Guidelines for the Management of Traumatic Dental Injuries II-Avulsion of Permanent Teeth 8/28/09

LUTHERAN MEDICAL CENTER
Dental Residency Program
Literature Review Form

Resident: Murphy Date:8/28/09 Region: Prov.
Article title: Guidelines for the Management of Traumatic Dental Injuries II-Avulsion of Permanent Teeth
Author(s): Flores, Marie. Lars Andersson, et al.
Journal: Dental Traumatology
Volume #; Number; Page #s): 23, 130-136
Year: 2007
Major topic: How to treat permanent teeth avulsions
Type of Article: Clinical Review
Main Purpose: Discuss treatment options and modalities for permanent teeth avulsions
Overview of method of research; Review of Treatment options

Findings. Dental trauma occurs in 5% of adult injuries, and as high as 18% of pre school children injury. Avulsions of permanent teeth are the most serious of all dental injuries. The measures that were taken at the time of the accident or immediately following the accident greatly affect the prognosis. An appropriate treatment plan, depending on the circumstances are crucial for a good prognosis. The International Association of Dental Traumatology(IADT) has developed a consensus review after referencing the most current literature and group discussions. The IADT does not guarantee favorable outcomes from following the guidelines, but using them can maximize the chance of success. Guidelines can be accessed at www.iadt-dentaltrauma.org. As dentists, it’s important for us to give appropriate advice to the public about first aid for avulsed. First aid for avulsed teeth include keeping the patient calm, handling the tooth by the crown only, rinsing it briefly for 10 seconds, placing the tooth in HBSS or milk, and seeking emergency treatment immediately for pulp testing, radiographs, and splinting. Radiographs should include a shot at a 90 degree angle, an occlusal, and lateral view.

Tooth Re-implanted Prior to Arrival
-Irrigate area-apply flexible splint
-Administer antibiotics(doxycycline 2x daily for 1 week)
-Tetanua shot if needed-Initiate RCT 7-10 days after reimplantation
-Soft diet for 2 weeks, .1% Chlorhexidine Rinse daily

Tooth Kept in special storage <60 min
-Irrigate root surface and apical foramen with a stream of saline and place tooth in saline.
-Reimplant tooth slowly, suture gingival lacerations
-Follow tx above starting at admin. antibiotics

MORE TO COME
Key points in the article discussion:
Summary of conclusions: Assessment of article:

Transplantation of Premolars as an Approach for Replacing Avulsed Teeth 8/28/09

Resident: Murphy
Date: 8/28/09
Article title: Transplantation of Premolars as an Approach for Replacing Avulsed Teeth
Author(s): Andreason, Jens. Ole Shwartz, etc.Journal: Pediatric Dentistry, Vol. 31, #2, pg 129-132
Major topic: Treatment modalities for transplanting premolars Type of Article: Clinical Review

Findings: The anterior maxilla is the primary site for dental traumas, with the peak incidence being from between 8 and 12 years old. 7-8% of these injuries involve an avulsed tooth, or a tooth that was not able to be re-implanted. Filling the space left by a lost tooth can be accomplished in many ways. Orthodontic closure, Removable appliance, conventional fixed bridge, acid etched bridge, implant, autotransplantation of premolars, and no treatment. Aside from Orthodontic closure, transplantation of premolars is the most biological approach. The space is filled with a vital tooth that will erupt in harmony with other teeth, won’t compromise the health of adjacent teeth, and has a good prognosis.
The most decisive factor affecting successful transplantation is the stage of root development, with a root with ¾ formed being the best. Studies show that this stage of root development is optimal for pulpal and PDL healing. This method has a 90% success rate.
Maxillary second and mandibular first and second premolars are the teeth that are used (excluding maxillary firsts due to their two roots). Teeth that are used as grafts have to be shaped with restorative procedures.
Key factors for success of the transplantation include minimal trauma to hertwigs root sheath during harvesting and re-implanting, pre/post op antibiotics, and using a tooth that’s root is in the correct developmental stage. Standard tooth removal techniques should not be used, and only clinicians who are familiar with the proper technique should attempt the treatment.
Complications include pulpal necrosis, root resorption, infection, and ankylosis(the worst). Ankylosis prevents eruption and leads to the replacement of root with bone. One option is to separate the crown from the root, leaving the root in the socket to preserve the growth of the alvelolar process.

Conclusions:
-Premolar transplantation is an excellent alternative treatment plan to other conventional options.
-Minimize trauma as much as possible to HRS, dental pulp, and PDL.
-Reimplanted teeth can be shaped with restorative options.
-Only professionals who are adept at doing this procedure so attempt it.

Assessment of article: It was an interesting article to read. For a subject that I thought would have extensive explanation on how to/not to do it, why to/not do it, it was extremely short. I think there should have been more of a discussion on how to do the treatment. Also, the article made some vague statements about how “studies show” that this treatment option is excellent, but don’t list any reasons why. Good article, could have been great.

Orofacial trauma in child abuse: types, prevalence, management, and the dental profession's involvement

Department of Pediatric Dentistry

Lutheran Medical Center

Date: 08/28/2009

Article title: Orofacial trauma in child abuse: types, prevalence, management, and the dental profession's involvement

Author(s): Howard L. Needleman, DMD

Journal: Pediatric Dentistry

Volume (number): Vol 8

Month, Year: 1986

Major topic: Child abuse

Minor topics: dental trauma management

Type of Article: Review of Literature

Main Purpose: Review types of injuries to the primary dentition and present evidence based treatments

Overview of method of research: Review of Literature as well as professional opinion

Findings:

Trauma to the head and associated areas occurs in approximately 50% of cases of physically abused children.

Soft tissues are the most common injury in child abuse and are usually on the face

Injuries to the upper lip and frenum are common findings in severely abused children

As dentists make an effort to be aware of these injuries, abuse detection will increase.

Key points/Summary :

• Common abuse findings: Fractures, subdural hematomas, abrasions & lacerations, contussions & ecchymoses, bursns, bites, dental trauma.
• In the past, dentists have done a poor job reporting abuse; dentists have not always been aware that they are legally mandatory reporters.
• The primary goal in detection is to bring the needed social services to families to help them overcome their problems.
• How to detect abuse:
• Is the injury consistent with the history?
• Are there signs of previous traumas?
• Is there bruising at various levels of healing?
• Does the parent exhibit unusual behavior are does the child seem to be traumatized?
• Is there evidence of neglect or poor supervision?
• Make appropriate referrals when pathology presents you are uncomfortable treating
• If the injury is within your realm of specialty, then treat appropriately.
• Soft tissue: use ice packs
• Abrasions: cleanse and dress as needed
• Frenum tears: suture only if alveolar bone is exposed and the wound opens with lip movement
• Suture choice: 5-0 or 6-0 silk for skin removing them 4 days post-op; 3-0, 4-0 chromic gut for muscalature; 4-0, 5-0 plain gut for mucosa.
• Human bites: very serious, antibiotics recommended and don't close wound. (refer this)
• Facial fractures are relatively rare, but nasal fractures occur most frequently. Refer all alveolar and mandible fractures to an oral surgeon--even if treatment is not indicated.

Assessment of article: A solid review of child abuse as it pertains to pediatric dentistry, but a lot of the literature used is really dated. It would be nice to see a current article on this same topic.