Dental problems

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�
      • Immediate referral�
  • 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�
  • Adult
    • Replace avulsed tooth as soon as possible! (as long as no alveolar ridge fx, no severe socket injury)
      • Rinse tooth in saline, socket is suctioned (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)���
  • Child
    • Do not reimplant primary teeth
      • Refer to pedodontist for space maintainer�
• Bleeding Socket
  • ��Apply pressure by having pt bite on gauze or tea bag

Odontogenic infections

Dental Carie/Pulpitis==

dental referal only

Periapical vs. Periodontal Abcess==

drain

PCN V

Exquisite pain to percussion suggests an underlying periapical abscess,

More commonly, fluctuant abscesses are a result of periodontal abscesses and are best treated with an incision and drainage

See Also:

Acute Alveolar Osteitis (Dry Socket)

Dental Numbers