXTRAORAL DRY TIME <60 MINUTES >60 MINUTES - REIMPLANTATION & SPLINTING FOLLOW UP AND PROGNOSIS
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INTRODUCTION Losing a tooth can be one of the most distressing incidents for an individual. If the sufferer is child, then the psychological trauma is suffered by whole family. These injuries pose a particular challenge because they occur quickly and unpredictably .
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As early as 400 BC, Hippocrates suggested that displaced teeth should be replaced and fastened to adjacent teeth with wire. Modern emergency departments focus on re-implanting teeth as soon as possible, minimizing periodontal damage, and preventing infection of the pulp tissue.
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Perhaps one of the earliest documented case of an avulsed tooth was reported by BIGELOW a 21 year old dental student in New England in 1866 (DCNA)
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Defn- Clinical situation in which the tooth is completely displaced out of its socket following a traumatic impact. Of all dental injuries, avulsion is the most serious because it not only disrupt the marginal gingival seal but also involves injury to pulpal blood vessels, cementum, nerves and periodontal ligament at the same time. DENTAL AVULSION
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CLASS V: Teeth lost as a result of trauma (Ellis 1960) CLASS 9: Avulsion of tooth ( WHO 1978) CLASS 12: Exarticulation( Andreasen -1981) N 503.22: Avulsion (exarticulation) - complete displacement of the tooth out of its socket. (International Classification of Diseases (1992) ACCORDING TO VARIOUS CLASSIFICATIONS
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1% to 16% in permanent dentition (TROPE-1995) 7% to 13% in primary dentition ( ANDREASEN- 1995) PREVALENCE
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SEX & AGE MALE : FEMALE RATIO IS 2-3:1. MOST OFTEN IN 8-12 YEARS OF AGE. At this age, the loosely structured periodontal ligament surrounding erupting teeth with incomplete roots provides only minimal resistance to an extrusive force.
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CAUSES FIGHT INJURIES SPORTS INJURIES FALL AGAINST HARD OBJECTS ROAD AND TRAFFIC ACCIDENT In young, falls and sporting activities account for most injuries. In later teenaged years, motor vehicle collisions and assaults account for most injuries.
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PATHOPHYSIOLOGY The usual cause is a direct force sufficient to overcome the bond between the affected tooth and the periodontal ligament within the cradling alveolar socket.
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PRIMARY TEETH TO PREVENT FUTHER INJURY TO PERMANENT SUCCESSOR - SHOULD NOT BE REPLANTED DUE TO POTENTIAL DAMAGE TO PERMANENT SUCCESSOR & FREQUENT PULPAL NECROSIS OBJECTIVE
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PERMANENT TEETH REPLANTED AS SOON AS POSSIBLE TO STABILIZE IN ANATOMICAL LOCATION OPTIMIZE HEALING OF PERIODONTAL LIGAMENT AND NEUROVASCULAR SUPPLY MAINTAIN ESTHTIC AND FUNCTIONAL INTEGRITY
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EXTRA ALVEOLAR DURATION CONDITION OF AVULSED TOOTH AGE AND ROOT DEVELOPMENT SUCCESSFUL TREATMENT DEPENDS UPON
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Patient should be encouraged for immediate replantation.( Aim of the treatment should always be to replant the tooth back into its socket as quickly as possible.) Handle the tooth by the crown only. Do not touch the root. If the tooth is contaminated, rinse it for 10 seconds with a cold running water or stream of saline ( with a syringe).
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If it is impractical to replant the tooth immediately at the site of injury, tooth should be stored in proper medium so as to increase the chances of survival of the PDL cells still attached to the root surfaces. AND THE PATIENT SHOULD SEEK AN EMERGENCY SERVICE FOR FURTHER TREATMENT
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HBSS (Save-A-Tooth) Milk Saline Saliva Tap water Hank’s Balanced Salt Solution (HBSS) TRANSPORT MEDIA
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HISTORY PATIENT'S AGE: Anterior primary teeth are usually present until age 6-7 years. MECHANISM OF INJURY LOCATION OF THE TOOTH: Time period for which tooth is out of the socket. STORAGE MEDIA: Determine if the tooth was stored dry or in solution.
