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pediatric dentistry 4

pediatric dentistry 4

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Published by: api-19840404 on Nov 30, 2009
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09/06/2014

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Dental trauma : examination & treatment planning

"the reasonable man adapts himself to the world ; the unreasonable one persists in trying to adapts
the world to him self . therefore , all the progress depends on the unreasonable man "
george bernard show

1
11\ 3 \ 2009
Hey lovely dentists ,

in this lecture I will introduce you to the aspects of examination , how to
examine a patient who has had a
traumatic accident and how to diagnose
& plan the treatment for that patient . but
before talking about those interesting
subjects , I will talk a little bit about \u00ab

principles of trauma
management :
1 . triage & stabilize :

Means you have to asses everything
around you & have everything under
control and it includes :
A - assessing the level of

consciousness of the patient , it's a
kind of neurological assessment
,so the question you should ask yourself is : is he conscious or

unconscious after the trauma?
After that the question will be :
How do you know if the patient is conscious or not ?

- look at the patient, notice if you can see
- signs of disorientation .
- he can't stand up .
- amnesia; which means forgetting. you can check it by

asking the patient : what is your name? if he can't answer it , then there is some sort of loss of consciousness , or by asking where do you live ? or what happened ? some

of them can probably talk but they can't remember or tell you
exactly what happened.
- vomiting , nausea , drowsiness ; which is your logic signs of loss of
consciousness .
- signs of some sort of head injury.
FG
Main topics will be discussed:
1- principles of trauma management .
2- diagnosis :
- history .
- clinical examination.
- radiographic examination .
- vitality testing.
3- treatment planning.
ED
Dental trauma : examination & treatment planning

"the reasonable man adapts himself to the world ; the unreasonable one persists in trying to adapts
the world to him self . therefore , all the progress depends on the unreasonable man "
george bernard show

2
11\ 3 \ 2009
B - paresthesia of lips or anywhere else ; means one of the nerves has been
hit or the blow was very hard.

C - battle sign ; redness on the mastoid process. when the patient got a hit on
one of the sides, then the mastoid process will look red because of
hematoma , it seems like an ecchymosis behind ear.

D - raccoon sign ; black eye result from an orbital fracture in the bone .
E - skull fractures : in this case you may see CSF ( cerebrospinal fluid )
seeping out of the ear or nose ( nasal or auditory discharge ).
F - subjective assessment ; do you think there will be child abuse involved
in the case or the scenario? , or it's just a trauma by accident or by just a
fell . of course there are other ways to assess child abuse ( not into
discussion right now ).
2. treat the injury as soon as possible; avoid any delay , especially in
severe injuries .
3. you have to be calm & professional , when a child come to your clinic

due to a trauma the parents will be with him in addition to other family
members or relatives , everybody will be in panic and they will be alarmed ,
may be they will be screaming , shouting ,crying , accusing each other or
feeling guilty , so you as a dentist you have to be calm you have to be the
person who relaxes everyone , doesn't mean that you forget everything
and you start relaxing the patient's relatives, but what I mean is to be
professional , you have to reassure them , tell them what is happening, tell
them that this is not helping me plz step outside calmly & let me do my work
, so you have to have a say in this .

4. thorough documentation ; means everything you see, have to be

documented such as medical history ,clinical & radiographic findings .
don't lose your x-rays . if you did vitality testing record the results .
photographs , study models so by this way no one will accus e you later on .
if the tooth lose vitality & the parents say it's because of your poor
management , so you can say no I did my pulp testing & it say s so & so, the
radiograph I took shows this & tenderness to percussion shows this , so you
have evidences .

Dental trauma : examination & treatment planning

"the reasonable man adapts himself to the world ; the unreasonable one persists in trying to adapts
the world to him self . therefore , all the progress depends on the unreasonable man "
george bernard show

3
11\ 3 \ 2009

Dentists , now you will find a slide containing 2 pictures , the doctor doesn't
know what happened with the child in the picture and she don't know why
does she put that picture , but she thinks that it's just a blow luxation ( that's
what I heard) injury on the teeth.

Now after we talked a little about the principles of trauma management , of
course everyone of us wanna reachd ia g n o sis .

Dental injury should always be considered as emergency & treated
immediately , and a dental injury means any blow to the teeth , especially if it
exposing the pulp or causing mobilization of teeth . We treat the patient to
improve the prognosis, so we provide the best tre atment so we can reach the
best prognosis .

the first priority while giving treatment is to relief pain, sometimes you
have to delay pulp therapy because the patient is in pain , the second thing we
should take care of during treatment is to enhance functions ; which means
using the tooth for mastication , speech & so on . the third thing isa es th eti c s
,although it has a high sequence among teenagers & all of us but this is the
sequence of priorities.!

Diagnosis include :
History, that will also include medical history .
--clinical examination , that will include extra & intra oral examination , soft &
hard tissue examination.
-radiographic examination .
-vitality testing .
History : means the questions that you are going to ask in order to reach

your diagnosis & build your treatment plan . in the case of trauma there are
specific questions differ from the history you take for any patient. You have to
include the name , age , sex, address & telephone number to contact your
patient , apart from the necessity of those informations , the ability of the
patient to provide those gives you a clue about consciousness ; if he can
remember his name , his address & his telephone number that means he is
conscious & the head injury is not severe.

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