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Primary Dentition: Trauma & Space Management

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

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Primary Dentition: Trauma & Space Management

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  1. 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

  2. Trauma

  3. Explore the Problem • Find out the story • Who • What • When • Where • Why • How • Prioritize medical status/condition(s) • Primary vs. permanent dentition

  4. How to Address the Problem • Medical evaluation • Glascow Coma Scale • Behavior/mental status • Clinical exam • Radiographic exam

  5. 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

  6. 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

  7. Rule Out Child Abuse • Does the story make sense? • Are there repeated occurrences?

  8. 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

  9. Space Management

  10. They’re Just Baby Teeth • Know the exfoliation and eruption table – at least a rough estimate • Rule of 3

  11. Types of Space Maintenance Appliances • Band and loop • Distal shoe • Bilateral – Permanent Teeth • Upper: Nance/TPA • Lower: Lingual Holding Arch

  12. 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

  13. 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)).

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