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CLINICAL EXAMINATION INSPECTION Surrounding soft tissue area. PALPATION Determine if the tooth or if an entire segment is mobile. MISSING TOOTH If the tooth is not found, consider complete intrusion of the tooth into underlying alveolar bone.
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TOOTH should be without advanced PERIODONTAL DISEASES SOCKET should be reasonably INTACT EXTRA ALVEOLAR PERIOD/ DRY TIME CLOSED/ OPEN APEX CONSIDERATION
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IMMUNOCOMPROMISE CONGENITAL CARDIAC ANAMOLY SEIZURE DISORDERS MENTAL DISABILITIES UNCONTROLLED DIABETES DECIDIOUS TEETH IF OTHER SERIOUS INJURIES PRESENT IN THE BODY, MANAGEMENT OF AVULSED TEETH IS NOT IMPORTANT……………… CONTRAINDICATIONS
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TEETH WITH SHORT EXTRA ORAL TIME (LESS THAN 60 MINUTES)… TREATMENT PROCEDURE
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IF REPLANTATION IS DECIDED…. 1. TOOTH IS PLACED IN SALINE 2. RINSE WITH A FLOW OF SALINE 3. REPOSITION using light gentle pressure SPLINTING
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Handle the tooth by the crown. No effort should be made to sterilize the root surface, it will damage vital periodontal tissue and cementum Replanted tooth should fit loosely in the alveolus in order to prevent further damage to the root surface. Splint should allow physiologic tooth movement and should be easy to clean. Verify radiographically Splint should be removed gently. PRECAUTION
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FOLLOW UP CLINICAL FOLLOW UP IS RECOMMENDED 1 WEEK 2-3 WEEKS 3-4 WEEKS 6-8 WEEKS EVERY 6 MONTHS – 5YEARS
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FURTHER OUT-PATIENT CARE ADVISE Soft diet Avoid eating solid foods to prevent loss of stabilizing dressing. Strict oral hygeine care should be maintained with the help of soft brush and chlorhexidine rinses (0.12%)
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COMPLICATIONS Loss of tooth Loss of space can be expected if injury occurred prior to the eruption of the canines and in children with crowded dentitions Cosmetic deformity Speech development may be transiently affected if primary incisors are lost before child masters articulation Damage to permanent successor (38% - 85%) Delayed and ectopic eruption of permanent tooth due to injured primary tooth Infection
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TREATMENT IS DIRECTED AT MINIMIZING THE EFFECT OF TWO PRIMARY COMPLICATIONS: - PULPAL INFECTION - ATTACHMENT DAMAGE
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PROGNOSIS Immature permanent teeth(25-34%) > older permanent teeth(8%). RCT is necessary when necrotic tooth pulp becomes infected. The chance of a successful reimplantation is dependent upon the amount of time the tooth has been out of the socket. EDUCATION OF PATIENTS TOWARD SELF-REIMPLANTATION MAY HELP TO DECREASE THE OUT-OF-SOCKET TIME.
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EXTRA-ORAL TIME DRY TIME > 60 MINUTES…
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PDL has no chance of survival If replanted it will ultimately undergo replacement resorption and eventually lost EXTRA ORAL DRY TIME MORE THAN 60 MIN
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TOOTH IS SAVED TILL THE FACIAL GROWTH IS COMPLETED SO ULTIMATE GOAL IS TO SLOW DOWN THE RESORPTION PROCESS RATIONALE
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In case of delayed replantation, endodontic treatment can be done extra orally also. Treatment with CaOH Normal root canal treatment with GP and sealers ENDODONTIC TREATMENT
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HEALING IS DIRECTLY RELATED TO - EXTRAORAL PERIOD - CONDITION IN WHICH IT WAS MAINTAINED
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TREATMENT – SIGNIFICANT CHALLENGE IN THE PAST, REPLANTATION WAS CONSIDERED AS TEMPORARY MEASURES. HOWEVER WITH ADVANCEMENT AND IMPROVEMENT BETTER RESULTS ARE OBTAINED. MANY CASES HAVE BEEN REPORTED, WHERE TOOTH HAVE SUCCESSFULLY SURVIVED FOR 20-40 YEARS. CONCLUSION
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ANATOMY of TEETH 2 1...
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