alvulsed tooth clarification

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This is a mail that I send to the RCS regarding a doubt I had the other day in the course and they told me to contact them after the exam.I hope this is help you for you all!Message that was sent:During the course we were told to send an email to you regarding some doubts that the teachers where not sure about the answers.

The questions were the following:

In the osce station number 9, related with the child that had an accident and as a consequence an avulsed tooth we are supposed to ask by

the phone to the father if the child was

having any

a) cardiac status

bleeding problems

c) tetanus statusTaking into account that this is an emergency situation and that the most important thing at this moment is to put the tooth back in place as

soon as possible

I imagine that these questions are to determine if we can tell the patient to put the tooth back in place or if this action is contraindicated.

So my doubt is What if the child has a past history of rheunmatic fever?

or any other cardiac problem?) would it be contraindicated, to put the tooth back in place?

What if the patient has bleeding problems like Haemophilia? (Should we put the tooth back in place and tell father to take him to hospital?)

Tetanus status: is it relevant to ask that in this moment,? is it going

to affect the decision of putting the tooth back in place at that moment or is this something that we can ask later whem patient arrive to our surgery to decide to give a booster of tetanus?

I really appreciate your help as I am having the exam in 3 weeks time and I believe this information is relevant.Answer

Taking into account that this is an emergency situation and that the most important thing at this moment is to put the tooth back in place as

soon as possible

I imagine that these questions are to determine if we can tell the patient to put the tooth back in place or if this action is contraindicated.

So my doubt is What if the child has a past history of rheunmatic fever?

or any other cardiac problem?) would it be contraindicated, to put the tooth back in place?

What if the patient has bleeding problems like Haemophilia? (Should we put the tooth back in place and tell father to take him to hospital?)

Tetanus status: is it relevant to ask that in this moment,? is it going

to affect the decision of putting the tooth back in place at that moment or is this something that we can ask later whem patient arrive to our surgery to decide to give a booster of tetanus?

I really appreciate your help as I am having the exam in 3 weeks time and I believe this information is relevant.

The course was excellent and highly recommended!Firstly the idea of the question is to test the ability of a clinican communicate with a patient over the phone concerning replanting

a tooth. It is important to take a brief medical history but essentially the tooth needs to be put back in. It is important

to ask briefly about tetanus status as if they are not up to date you may advise they see their GP for a booster.

Also if the patient has suffered any other injuries such as head injury then this is priority over replanting of teh tooth and the patient should go to their local hsopital asap.

Concerning cardiac status, it is not contraindicated to put the tooth back in . We do not have to give AB cover anymore for dental procedures as risk of having a bacteriaemia is less than that of an anaphylaxis.

With bleeding disorders like haemophilia you would still replant the tooth as this can help will stopping bleeding, however if they are not happy to do so then they can put in milk for replantation later. Their medical health is of priority here and therefore

they should be seen by their haemophilia centre for the relevant cover.

Any patient with haemophilia will be under a haemophilia unit at the hospital ad have a designated nurse specialist and doctor looking after them.

If a patient is immunocompromised then you will need to weight up the risk and benefits of replanting the tooth. The British Society of Paedaitric Dentistry guidelines of replantation of an avulsed tooth (Gregg 1997) advise not to do if the child is severely

immunocompromised. In these situations it maybe better to liaise with the medical teams looking after the patient prior to doing anything.

At the end of the day patient safety MUST always be considered when deciding what treatment to undertake.

If you go onto the BSPD website and look under publications you will able to access the guideline for replanation of an avulsed tooth which summarises this topic well.the end of the mailGaby