Dental problems: Difference between revisions

Latest revision as of 17:23, 10 January 2022

Background

Dental Numbering

Classic dental numbering.

Adult (permanent) teeth identified by numbers
- From the midline to the back of the mouth on each side, there is a central incisor, a lateral incisor, a canine, two premolars (bicuspids), and three molars
Children (non-permanent) teeth identified by letters
Common landmarks:
- 1: Right upper wisdom
- 8 & 9: Upper incisors
- 16: Left upper wisdom
- 17: Left lower wisdom
- 24 & 25: Lower incisors
- 32: Right lower wisdom

Diagram of the tooth displaying the enamel, dentin, and pulp

Anatomy of the periodontium. The crown of the tooth is covered by enamel (A). Dentin (B). The root of the tooth is covered by cementum. C, alveolar bone. D, subepithelial connective tissue. E, oral epithelium. F, free gingival margin. G, gingival sulcus. H, principal gingival fibers. I, alveolar crest fibers of the periodontal ligament (PDL). J, horizontal fibers of the PDL. K, oblique fibers of the PDL.

Tooth descriptors

Maxillary teeth: upper row
Mandibular teeth: lower row
Facial: Portion of tooth seen when the mouth is open/smiles. Applicable to all teeth
- Labial: facial surface of the incisors and canines
- Buccal: facial surface of the premolars and molars
Oral: Portion of tooth that faces the tongue or palate. Applies to all teeth
- Lingual: Toward the tongue; the oral surface of the mandibular teeth
- Palatal: Toward the palate; the oral surface of the maxillary teeth
Apical: Toward the tip of the root of the tooth
Coronal: Toward the crown or the biting surface of the tooth
- Occlusal: Biting or chewing surface of the premolars and molars
- Incisal: Biting or chewing surface of the incisors and canines
Approximal/interproximal: contacting surfaces between two adjacent teeth
- Mesial: interproximal surface facing anteriorly or closest to the midline
- Distal: interproximal surface facing posteriorly or away from the midline ^[1]

Clinical Features

Differential Diagnosis

Dentoalveolar Injuries

Odontogenic Infections

Acute alveolar osteitis (dry socket)
Acute necrotizing ulcerative gingivitis (trench mouth)
Dental abscess
- Periapical abscess
- Periodontal abscess
Ludwig's angina
Pulpitis (dental caries)
Pericoronitis
Peritonsillar abscess (PTA)
Retropharyngeal abscess
Vincent's angina - tonsillitis and pharyngitis

Other

Maxillofacial Trauma

Ears
- Auricular hematoma
Nose
- Nasal fracture
- Nasal septal hematoma
Oral
Other face
- Le Fort fractures
- Mandible fracture
Zygomatic arch fracture
Zygomaticomaxillary (tripod) fracture
Related

Facial Swelling

Buccal space infections
Dental problems
Canine space infection
Facial cellulitis
Herpes zoster
Masticator space infections
Maxillofacial trauma
Neoplasm
Parapharyngeal space infection
Salivary gland diagnoses
- Parotitis
  - Bilateral parotitis
  - Suppurative parotitis
  - Viral parotitis (Mumps)
- Ranula
- Sialoadenitis
- Sialolithiasis
Superior vena cava syndrome

Evaluation

Dental Anesthesia

Management

For pain consider anesthesia with nerve block

Disposition

External Links

References

↑ Benko K. Emergency Dental Procedures. In: Roberts and Hedges' Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia, PA: Elsevier; 2014.

Authors:

[Emergency_Dental_Procedures-1] Benko K. Emergency Dental Procedures. In: Roberts and Hedges' Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia, PA: Elsevier; 2014.

[1]

