Dental problems

Revision as of 09:07, 27 June 2012 by Rossdonaldson1 (talk | contribs) (Tooth Subluxation)

Dentoalveolar Injuries

  1. Tooth Fracture
  1. Tooth Subluxation

Tooth Avulsion

  1. Dental emergency
  2. Often associated with alveolar ridge fracture
  1. Where is the tooth?
    1. May be intruded, aspirated, swallowed, or embedded in the oral mucosa
      1. Consider facial films, CXR
  2. Adult
    1. Replace avulsed tooth as soon as possible (as long as no alveolar ridge fx, no severe socket injury)
      1. If reimplanted within 1hr 66% chance of good outcome
      2. Rinse tooth in saline, suction socket (if necessary), reimplant tooth, bond tooth to neighboring teeth
      3. Manipulate tooth only by the crown
    2. Storage solution (in order of efficacy): Hank's balanced salt solution > Milk > saliva > saline
    3. Penicillin or clindamycin
  3. Child
    1. Do not reimplant primary teeth
      1. Refer to pedodontist for space maintainer

Bleeding Dental 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)

Background

  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

Treatment

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

See Also

Source

  • ER Atlas
  • Tintinalli
  • UpToDate