Dental problems: Difference between revisions
 
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==Dentoalveolar Injuries==
==Background==
{{Dental numbers}}


===Fracture===
[[File:Enamel.png|thumb|Diagram of the tooth displaying the enamel, dentin, and pulp]]
# Enamel
[[File:Periodontium.png|thumb|Anatomy of the periodontium. The crown of the tooth is covered by enamel (A). Dentin (B). The root of the tooth is covered by cementum. C, alveolar bone. D, subepithelial connective tissue. E, oral epithelium. F, free gingival margin. G, gingival sulcus. H, principal gingival fibers. I, alveolar crest fibers of the periodontal ligament (PDL). J, horizontal fibers of the PDL. K, oblique fibers of the PDL.]]
## 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===
===Tooth descriptors===  
# Apply pressure by having pt bite on gauze or tea bag
*Maxillary teeth: upper row
*Mandibular teeth: lower row
*Facial: Portion of tooth seen when the mouth is open/smiles. Applicable to all teeth
**Labial: facial surface of the incisors and canines
**Buccal: facial surface of the premolars and molars
*Oral: Portion of tooth that faces the tongue or palate. Applies to all teeth
**Lingual: Toward the tongue; the oral surface of the mandibular teeth
**Palatal: Toward the palate; the oral surface of the maxillary teeth
*Apical: Toward the tip of the root of the tooth
*Coronal: Toward the crown or the biting surface of the tooth
**Occlusal: Biting or chewing surface of the premolars and molars
**Incisal: Biting or chewing surface of the incisors and canines
*Approximal/interproximal: contacting surfaces between two adjacent teeth
**Mesial: interproximal surface facing anteriorly or closest to the midline
**Distal:  interproximal surface facing posteriorly or away from the midline <ref name="Emergency Dental Procedures">Benko K. Emergency Dental Procedures. In: Roberts and Hedges' Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia, PA: Elsevier; 2014. </ref>


== Odontogenic infections ==
==Clinical Features==
=== Dental Caries/Pulpitis ===
<gallery mode="packed">
#Two types: reversible pulpitis and irreversible pulpitis
File:PMC3514946 CCD-3-194-g001.png|[[Dental fracture]]
##Reversible Pulpitis
File:Ulcerative necrotizing gingivitis.jpg|[[Ulcerative necrotizing gingivitis]]
###Duration of pain is short (seconds)
File:PMC5149104 jced-8-e634-g001.png|[[Dental fracture]]
###Associated with noxious stimuli (cold or heat)
File:PMC4355813 CRID2015-197202.006.png|[[Dental avulsion]]
##Irreversible Pulpitis
File:DrySocket.jpg|[[Acute alveolar osteitis]]
###Duration of pain is long (hours) and intense
File:gingivitis.jpg|[[Gingival hyperplasia]]
###Associated with noxious stimuli or may occur spontaneously
File:Abces parulique.jpg|thumb|[[Periapical abscess]]
###Tx = root canal or extraction
File: Gingival_bleeding.png |Gingival bleeding from [[scurvy]]
File:Pericoronitis.jpg|[[Pericoronitis]]
</gallery>


=== Periapical Abcess ===
==Differential Diagnosis==
#Treatment
{{Dental Problems DDX}}
##I&D
{{Maxillofacial trauma DDX}}
##Penicillin VK 500mg PO QID OR Clindamycin 300mg PO QID
{{Facial swelling DDX}}
##Dental referral


=== Trench Mouth (Acute Necrotizing Ulcerative Gingivitis) ===
==Evaluation==
#Severe gingival disease with inflamed, friable, ulcerated gingiva w/ gray pseudomembrane
 
#Present with fever, foul breath, strong metallic taste
[[File: Innervation-of-the-tooth-9-anatomy-of-local-anesthesia-pocket-dentistry.jpg|thumb|Dental Anesthesia]]
#Anaerobic flora are most common source
==Management==
#Treat with peridex and PO Abx covering oral flora, dental referral
*For pain consider anesthesia with nerve block
#Admission with parenteral Abx in patients with severe/systemic symptoms
**[[Nerve Block: Infraorbital]]
**[[Nerve Block: Superior Alveolar]]
**[[Nerve Block: Inferior Alveolar]]
 
==Disposition==


==See Also==
==See Also==
[[Acute Alveolar Osteitis (Dry Socket)]]
*[[Maxillofacial trauma]]
*[[Diagnoses by Body Part (Main)]]


[[Dental Numbers]]
==External Links==
 
==References==
<references/>


[[Category:ENT]]
[[Category:ENT]]
 
[[Category:ID]]
 
[[Category:Trauma]]
== Source ==
[[Category:Symptoms]]
ER Atlas

Latest revision as of 17:23, 10 January 2022

Background

Dental Numbering

Classic dental numbering.
  • Adult (permanent) teeth identified by numbers
    • From the midline to the back of the mouth on each side, there is a central incisor, a lateral incisor, a canine, two premolars (bicuspids), and three molars
  • Children (non-permanent) teeth identified by letters
  • Common landmarks:
    • 1: Right upper wisdom
    • 8 & 9: Upper incisors
    • 16: Left upper wisdom
    • 17: Left lower wisdom
    • 24 & 25: Lower incisors
    • 32: Right lower wisdom
Diagram of the tooth displaying the enamel, dentin, and pulp
Anatomy of the periodontium. The crown of the tooth is covered by enamel (A). Dentin (B). The root of the tooth is covered by cementum. C, alveolar bone. D, subepithelial connective tissue. E, oral epithelium. F, free gingival margin. G, gingival sulcus. H, principal gingival fibers. I, alveolar crest fibers of the periodontal ligament (PDL). J, horizontal fibers of the PDL. K, oblique fibers of the PDL.

Tooth descriptors

  • Maxillary teeth: upper row
  • Mandibular teeth: lower row
  • Facial: Portion of tooth seen when the mouth is open/smiles. Applicable to all teeth
    • Labial: facial surface of the incisors and canines
    • Buccal: facial surface of the premolars and molars
  • Oral: Portion of tooth that faces the tongue or palate. Applies to all teeth
    • Lingual: Toward the tongue; the oral surface of the mandibular teeth
    • Palatal: Toward the palate; the oral surface of the maxillary teeth
  • Apical: Toward the tip of the root of the tooth
  • Coronal: Toward the crown or the biting surface of the tooth
    • Occlusal: Biting or chewing surface of the premolars and molars
    • Incisal: Biting or chewing surface of the incisors and canines
  • Approximal/interproximal: contacting surfaces between two adjacent teeth
    • Mesial: interproximal surface facing anteriorly or closest to the midline
    • Distal: interproximal surface facing posteriorly or away from the midline [1]

Clinical Features

Differential Diagnosis

Dentoalveolar Injuries

Odontogenic Infections

Other

Maxillofacial Trauma

Facial Swelling

Evaluation

Dental Anesthesia

Management

Disposition

See Also

External Links

References

  1. ↑ Benko K. Emergency Dental Procedures. In: Roberts and Hedges' Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia, PA: Elsevier; 2014.
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