Dental problems: Difference between revisions

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

Acute alveolar osteitis (dry socket)
Acute necrotizing ulcerative gingivitis (trench mouth)
Dental abscess
- Periapical abscess
- Periodontal abscess
Ludwig's angina
Pulpitis (dental caries)
Pericoronitis
Peritonsillar abscess (PTA)
Retropharyngeal abscess
Vincent's angina - tonsillitis and pharyngitis

Other

Maxillofacial Trauma

Ears
- Auricular hematoma
Nose
- Nasal fracture
- Nasal septal hematoma
Oral
Other face
- Le Fort fractures
- Mandible fracture
Zygomatic arch fracture
Zygomaticomaxillary (tripod) fracture
Related

Facial Swelling

Buccal space infections
Dental problems
Canine space infection
Facial cellulitis
Herpes zoster
Masticator space infections
Maxillofacial trauma
Neoplasm
Parapharyngeal space infection
Salivary gland diagnoses
- Parotitis
  - Bilateral parotitis
  - Suppurative parotitis
  - Viral parotitis (Mumps)
- Ranula
- Sialoadenitis
- Sialolithiasis
Superior vena cava syndrome

Evaluation

Dental Anesthesia

Management

For pain consider anesthesia with nerve block

Disposition

External Links

References

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

Authors:

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

[1]

@@ Line 1: / Line 1: @@
-==Dentoalveolar Injuries==
+==Background==
+{{Dental numbers}}
-===Fracture===
+[[File:Enamel.png|thumb|Diagram of the tooth displaying the enamel, dentin, and pulp]]
-#Enamel (Ellis Class I)
+[[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 only; nothing to do
-#Enamel + dentin (yellowish) (Ellis Class II)
-##Pts experience sensitivity to hot/cold stimuli and air passing over tooth during breathing
-##Cover exposed dentin to decrease pulpal contamination
-###Place dental cement over fracture site
-###Next day f/u
-#Enamel + dentin + pulp (reddish) (Ellis Class III)
-##On wiping fractured surface with gauze, blood is easily seen
-##Immediate referral (dental emergency)
-##If no dentist is available:
-###1. Cover exposed pulp with calcium hydroxide base
-###2. Cover this and the remaining exposed dentin with dental cement
-===Subluxation===
+===Tooth descriptors===
-#Extrusive Luxation
+*Maxillary teeth: upper row
-##Reposition tooth
+*Mandibular teeth: lower row
-##F/u within 24hr for stabilization
+*Facial: Portion of tooth seen when the mouth is open/smiles. Applicable to all teeth
-##Temporizing measure: Periodontal pack in which tooth is bonded to its two neighboring teeth on both sides
+**Labial: facial surface of the incisors and canines
-#Lateral Luxation
+**Buccal: facial surface of the premolars and molars
-##More extensive injury than extrusive luxation
+*Oral: Portion of tooth that faces the tongue or palate. Applies to all teeth
-###Associated with cracking or fracture of the surrounding alveolar bone
+**Lingual: Toward the tongue; the oral surface of the mandibular teeth
-##Treatment
+**Palatal: Toward the palate; the oral surface of the maxillary teeth
-###Attempt repositioning of tooth
+*Apical: Toward the tip of the root of the tooth
-###Apply temporary splinting with periodontal dressing
+*Coronal: Toward the crown or the biting surface of the tooth
-###F/u within 24hr for stabilization
+**Occlusal: Biting or chewing surface of the premolars and molars
-#Intrusive Luxation
+**Incisal: Biting or chewing surface of the incisors and canines
-##Most serious because of significant damage to alveolar socket and periodontal ligament
+*Approximal/interproximal: contacting surfaces between two adjacent teeth
-##Treatment
+**Mesial: interproximal surface facing anteriorly or closest to the midline
-###Allow tooth to erupt on its own
+**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>
-===Avulsion===
+==Clinical Features==
-#Dental emergency
+<gallery mode="packed">
-#Often associated with alveolar ridge fracture
+File:PMC3514946 CCD-3-194-g001.png|[[Dental fracture]]
+File:Ulcerative necrotizing gingivitis.jpg|[[Ulcerative necrotizing gingivitis]]
+File:PMC5149104 jced-8-e634-g001.png|[[Dental fracture]]
+File:PMC4355813 CRID2015-197202.006.png|[[Dental avulsion]]
+File:DrySocket.jpg|[[Acute alveolar osteitis]]
+File:gingivitis.jpg|[[Gingival hyperplasia]]
+File:Abces parulique.jpg|thumb|[[Periapical abscess]]
+File: Gingival_bleeding.png |Gingival bleeding from [[scurvy]]
+File:Pericoronitis.jpg|[[Pericoronitis]]
+</gallery>
-#Where is the tooth?
+==Differential Diagnosis==
-## May be intruded, aspirated, swallowed, or embedded in the oral mucosa
+{{Dental Problems DDX}}
-###Consider facial films, CXR
+{{Maxillofacial trauma DDX}}
-#Adult
+{{Facial swelling DDX}}
-##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
-##Penicillin or clindamycin
-#Child
-##Do not reimplant primary teeth
-###Refer to pedodontist for space maintainer
-===Bleeding Socket===
+==Evaluation==
-# Apply pressure by having pt bite on gauze or tea bag
-== Odontogenic infections ==
+[[File: Innervation-of-the-tooth-9-anatomy-of-local-anesthesia-pocket-dentistry.jpg|thumb|Dental Anesthesia]]
-=== Dental Caries/Pulpitis ===
+==Management==
-#Two types: reversible pulpitis and irreversible pulpitis
+*For pain consider anesthesia with nerve block
-##Reversible Pulpitis
+**[[Nerve Block: Infraorbital]]
-###Duration of pain is short (seconds)
+**[[Nerve Block: Superior Alveolar]]
-###Associated with noxious stimuli (cold or heat)
+**[[Nerve Block: Inferior Alveolar]]
-##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 ===
+==Disposition==
-#Treatment
-##I&D
-##Penicillin VK 500mg PO QID OR Clindamycin 300mg PO QID
-##Dental referral
-=== Trench Mouth (Acute Necrotizing Ulcerative Gingivitis) ===
+==See Also==
-====Background====
+*[[Maxillofacial trauma]]
-#Severe gingival disease
+*[[Diagnoses by Body Part (Main)]]
-#Must distinguish from herpes gingivostomatitis
-##Herpes has more systemic signs, less bleeding, lack of interdental papilla involvement
+==External Links==
-#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==
+==References==
-*[[Acute Alveolar Osteitis (Dry Socket)]]
+<references/>
-*[[Dental Numbers]]
 [[Category:ENT]]
+[[Category:ID]]
-== Source ==
+[[Category:Trauma]]
-*ER Atlas
+[[Category:Symptoms]]
-*Tintinalli