Download Pediatric Radiography Pediatric Restorative Dentistry

Primary Dentition:
Trauma & Space Management
Dr. Ha T. Jacklynn Thai
Board Certified Pediatric Dentist
Associate Professor, University of California, San Francisco
Department of Pediatric Dentistry
HRSA Program: Pediatric Dentistry in Hygiene Dentistry
24700 Calaroga Ave. Suite 104 ~ Hayward, CA 94545 ~ 510.785.9295
Trauma
Explore the Problem
Find out the story
Who
What
When
Where
Why
How
Prioritize medical status/condition(s)
Primary vs. permanent dentition
How to Address the Problem
Medical evaluation
Glascow Coma Scale
Behavior/mental status
Clinical exam
Radiographic exam
Types of traumas
Common types of trauma
Fracture
Tooth
Root
Alveolar bone
Concussion – tenderness
Movement of tooth position
Subluxation – increased mobility but not been displaced.
Bleeding from gingival sulcus
Extrusion
Intrusion
Lateral luxation
Avulsion
Cut lip or other soft tissue
Avulsed Teeth
How was it brought to you?
How long has it been out of the mouth?
Primary teeth
Do NOT reimplant
Permanent teeth
Patient age – is apex open or closed?
How long as it been out of the mouth?
Splint
Possible sequelae
Necrosis
Tooth discoloration
Pulpal obliteration
Ankylosis
Loss of tooth
Rule Out Child Abuse
Does the story make sense?
Are there repeated occurrences?
Goals of Trauma Management in
the Primary Dentition
Get patient out of pain
Preserve oral health/oral structures
Preserve adult dentition
Preserve/restore or maximize quality
of life
Opportunity for patient
education/anticipatory guidance
Space Management
They’re Just Baby Teeth
Know the exfoliation and eruption
table – at least a rough estimate
Rule of 3
Types of Space Maintenance
Appliances
Band and loop
Distal shoe
Bilateral – Permanent Teeth
Upper: Nance/TPA
Lower: Lingual Holding Arch
Goals of Space Management
Prevent loss of arch length, width,
and perimeter by maintaining the
relative position of the existing
dentition
Space maintenance is NOT space
gain
Space maintenance does not rule out
future orthodontics
Few Thoughts to Walk Away With
Regarding Pediatric Dental Care
Health Professional Service
Proper consent
Definition of a household
Co-parent – amicable or not?
MINOR MUST BE 15 YEARS OF AGE OR OLDER LAW
CONFIDENTIALITY AND/OR INFORMING OBLIGATION OF THE
HEALTH CARE PROVIDER GENERAL MEDICAL CARE “A minor may
consent to the minor's medical care or dental care if all of the following
conditions are satisfied: (1) The minor is 15 years of age or older. (2)
The minor is living separate and apart from the minor's parents or
guardian, whether with or without the consent of a parent or guardian
and regardless of the duration of the separate residence. (3) The minor
is managing the minor's own financial affairs, regardless of the source
of the minor's income.” (Cal. Fam. Code § 6922(a)).