Dental problems: Difference between revisions

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==Dentoalveolar Injuries==
==Background==
{{Dental numbers}}


[[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.]]


* Fracture
===Tooth descriptors===
* Enamel
*Maxillary teeth: upper row
* Routine f/u
*Mandibular teeth: lower row
* Nothing to do
*Facial: Portion of tooth seen when the mouth is open/smiles. Applicable to all teeth
* Enamel + dentin (yellowish)
**Labial: facial surface of the incisors and canines
* Adult
**Buccal: facial surface of the premolars and molars
* Next day f/u
*Oral: Portion of tooth that faces the tongue or palate. Applies to all teeth
* Consider placing calcium hydroxide paste over fracture site as needed for comfort
**Lingual: Toward the tongue; the oral surface of the mandibular teeth
* Child
**Palatal: Toward the palate; the oral surface of the maxillary teeth
* Place calcium hydroxide paste
*Apical: Toward the tip of the root of the tooth
* More important in children than adults because children have less dentin to protect the pulp
*Coronal: Toward the crown or the biting surface of the tooth
* Immediate referral
**Occlusal: Biting or chewing surface of the premolars and molars
* Enamel + dentin + pulp (reddish)
**Incisal: Biting or chewing surface of the incisors and canines
* Immediate referral (dental emergency)
*Approximal/interproximal: contacting surfaces between two adjacent teeth
* If no dentist is available, place moist cotton over exposed pulp and cover with foil or seal with canal sealant
**Mesial: interproximal surface facing anteriorly or closest to the midline
* Consider antibiotics (penicillin or clindamycin)
**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>
* 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==
==Clinical Features==
<gallery mode="packed">
File:PMC3514946 CCD-3-194-g001.png|[[Dental fracture]]
File:Ulcerative necrotizing gingivitis.jpg|[[Ulcerative necrotizing gingivitis]]
File:PMC5149104 jced-8-e634-g001.png|[[Dental fracture]]
File:PMC4355813 CRID2015-197202.006.png|[[Dental avulsion]]
File:DrySocket.jpg|[[Acute alveolar osteitis]]
File:gingivitis.jpg|[[Gingival hyperplasia]]
File:Abces parulique.jpg|thumb|[[Periapical abscess]]
File: Gingival_bleeding.png |Gingival bleeding from [[scurvy]]
File:Pericoronitis.jpg|[[Pericoronitis]]
</gallery>


==Differential Diagnosis==
{{Dental Problems DDX}}
{{Maxillofacial trauma DDX}}
{{Facial swelling DDX}}


==Evaluation==


Dental Carie/Pulpitis==
[[File: Innervation-of-the-tooth-9-anatomy-of-local-anesthesia-pocket-dentistry.jpg|thumb|Dental Anesthesia]]
==Management==
*For pain consider anesthesia with nerve block
**[[Nerve Block: Infraorbital]]
**[[Nerve Block: Superior Alveolar]]
**[[Nerve Block: Inferior Alveolar]]


==Disposition==


==See Also==
 
*[[Maxillofacial trauma]]
dental referal only
*[[Diagnoses by Body Part (Main)]]
 
 
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
 


==External Links==


==References==
<references/>


[[Category:ENT]]
[[Category:ENT]]
[[Category:ID]]
[[Category:Trauma]]
[[Category:Symptoms]]

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

Other

Maxillofacial Trauma

Facial Swelling

Evaluation

Dental Anesthesia

Management

Disposition

See Also

External Links

References

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