Dental problems: Difference between revisions
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===Fracture=== | ===Fracture=== | ||
# Enamel | #Enamel (Ellis Class I) | ||
## Routine f/u | ##Routine f/u only; nothing to do | ||
#Enamel + dentin (yellowish) (Ellis Class II) | |||
# Enamel + dentin (yellowish) | ##Pts experience sensitivity to hot/cold stimuli and air passing over tooth during breathing | ||
## | ##Cover exposed dentin to decrease pulpal contamination | ||
## | ###Place dental cement over fracture site | ||
### | ###Next day f/u | ||
## | #Enamel + dentin + pulp (reddish) (Ellis Class III) | ||
# | ##On wiping fractured surface with gauze, blood is easily seen | ||
##Immediate referral (dental emergency) | |||
##If no dentist is available: | |||
# Enamel + dentin + pulp (reddish) | ###1. Cover exposed pulp with calcium hydroxide base | ||
## Immediate referral (dental emergency) | ###2. Cover this and the remaining exposed dentin with dental cement | ||
## If no dentist is available | |||
## | |||
===Subluxation=== | ===Subluxation=== | ||
# | #Extrusive Luxation | ||
## | ##Reposition tooth | ||
##F/u within 24hr for stabilization | |||
## | ##Temporizing measure: Periodontal pack in which tooth is bonded to its two neighboring teeth on both sides | ||
## Temporizing measure: Periodontal pack in which tooth is bonded to its two neighboring teeth on both sides | #Lateral Luxation | ||
##More extensive injury than extrusive luxation | |||
###Associated with cracking or fracture of the surrounding alveolar bone | |||
##Treatment | |||
###Attempt repositioning of tooth | |||
###Apply temporary splinting with periodontal dressing | |||
###F/u within 24hr for stabilization | |||
#Intrusive Luxation | |||
##Most serious because of significant damage to alveolar socket and periodontal ligament | |||
##Treatment | |||
###Allow tooth to erupt on its own | |||
===Avulsion=== | ===Avulsion=== | ||
# Dental emergency | #Dental emergency | ||
# Where is the tooth? | #Often associated with alveolar ridge fracture | ||
#Where is the tooth? | |||
## May be intruded, aspirated, swallowed, or embedded in the oral mucosa | ## May be intruded, aspirated, swallowed, or embedded in the oral mucosa | ||
### Consider facial films, CXR | ###Consider facial films, CXR | ||
# Adult | #Adult | ||
## Replace avulsed tooth as soon as possible (as long as no alveolar ridge fx, no severe socket injury) | ##Replace avulsed tooth as soon as possible (as long as no alveolar ridge fx, no severe socket injury) | ||
### Rinse tooth in saline, suction socket (if necessary), reimplant tooth, bond tooth to neighboring teeth | ###Rinse tooth in saline, suction socket (if necessary), reimplant tooth, bond tooth to neighboring teeth | ||
### Manipulate tooth only by the crown | ###Manipulate tooth only by the crown | ||
## Storage solution (in order of efficacy): Hank's balanced salt solution > Milk > saliva > saline | ##Storage solution (in order of efficacy): Hank's balanced salt solution > Milk > saliva > saline | ||
## | ##Penicillin or clindamycin | ||
#Child | #Child | ||
##Do not reimplant primary teeth | ##Do not reimplant primary teeth |
Revision as of 11:27, 21 November 2011
Dentoalveolar Injuries
Fracture
- Enamel (Ellis Class I)
- Routine f/u only; nothing to do
- Enamel + dentin (yellowish) (Ellis Class II)
- Pts experience sensitivity to hot/cold stimuli and air passing over tooth during breathing
- Cover exposed dentin to decrease pulpal contamination
- Place dental cement over fracture site
- Next day f/u
- Enamel + dentin + pulp (reddish) (Ellis Class III)
- On wiping fractured surface with gauze, blood is easily seen
- Immediate referral (dental emergency)
- If no dentist is available:
- 1. Cover exposed pulp with calcium hydroxide base
- 2. Cover this and the remaining exposed dentin with dental cement
Subluxation
- Extrusive Luxation
- Reposition tooth
- F/u within 24hr for stabilization
- Temporizing measure: Periodontal pack in which tooth is bonded to its two neighboring teeth on both sides
- Lateral Luxation
- More extensive injury than extrusive luxation
- Associated with cracking or fracture of the surrounding alveolar bone
- Treatment
- Attempt repositioning of tooth
- Apply temporary splinting with periodontal dressing
- F/u within 24hr for stabilization
- More extensive injury than extrusive luxation
- Intrusive Luxation
- Most serious because of significant damage to alveolar socket and periodontal ligament
- Treatment
- Allow tooth to erupt on its own
Avulsion
- Dental emergency
- Often associated with alveolar ridge fracture
- Where is the tooth?
- May be intruded, aspirated, swallowed, or embedded in the oral mucosa
- Consider facial films, CXR
- May be intruded, aspirated, swallowed, or embedded in the oral mucosa
- Adult
- Replace avulsed tooth as soon as possible (as long as no alveolar ridge fx, no severe socket injury)
- Rinse tooth in saline, suction socket (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
- Penicillin or clindamycin
- Replace avulsed tooth as soon as possible (as long as no alveolar ridge fx, no severe socket injury)
- Child
- Do not reimplant primary teeth
- Refer to pedodontist for space maintainer
- Do not reimplant primary teeth
Bleeding Socket
- Apply pressure by having pt bite on gauze or tea bag
Odontogenic infections
Dental Caries/Pulpitis
- Two types: reversible pulpitis and irreversible pulpitis
- Reversible Pulpitis
- Duration of pain is short (seconds)
- Associated with noxious stimuli (cold or heat)
- Irreversible Pulpitis
- Duration of pain is long (hours) and intense
- Associated with noxious stimuli or may occur spontaneously
- Tx = root canal or extraction
- Reversible Pulpitis
Periapical Abcess
- Treatment
- I&D
- Penicillin VK 500mg PO QID OR Clindamycin 300mg PO QID
- Dental referral
Trench Mouth (Acute Necrotizing Ulcerative Gingivitis)
Background
- Severe gingival disease
- Must distinguish from herpes gingivostomatitis
- Herpes has more systemic signs, less bleeding, lack of interdental papilla involvement
- Associated with immunosuppression, especially HIV
Clinical Features
- Triad of:
- Pain
- Ulcerated or "punched out" interdental papillae
- 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
Source
- ER Atlas
- Tintinalli