Dental problems: Difference between revisions
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# Apply pressure by having pt bite on gauze or tea bag | # Apply pressure by having pt bite on gauze or tea bag | ||
== | == Odontogenic Infections == | ||
=== Dental Caries | === [[Dental Caries (Pulpitis)]] === | ||
#Two types: reversible pulpitis and irreversible pulpitis | #Two types: reversible pulpitis and irreversible pulpitis | ||
##Reversible Pulpitis | ##Reversible Pulpitis |
Revision as of 09:00, 27 June 2012
Dentoalveolar Injuries
Tooth Fracture
- Enamel (Ellis Class I)
- 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:
- Cover exposed pulp with calcium hydroxide base
- Cover this and the remaining exposed dentin with dental cement
Tooth Subluxation
- Extrusive Luxation
- Reposition tooth
- F/u within 24hr for stabilization
- Temporizing measure: Periodontal pack in which tooth is bonded to its two neighboring teeth on both sides
- Lateral Luxation
- More extensive injury than extrusive luxation
- Associated with cracking or fracture of the surrounding alveolar bone
- Treatment
- Attempt repositioning of tooth
- Apply temporary splinting with periodontal dressing
- F/u within 24hr for stabilization
- More extensive injury than extrusive luxation
- Intrusive Luxation
- Most serious because of significant damage to alveolar socket and periodontal ligament
- Treatment
- Allow tooth to erupt on its own
Tooth Avulsion
- Dental emergency
- Often associated with alveolar ridge fracture
- Where is the tooth?
- May be intruded, aspirated, swallowed, or embedded in the oral mucosa
- Consider facial films, CXR
- May be intruded, aspirated, swallowed, or embedded in the oral mucosa
- Adult
- Replace avulsed tooth as soon as possible (as long as no alveolar ridge fx, no severe socket injury)
- If reimplanted within 1hr 66% chance of good outcome
- 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
- Replace avulsed tooth as soon as possible (as long as no alveolar ridge fx, no severe socket injury)
- Child
- Do not reimplant primary teeth
- Refer to pedodontist for space maintainer
- Do not reimplant primary teeth
Bleeding Dental Socket
- Apply pressure by having pt bite on gauze or tea bag
Odontogenic Infections
Dental Caries (Pulpitis)
- Two types: reversible pulpitis and irreversible pulpitis
- Reversible Pulpitis
- 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
- Reversible Pulpitis
Periapical Abcess
- Treatment
- 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
Source
- ER Atlas
- Tintinalli
- UpToDate