Dental problems: Difference between revisions
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Revision as of 22:50, 15 November 2011
Dentoalveolar Injuries
Fracture
- Enamel
- 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
- Place calcium hydroxide paste
- Immediate referral
- Adult
- 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
- 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)
- 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)
- 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 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