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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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