Management of Dental Emergencies in Children and Adolescents – 6 September 2019

Management of Dental Emergencies in Children and Adolescentsby Klaus W. Neuhaus (Editor), Adrian Lussi (Editor)

A unique, multidisciplinary manual for the treatment of pediatric dental emergencies for general practitioners and non-pediatric specialists Management of Dental Emergencies in Children and Adolescents presents the diagnostic skills, treatment options, and management strategies necessary to provide effective and appropriate dental care for children and adolescents.

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This authoritative manual helps dental practitioners manage potentially stressful situations with children and adolescents while improving their competence in a wide range of urgent pediatric situations. An emphasis on managing the therapeutic demands of both younger patients and their parents enables readers to have greater confidence in handling demanding emergency situations in daily practice. An expert team of contributors explain how to manage tooth substance loss, endodontic problems in deciduous teeth, the long-term consequences of early tooth loss, the dental issues related to oral health, and more.

Guiding practitioners through the unique challenges of pediatric dental emergencies, this book: Explains the differences in treating and managing dental emergencies in children compared to adults Covers all types of pediatric dental emergencies including open pulp in permanent and deciduous teeth, missing teeth, and non-infective dental conditions Offers clinical vignettes and photographs to highlight clinical relevance Includes chapters by experts in multiple disciplines such as endodontics, restorative dentistry, pediatric dentistry, prosthodontics, and orthodontics The first textbook to focus exclusively on young patients in need of acute dental care, Management of Dental Emergencies in Children and Adolescents is a much-needed resource for general and specialist dentists as well as trainee and specialist pediatric dentists.

Management of Dental Emergencies in Children and Adolescents Contents

Contributors ix
Preface xiii
Invited Preface xv
Acknowledgements xvii
About the Companion Website xix
Unit 1 General Considerations for Emergency Management in Children
and Adolescents 1
1.1 Developmental and Histological Aspects of Deciduous and Young Permanent Teeth 3
Markus Schaffner and Adrian Lussi
1.2 Pulp Biology of Deciduous and Permanent Teeth 13
Wolfgang H. Arnold, Ella A. Naumova and Vlasios Goulioumis
1.3 Management of Odontogenic Infections: Indications for Antibiotics 23
Rafael Lazarin and Vivianne Chappuis
1.4 Management of Pain and Fear: Behavioural Management, Anaesthesia and Sedation 35
Klaus W. Neuhaus and Nathalie Scheidegger Stojan
1.5 Management of Radiographic Needs 43
Karl Dula
Unit 2 Management of Tooth Substance Loss 63
2.1 Deep Carious Lesions and the Dental Pulp 65
Falk Schwendicke and Nicola P. Innes
2.2 Management of Crown Fractures and Crown‐Root Fractures 79
Gabriel Krastl and Julia Amato
2.3 Management of Root Fractures 91
Dan‐Krister Rechenberg
vi Contents
Unit 3 Management of Open Pulp in Permanent Teeth 103
3.1 Pulpotomy after Trauma 105
Hrvoje Jurić
3.2 Pulpectomy with Open Apex 119
Isabelle Portenier, Klaus W. Neuhaus and Maria Lessani
3.3 Regenerative Endodontic Procedures 131
Richard Steffen
Unit 4 Management of Open Pulp in Deciduous Teeth 137
4.1 Pulpotomy 139
Eirini Stratigaki and Joana Monteiro
4.2 Pulpectomy of Deciduous Teeth 149
Klaus W. Neuhaus and Jan Kühnisch
4.3 Tooth Extraction 159
Hubertus van Waes
Unit 5 Management of Missing Teeth 163
5.1 Reconstructive Considerations: Temporary and Long‐Term Treatment Options 165
Nicola U. Zitzmann and Nadja Rohr
5.2 Management of Avulsed Teeth 177
Andrea Zürcher and Andreas Filippi
5.3 Autotransplantation: Ankylosis and External Root Resorption after Trauma 189
Manfred Leunisse, Dick S. Barendregt, Marcel L. E. Linssen and Edwin Eggink
5.4 Orthodontic Aspects of Missing Teeth at Various Ages 199
Carlalberta Verna and Birte Melsen
Unit 6 Management of Oral Health Conditions 217
6.1 Viral Causes Affecting the Oral Mucosa 219
Michael M. Bornstein, Cynthia K. Y. Yiu and Valerie G. A. Suter
6.2 Non‐infective Swellings: Cysts, Tumours and Ranulas 233
Valerie G. A. Suter and Michael M. Bornstein
6.3 Oral Problems in Patients Undergoing Haematology or Oncology Treatment 245
Adrian M. Ramseier, Jakob Passweg and Tuomas Waltimo
Contents vii
Unit 7 Management of Non-infective Dental Conditions 255
7.1 Molar–Incisor Hypomineralisation 257
Jan Kühnisch and Roswitha Heinrich‐Weltzien
7.2 Dentine Hypersensitivity 269
Thiago Saads Carvalho and Samira Helena João‐Souza
7.3 Cracked Tooth Syndrome 275
Renata Chałas and Stefan Hänni
Index 283

