Dental problems

Dentoalveolar Injuries

Fracture

1. Enamel
   1. Routine f/u
   2. Nothing to do
2. Enamel + dentin (yellowish)
   1. Adult
      1. Next day f/u
      2. Consider placing calcium hydroxide paste over fracture site as needed for comfort
   2. Child
      1. Place calcium hydroxide paste
         1. More important in children than adults because children have less dentin to protect the pulp
   3. Immediate referral
3. Enamel + dentin + pulp (reddish)
   1. Immediate referral (dental emergency)
   2. If no dentist is available, place moist cotton over exposed pulp and cover with foil or seal with canal sealant
   3. Consider antibiotics (penicillin or clindamycin)

Subluxation

1. Minimally mobile
   1. Soft diet for 14 days
2. Markedly mobile
   1. Immediate referral for stabilization
   2. Temporizing measure: Periodontal pack in which tooth is bonded to its two neighboring teeth on both sides

Avulsion

1. Dental emergency
2. Where is the tooth?
   1. May be intruded, aspirated, swallowed, or embedded in the oral mucosa
      1. Consider facial films, CXR
3. Adult
   1. Replace avulsed tooth as soon as possible (as long as no alveolar ridge fx, no severe socket injury)
      1. Rinse tooth in saline, suction socket (if necessary), reimplant tooth, bond tooth to neighboring teeth
      2. Manipulate tooth only by the crown
   2. Storage solution (in order of efficacy): Hank's balanced salt solution > Milk > saliva > saline
   3. Tetanus vaccine if indicated
   4. Consider antibiotics (penicillin or clindamycin)
4. Child
   1. Do not reimplant primary teeth
      1. Refer to pedodontist for space maintainer

Bleeding Socket

1. Apply pressure by having pt bite on gauze or tea bag

Odontogenic infections

Dental Caries/Pulpitis

1. Two types: reversible pulpitis and irreversible pulpitis
   1. Reversible Pulpitis
      1. Duration of pain is short (seconds)
      2. Associated with noxious stimuli (cold or heat)
   2. Irreversible Pulpitis
      1. Duration of pain is long (hours) and intense
      2. Associated with noxious stimuli or may occur spontaneously
      3. Tx = root canal or extraction

Periapical Abcess

1. Treatment
   1. I&D
   2. Penicillin VK 500mg PO QID OR Clindamycin 300mg PO QID
   3. Dental referral

Trench Mouth (Acute Necrotizing Ulcerative Gingivitis)

1. Severe gingival disease with inflamed, friable, ulcerated gingiva w/ gray pseudomembrane
2. Present with fever, foul breath, strong metallic taste
3. Anaerobic flora are most common source
4. Treat with peridex and PO Abx covering oral flora, dental referral
5. Admission with parenteral Abx in patients with severe/systemic symptoms

See Also

Acute Alveolar Osteitis (Dry Socket)

Dental Numbers

Source

ER Atlas