@@ Line 1: / Line 1: @@
-==Dentoalveolar Injuries==
+==Background==
-#[[Tooth Fracture]]
+{{Dental numbers}}
-#[[Tooth Subluxation]]
-#[[Tooth Avulsion]]
+[[File:Enamel.png|thumb|Diagram of the tooth displaying the enamel, dentin, and pulp]]
+[[File:Periodontium.png|thumb|Anatomy of the periodontium. The crown of the tooth is covered by enamel (A). Dentin (B). The root of the tooth is covered by cementum. C, alveolar bone. D, subepithelial connective tissue. E, oral epithelium. F, free gingival margin. G, gingival sulcus. H, principal gingival fibers. I, alveolar crest fibers of the periodontal ligament (PDL). J, horizontal fibers of the PDL. K, oblique fibers of the PDL.]]
-===[[Bleeding Dental Socket]]===
+===Tooth descriptors===
-# Apply pressure by having pt bite on gauze or tea bag
+*Maxillary teeth: upper row
+*Mandibular teeth: lower row
+*Facial: Portion of tooth seen when the mouth is open/smiles. Applicable to all teeth
+**Labial: facial surface of the incisors and canines
+**Buccal: facial surface of the premolars and molars
+*Oral: Portion of tooth that faces the tongue or palate. Applies to all teeth
+**Lingual: Toward the tongue; the oral surface of the mandibular teeth
+**Palatal: Toward the palate; the oral surface of the maxillary teeth
+*Apical: Toward the tip of the root of the tooth
+*Coronal: Toward the crown or the biting surface of the tooth
+**Occlusal: Biting or chewing surface of the premolars and molars
+**Incisal: Biting or chewing surface of the incisors and canines
+*Approximal/interproximal: contacting surfaces between two adjacent teeth
+**Mesial: interproximal surface facing anteriorly or closest to the midline
+**Distal:  interproximal surface facing posteriorly or away from the midline <ref name="Emergency Dental Procedures">Benko K. Emergency Dental Procedures. In: Roberts and Hedges' Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia, PA: Elsevier; 2014. </ref>
-== Odontogenic Infections ==
+==Clinical Features==
-=== [[Dental Caries (Pulpitis)]] ===
+<gallery mode="packed">
-#Two types: reversible pulpitis and irreversible pulpitis
+File:PMC3514946 CCD-3-194-g001.png|[[Dental fracture]]
-##Reversible Pulpitis
+File:Ulcerative necrotizing gingivitis.jpg|[[Ulcerative necrotizing gingivitis]]
-###Duration of pain is short (seconds)
+File:PMC5149104 jced-8-e634-g001.png|[[Dental fracture]]
-###Associated with noxious stimuli (cold or heat)
+File:PMC4355813 CRID2015-197202.006.png|[[Dental avulsion]]
-##Irreversible Pulpitis
+File:DrySocket.jpg|[[Acute alveolar osteitis]]
-###Duration of pain is long (hours) and intense
+File:gingivitis.jpg|[[Gingival hyperplasia]]
-###Associated with noxious stimuli or may occur spontaneously
+File:Abces parulique.jpg|thumb|[[Periapical abscess]]
-###Tx = root canal or extraction
+File: Gingival_bleeding.png |Gingival bleeding from [[scurvy]]
+File:Pericoronitis.jpg|[[Pericoronitis]]
+</gallery>
-=== [[Periapical Abcess]] ===
+==Differential Diagnosis==
-#Treatment
+{{Dental Problems DDX}}
-##I&D
+{{Maxillofacial trauma DDX}}
-##Penicillin VK 500mg PO QID OR Clindamycin 300mg PO QID
+{{Facial swelling DDX}}
-##Dental referral
-=== [[Trench Mouth (Acute Necrotizing Ulcerative Gingivitis)]] ===
+==Evaluation==
-====Background====
-#Severe gingival disease
+[[File: Innervation-of-the-tooth-9-anatomy-of-local-anesthesia-pocket-dentistry.jpg|thumb|Dental Anesthesia]]
-#Must distinguish from herpes gingivostomatitis
+==Management==
-##Herpes has more systemic signs, less bleeding, lack of interdental papilla involvement
+*For pain consider anesthesia with nerve block
-#Associated with immunosuppression, especially HIV
+**[[Nerve Block: Infraorbital]]
-====Clinical Features====
+**[[Nerve Block: Superior Alveolar]]
-#Triad of:
+**[[Nerve Block: Inferior Alveolar]]
-##Pain
-##Ulcerated or "punched out" interdental papillae
+==Disposition==
-##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==
-*[[Acute Alveolar Osteitis (Dry Socket)]]
+*[[Maxillofacial trauma]]
-*[[Dental Numbers]]
+*[[Diagnoses by Body Part (Main)]]
+==External Links==
+==References==
+<references/>
 [[Category:ENT]]
+[[Category:ID]]
-== Source ==
+[[Category:Trauma]]
-*ER Atlas
+[[Category:Symptoms]]
-*Tintinalli
-*UpToDate