Management of Dental Emergencies in Children and Adolescents Preface

Dear readers,
Dental emergency situations are often demanding due to the patient’s pain, or due to time constraints on the dentists’ side. When children or adolescents suffer dental emergencies, the situation might be even more challenging because of the patients’ age, the worried patients, not rarely accompanied by loud screaming. In this setting it is demanding for the dental team to remain quiet and provide the necessary and considerate treatment.

This book aims at providing some assistance to dental practitioners in order to better manage potentially stressful situations with children and adolescents in the dental office. The focus lies on the management of therapeutic demands. The content of this book is not totally new. Knowledge can be obtained from books on dental traumatology, cariology, pediatric dentistry, endodontology, or orthodontics.

However, this is the first time that a textbook particularly emphasizes how to manage emergency situations with young patients only, and which treatments potentially could be offered once the acute emergency is over. While the first section of the book recapitulates the biologic and developmental differences between treatment of adults vs.
children/adolescents, the following chapters emphasize how to manage tooth substance loss, how to deal with endodontic problems in deciduous teeth or in teeth with an open apex. Furthermore, general dental practitioners should be aware of the long‐term consequences of early tooth loss, and of methods to deal with that.

Because teeth are not the only possible cause for emergencies in the dental office, other chapters focus on oral health related problems and on the management of non‐ infective conditions. We are happy about the more than competent team of contributing authors. We chose authors that deal with young to very young patients every day in order to guarantee as much practical relevance as possible. At the same time the authors are experienced lecturers and have up‐to‐date theoretical knowledge included in their chapters.

We hope that reading this book help the readers to acquire a higher level of confidence while coping with demanding emergency situations of children and adolescents during daily work.

Klaus W. Neuhaus Adrian Luss

Management of Dental Emergencies in Children and Adolescents Invited Preface

Dental emergencies in children and adolescents are ‘grist for the mill’ for paediatric dentists and endodontists. However, during our initial dental training, we are mostly taught by individual disciplines, and therefore it is easy to miss the interdisciplinary nature of the care required for paediatric and adolescent emergencies that provides the
best outcome for the patient.

To have a book that brings the elements of comprehensive emergency care together is of great benefit to clinicians. The editors have brought together a host of dental clinicians as authors who have a wealth of relevant experience that is shared in the text. Emergencies in children are different to those for older individuals. As development is still occurring, this has great influence on treatment planning, as well as the ability to provide the best care for the child.
Development includes both physical, psychological and behavioural aspects, and these need to be considered in both immediate and long-term definitive care.

Treatment of emergencies has evolved over the years as the evidence has improved, however, there is still much to learn regarding the most appropriate care for the individual patient. For example, the chapter on management of deep carious lesions illustrates the vast changes that have evolved as the related evidence-base increases in size
and validity – treatment of the deep carious lesion is far less aggressive than in previous decades, as the importance of maintenance of pulpal health and ‘sealing’ of the lesion has become preeminent.

Another example is the chapter on regenerative endodontics, an area of clinical care that was non-existent 25 years ago. The use of MTA, and now including newer calcium silicate-based materials, has revolutionised endodontics. The ability to encourage healthy tissue to re-establish itself in a root canal system previously filled with necrotic tissue creates the possibility of continued root development in a partially developed tooth and has wide-ranging clinical

In paediatric and adolescent emergencies, treatment decisions often need to be made immediately, therefore a sound understanding of the short- and long-term consequences of treatment options is vital, and the following text provides the clinician with a sound base to inform these decisions. The decision may be as dichotomous as whether to replant an avulsed permanent incisor or not – leading to the thought process which may include – how long has the extra-oral time been? How long was the ‘dry time’? What storage medium has been used? How developed is the tooth? Is the soft tissue and/or bony socket damaged? Is the child capable of accepting care in the dental chair, or will sedation or a general anaesthesia be necessary? Will this change my treatment options or recommendations? What do I talk to the parents about? Do I have informed consent? Should I extirpate the pulpal tissue – now or
later, or at all? When and how often is followup? What tests should I undertake? All leading to the question – what is the best option for the individual patient?

This contextually broad but concise text provides the clinician with ample information on how to deal with emergencies, from pulpotomies to facial swellings to posttrauma orthodontic tooth movement. The comprehensive nature of the text covering treatment of both the primary and permanent dentitions makes it a valuable reference text that should be in all dental clinics. Prof. David Manton The University of Melbourne Melbourne, Australia….

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