Dental problems

Dentoalveolar Injuries

1. 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)
2. 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
3. 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, socket is suctioned (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
4. Bleeding Socket
   1. Apply pressure by having pt bite on gauze or tea bag

Odontogenic infections

Dental Carie/Pulpitis

1. dental referral only

Periapical vs. Periodontal Abcess

1. drain
2. 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