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Front Back
List the cranial nerves.
Oh, oh, oh, to touch and feel very good velvet...ahh heaven

1. Olfactory - smell
2. Optic - vision
3. Oculomotor - eye movement
4. Trochlear - eye movement
5. Trigeminal - mus. of mastication, teeth, facial sensation
6. Abducens - eye movement
7. Facial - mus. of facial expression
8. Vestibulocochlear - senses sound, rotation & gravity
9. Glossopharyngeal - Taste post. 1/3 of tongue, parotid gland
10. Vagus - parasympathetic fibers, most laryngeal & pharyngeal muscles; voice muscles Symptom of damage: Dysphagia
11. Accessory Spinal - sternocleomastoid & trapezius
Damage: unable to shrug, weak head movement
12. Hypoglossal - tongue mus., swallowing and speech
Lefort fractures.
I - maxilla separates from the nasomaxillary complex (no fixation, closed reduction)
II - Nasomaxillary complex separates from upper face
III - separation of cranium from midface
What is the most common facial skeletal injury in hospitalized pedo patients?
Mandibular fractures
BOYS>GIRLS
Young patients→condylar/subcondylar fractures  
Adolescents→Angle of the mandible (area of developing 3rd molars)
What type of fracture should be suspected when there has been a blow to the chin?

What are the S/S?
Subcondylar fractures.

Palpate auditory meatus→unable to detect condylar head

Unilateral:
Jaw deviates on opening to side of fracture.

Bilateral:
Retrognathia
anterior open bite no present before.

NOTE: CHECK FOR BASILLAR SKULL FRACTURE
What are the exposure times for radiographs to detect foreign bodies intra and extra orally?
1/4 usual exposure for intraoral
1/2 ususal exposure for extraoral
What is the splint time for a alveolar segment fracture?
reapproximate segments and splint for 4 weeks

Teeth are stable in the mobile segment
What is the most common tooth injury in the primary dentition?
Subluxation:

An injury to the tooth supporting structures resulting in increased mobility and pain to percussion, but without displacement of the tooth. Bleeding from the gingival sulcus is evident if the child is seen shortly after the accident.

Tx: Observe
Define Lateral Luxation.
Tx?
Displacement of the tooth other than axially.

Tx (primary): observation or extraction if severe.

Tx (permanent): splint for 4wks; monitor pulp status, refer to endo if necessary.
INTRUSION

Displacement of the tooth into alveolar bone.

Tx (primary): Allow for spontaneous re-eruption (primary teeth)

Tx (permanent): immature tooth or intruded < 7mm then wait 3 weeks for spontaneous re eruption; if not then orthodontic repositioning

Majority intrude labial to developing tooth bud; PCO may be seen in the future
EXTRUSION

Partial displacement of the tooth out of its socket.

Tx (primary teeth): Minor then reposition or allow for spontaneous re-alignment.
Major (very mobile, occlusal interference then extract.

Tx (permanent teeth): Reposistion and spiint for 2wks, follow up with endo.
What is the treatment of primary tooth Avulsion?
Do not re-implant! Take intraoral and soft tissue radiographs.
What should you advise parents of after trauma to primary teeth?
color changes
premature exfoliation
pain, abcsess

Complications with permanent successors (trauma at less then 3 years old has greatest risk)
- discoloration, hypoplasia, crown/root formation disturbences, delayed eruption, ectopic eruptrion
What are the outcomes of a non complicated coronal fractures?
Pulp survivial (most common)
PCO
Pulp necrosis
What is the indicated tx for complicated permanent tooth crown fracture?
small exposure within hours→ direct pulp cap (MTA?CaOH)and restore

larger exposure and longer interval→cvek technique and restore. (MTA→GI/curable CaOH2→flowable→packable composite)

Monitor
What is a Cvek pulpotomy?
Remove a few mm of coronal pulp tissue
Contral pulp bleeding with pressure
Apply MTA (mineral trioxide aggregate) or CaOH2
Resotre.
MTA vs CAOH2 for direct pulp cap
MTA
Easier to use
less pulp irritation
more predictable pulp barrier
What is the tx for permanent tooth root fractures?
Cerival 1/3 poorest prognosis; splint for 4 months

No displacement, no mobility NO SPLINT

Mobility with fracture futher apically splint for 4 weeks. 

Radiographs @ incident, 4wks, 6-8wks, 6 months, 1 year.
 
Monitor pulp vitality in coronal portion
open apex →necrosis rare
if pulp necrosis is coronal segment treat as immature tooth.
apical root segment→no tx
What are some benefits of MTA?
Biocompatible
calcium in MTA diffuses through dentin to resorptive lesions 
helps to stop inflammatory root resorption
does not thin dentinal walls
better fracture resistance over time then CaOH2
What are some contraindications of reimplanting an avulsed permanent tooth?
Severe cardiac disease
uncontrolled seizure disorder
mental disability
compromised healing→impaired immune system
What is tx protocol for permanent tooth avulsion with extraoral time < 60 minutes?
1. If root contaminated then irrigate with saline
2. cover root with minocycline hydrochloride (arestin)
3. Remove clot from socket, irrigate with saline
4. Replant tooth
5. x-ray to verify position
6. flexible splint for 2 weeks
7. monitor pulp vitality for endo.
8. confirm tetanus booster
9. Doxycyline BID 7 days or penicillin vk if under 12 y/o; chlorhexidine
10. soft diet,
What is tx protocol for permanent tooth avulsion with extraoral time >60 minutes?
1. Replantation generally not indicated
2. Remove attached necrotic tissue.
3. perform endo before or after replanting
4. Remove clot with saline
5. Immerse tooth in 2% NaFl for 20 min
6. Replant tooth
7. Flexible splint for 4 WEEKS.
8. confirm tetanus booster
9. Doxycyline BID 7 days or Pen VK if under 12 y/o; chlorhexidine
10. soft diet,
What is the dosage of doxycylcine?
45 kg = 100mg BID
What is the dosage for Penicillin VK?
25-50 mg/kg/day max 3g.
What are the actions of formocresol in a pulpotomy?
Composition?
Fixation
Bacterialcidal
19% formaldehyde, 35% cresol, 15% glycerin and water.
What is the action of ferric sulfate in a pulptomy?
Protein layer that occludes caplillaries
non antimicrobial
What is the composiiton of vitapex?
iodoform (disinfectant) and cacium hydroxide
What is the indication for pulp revascularization?
Goal? Procedure?
Non-vital tooth
incomplete root formation 
Goal is to gain complete root formation

1. Non-mechanical debridement via copious irrigation
2. Triple antibiotic paste (ciprofloxacin, minocycline, metronidazole) for 3 wks.
3. Remove paste, induce bleeding at the apex, allow clot to reach CEJ
4. place MTA, restore.
5. monitor for continued root closure and thickening.
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