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}}
  
===Fracture===
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{{Maxillofacial trauma DDX}}
# Enamel
 
## Routine f/u
 
## Nothing to do
 
# Enamel + dentin (yellowish)
 
## Adult
 
### Next day f/u
 
### Consider placing calcium hydroxide paste over fracture site as needed for comfort
 
## Child
 
### Place calcium hydroxide paste
 
#### More important in children than adults because children have less dentin to protect the pulp
 
## Immediate referral
 
# Enamel + dentin + pulp (reddish)
 
## Immediate referral (dental emergency)
 
## If no dentist is available, place moist cotton over exposed pulp and cover with foil or seal with canal sealant
 
## Consider antibiotics (penicillin or clindamycin)
 
===Subluxation===
 
# Minimally mobile
 
## Soft diet for 14 days
 
# Markedly mobile
 
## Immediate referral for stabilization
 
## Temporizing measure: Periodontal pack in which tooth is bonded to its two neighboring teeth on both sides
 
===Avulsion===
 
# Dental emergency
 
# 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)
 
### 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
 
##Tetanus vaccine if indicated
 
##Consider antibiotics (penicillin or clindamycin)
 
#Child
 
##Do not reimplant primary teeth
 
###Refer to pedodontist for space maintainer
 
  
===Bleeding Socket===
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{{Facial swelling DDX}}
# Apply pressure by having pt bite on gauze or tea bag
 
  
== Odontogenic infections ==
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==See Also==
=== Dental Caries/Pulpitis ===
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*[[Dental numbers]]
#Two types: reversible pulpitis and irreversible pulpitis
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*[[Maxillofacial trauma]]
##Reversible Pulpitis
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*[[Diagnoses by Body Part (Main)]]
###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 ===
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==References==
#Treatment
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<references/>
##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==
 
*[[Acute Alveolar Osteitis (Dry Socket)]]
 
*[[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]]

Latest revision as of 00:49, 12 February 2017