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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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