Difference between revisions of "Dental problems"

 
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==Dentoalveolar Injuries==
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==Types==
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{{Template:Dental Problems DDX}}
  
===[[Tooth Fracture]]===
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{{Maxillofacial trauma DDX}}
#Enamel (Ellis Class I)
 
##Routine f/u only; nothing to do
 
#Enamel + dentin (yellowish) (Ellis Class II)
 
##Pts experience sensitivity to hot/cold stimuli and air passing over tooth during breathing
 
##Cover exposed dentin to decrease pulpal contamination
 
###Place dental cement over fracture site
 
###Next day f/u
 
#Enamel + dentin + pulp (reddish) (Ellis Class III)
 
##On wiping fractured surface with gauze, blood is easily seen
 
##Immediate referral (dental emergency)
 
##If no dentist is available:
 
###Cover exposed pulp with calcium hydroxide base
 
###Cover this and the remaining exposed dentin with dental cement
 
  
===[[Tooth Subluxation]]===
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{{Facial swelling DDX}}
#Extrusive Luxation
 
##Reposition tooth
 
##F/u within 24hr for stabilization
 
##Temporizing measure: Periodontal pack in which tooth is bonded to its two neighboring teeth on both sides
 
#Lateral Luxation
 
##More extensive injury than extrusive luxation
 
###Associated with cracking or fracture of the surrounding alveolar bone
 
##Treatment
 
###Attempt repositioning of tooth
 
###Apply temporary splinting with periodontal dressing
 
###F/u within 24hr for stabilization
 
#Intrusive Luxation
 
##Most serious because of significant damage to alveolar socket and periodontal ligament
 
##Treatment
 
###Allow tooth to erupt on its own
 
  
===[[Tooth Avulsion]]===
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==See Also==
#Dental emergency
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*[[Dental numbers]]
#Often associated with alveolar ridge fracture
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*[[Maxillofacial trauma]]
 
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*[[Diagnoses by Body Part (Main)]]
#Where is the tooth?
 
## May be intruded, aspirated, swallowed, or embedded in the oral mucosa
 
###Consider facial films, CXR
 
#Adult
 
##Replace avulsed tooth as soon as possible (as long as no alveolar ridge fx, no severe socket injury)
 
###If reimplanted within 1hr 66% chance of good outcome
 
###Rinse tooth in saline, suction socket (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
 
##Penicillin or clindamycin
 
#Child
 
##Do not reimplant primary teeth
 
###Refer to pedodontist for space maintainer
 
 
 
===[[Bleeding Tooth Socket]===
 
# Apply pressure by having pt bite on gauze or tea bag
 
 
 
== [[Odontogenic Infections]] ==
 
=== Dental Caries/Pulpitis ===
 
#Two types: reversible pulpitis and irreversible pulpitis
 
##Reversible Pulpitis
 
###Duration of pain is short (seconds)
 
###Associated with noxious stimuli (cold or heat)
 
##Irreversible Pulpitis
 
###Duration of pain is long (hours) and intense
 
###Associated with noxious stimuli or may occur spontaneously
 
###Tx = root canal or extraction
 
 
 
=== [[Periapical Abcess]] ===
 
#Treatment
 
##I&D
 
##Penicillin VK 500mg PO QID OR Clindamycin 300mg PO QID
 
##Dental referral
 
 
 
=== [[Trench Mouth (Acute Necrotizing Ulcerative Gingivitis)]] ===
 
====Background====
 
#Severe gingival disease
 
#Must distinguish from herpes gingivostomatitis
 
##Herpes has more systemic signs, less bleeding, lack of interdental papilla involvement
 
#Associated with immunosuppression, especially HIV
 
====Clinical Features====
 
#Triad of:
 
##Pain
 
##Ulcerated or "punched out" interdental papillae
 
##Gingival bleeding
 
#Secondary signs:
 
##Fetid breath
 
##"Wooden teeth" feeling
 
##Teeth mobility
 
##Fever
 
##Malaise
 
====Treatment====
 
#Chlorhexidine 0.01% oral rinse BID
 
#Metronidazole 500mg PO TID
 
#Dental debridement and scaling
 
  
==See Also==
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==References==
*[[Acute Alveolar Osteitis (Dry Socket)]]
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<references/>
*[[Dental Numbers]]
 
  
 
[[Category:ENT]]
 
[[Category:ENT]]
 
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[[Category:ID]]
== Source ==
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[[Category:Trauma]]
*ER Atlas
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[[Category:Symptoms]]
*Tintinalli
 
*UpToDate
 

Latest revision as of 00:49, 12 February 2017