Dental problems
Dentoalveolar Injuries
Fracture
- Enamel
- Routine f/u
- Nothing to do
- Enamel + dentin (yellowish)
- Adult
- Next day f/u
- Consider placing calcium hydroxide paste over fracture site as needed for comfort
- Child
- Place calcium hydroxide paste
- More important in children than adults because children have less dentin to protect the pulp
- Place calcium hydroxide paste
- Immediate referral
- Adult
- Enamel + dentin + pulp (reddish)
- Immediate referral (dental emergency)
- If no dentist is available, place moist cotton over exposed pulp and cover with foil or seal with canal sealant
- Consider antibiotics (penicillin or clindamycin)
Subluxation
- Minimally mobile
- Soft diet for 14 days
- Markedly mobile
- Immediate referral for stabilization
- Temporizing measure: Periodontal pack in which tooth is bonded to its two neighboring teeth on both sides
Avulsion
- Dental emergency
- Where is the tooth?
- May be intruded, aspirated, swallowed, or embedded in the oral mucosa
- Consider facial films, CXR
- May be intruded, aspirated, swallowed, or embedded in the oral mucosa
- Adult
- Replace avulsed tooth as soon as possible! (as long as no alveolar ridge fx, no severe socket injury)
- Rinse tooth in saline, socket is suctioned (if necessary), reimplant tooth, bond tooth to neighboring teeth
- Manipulate tooth only by the crown
- Storage solution (in order of efficacy): Hank's balanced salt solution > Milk > saliva > saline
- Tetanus vaccine if indicated
- Consider antibiotics (penicillin or clindamycin)
- Replace avulsed tooth as soon as possible! (as long as no alveolar ridge fx, no severe socket injury)
- Child
- Do not reimplant primary teeth
- Refer to pedodontist for space maintainer
- Do not reimplant primary teeth
Bleeding Socket
- Apply pressure by having pt bite on gauze or tea bag
Odontogenic infections
Dental Carie/Pulpitis
- dental referral only
Periapical vs. Periodontal Abcess
- drain
- PCN V
- dental referral
Exquisite pain to percussion suggests an underlying periapical abscess, though may point on gingiva (gumboil)
More commonly, fluctuant abscesses are a result of periodontal abscesses and are best treated with an incision and drainage
Trench Mouth (Acute Necrotizing Ulcerative Gingivitis)
- Severe gingival disease with inflamed,friable,ulcerated gingiva with gray pseudomembranes
- Present with fever,foul breath,strong metallic taste
- Anaerobic flora are most commons source
- Treat with peridex and PO Abx covering oral flora, dental referral
- Admission with parenteral Abx in patients with severe/systemic symptoms