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