Difference between revisions of "Dental problems"

(Trench Mouth (Acute Necrotizing Ulcerative Gingivitis))
(See Also)
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==See Also==
==See Also==
[[Acute Alveolar Osteitis (Dry Socket)]]
*[[Acute Alveolar Osteitis (Dry Socket)]]
*[[Dental Numbers]]
[[Dental Numbers]]
== Source ==
== Source ==
ER Atlas
ER Atlas

Revision as of 22:49, 15 November 2011

Dentoalveolar Injuries


  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)


  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


  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
  2. Must distinguish from herpes gingivostomatitis
    1. Herpes has more systemic signs, less bleeding, lack of interdental papilla involvement
  3. Associated with immunosuppression, especially HIV

Clinical Features

  1. Triad of:
    1. Pain
    2. Ulcerated or "punched out" interdental papillae
    3. Gingival bleeding
  2. Secondary signs:
    1. Fetid breath
    2. "Wooden teeth" feeling
    3. Teeth mobility
    4. Fever
    5. Malaise


  1. Chlorhexidine 0.01% oral rinse BID
  2. Metronidazole 500mg PO TID
  3. Dental debridement and scaling

See Also


ER Atlas