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| − | ==Dentoalveolar Injuries== | + | ==Types== |
| | + | {{Template:Dental Problems DDX}} |
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| − | ===Fracture===
| + | {{Maxillofacial trauma DDX}} |
| − | # Enamel
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| − | ## Routine f/u
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| − | ## Nothing to do
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| − | # Enamel + dentin (yellowish)
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| − | ## Adult
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| − | ### Next day f/u
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| − | ### Consider placing calcium hydroxide paste over fracture site as needed for comfort
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| − | ## Child
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| − | ### Place calcium hydroxide paste
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| − | #### More important in children than adults because children have less dentin to protect the pulp
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| − | ## Immediate referral
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| − | # Enamel + dentin + pulp (reddish)
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| − | ## Immediate referral (dental emergency)
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| − | ## If no dentist is available, place moist cotton over exposed pulp and cover with foil or seal with canal sealant
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| − | ## Consider antibiotics (penicillin or clindamycin)
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| − | ===Subluxation===
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| − | # Minimally mobile
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| − | ## Soft diet for 14 days
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| − | # Markedly mobile
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| − | ## Immediate referral 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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| − | ===Avulsion===
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| − | # Dental emergency
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| − | # 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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| − | ### 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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| − | ##Tetanus vaccine if indicated
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| − | ##Consider antibiotics (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 Socket===
| + | {{Facial swelling DDX}} |
| − | # 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== | | ==See Also== |
| − | [[Acute Alveolar Osteitis (Dry Socket)]] | + | *[[Dental numbers]] |
| | + | *[[Maxillofacial trauma]] |
| | + | *[[Diagnoses by Body Part (Main)]] |
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| − | [[Dental Numbers]]
| + | ==References== |
| | + | <references/> |
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| | [[Category:ENT]] | | [[Category:ENT]] |
| − | | + | [[Category:ID]] |
| − | | + | [[Category:Trauma]] |
| − | == Source ==
| + | [[Category:Symptoms]] |
| − | ER Atlas
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