treatment for corpsmen emergency dental monthly training/idc dental...management of pericoronitis...

EMERGENCY DENTAL

TREATMENT FOR CORPSMEN

CAPT JOHN BROWNING

OBJECTIVES

• Assess and Diagnose the Dental Patient

• Formulate Emergent Treatment Plans

• Handle/Place Dental Materials

• Prescribe Proper Medications for Dental

Emergencies

TOPICS of INTEREST

• Fractured Teeth

• Lost/Fractured Restorations

• Displaced Crowns

• Treatment of Dry Sockets and Pericoronitis

• Avulsed Teeth

• Dental Abscess

• Jaw Fractures

Management of Fractured Teeth:

• Enamel only

• Enamel/Dentin

• Enamel/Dentin/NERVE(pulp)

ENAMEL ONLY

Signs and Symptoms:

• Usually asymptomatic

• Tooth may be sensitive to touch/chew

• Bruised ligaments, time will heal.

• Tooth may feel sharp to tongue or cheek

Treatment:

• No emergency treatment necessary

• Fluoride varnish: half placebo, half real.

ENAMEL DENTIN

Signs and Symptoms:

• Usually somewhat symptomatic

• Tooth sensitive to changes in temperature

• Tooth may be sensitive to touch

Treatment:

• Dry tooth, cover any exposed dentin with Fuji IX

• If you see the blushing pink of pulp, dycal & fuji

• Fluoride Varnish

PULPAL EXPOSURE

Signs and Symptoms:

• Pulp Tissue Exposed

• Tooth Painful to Most All Stimuli.

Treatment:

• Remove Bulk Nerve Tissue if Possible

• Dycal covered with Fuji

• Prescribe Pain Meds as Needed

• Numb

• Remove pulp

• (if possible)

• Place dycal in chamber

• Cover with FUJI

• Pain meds

Dental Abscess

Signs and Symptoms

• Fluctuant swelling present on the gingiva,

palate, or in the buccal vestibule area.

• Painful to palpation

• Sensitive to percussion

• Patient may be feverish

• Don’t mess with lingual

Dental Abscess

Treatment

• Antibiotics indicated to control the spread

of the infection.

• Incision and drainage to help control the

spread of infection and manage pain.

Incision and Drainage

• Adequate anesthetic is important, but often

difficult to achieve profoundly in the

abscessed area.

Incision and Drainage

• Incision made into the swelling as coronal

as possible. Note: There are NO vital

structures towards the crown of the tooth.

• Incision should be approx 10ish mm

Incision and Drainage

• Scalpel down to bone

• Blunt instrument used to probe into the

swelling to facilitate the drainage

• Have suction standing by

• Compress with fingers

Incision and Drainage

• Irrigate with Saline.

• No sutures are required, we want it to continue to drain through the open wound.

Dental Abscess

Post Operative

• Antibiotics:

• Amoxicillin + Clavulunate 875mg/125mg b.i.d x7days

• PenVK 500mg q6h x7-10 days

• Penicillin Allergy Only:

• Clindamycin 300mg t.i.d. x7 days

• If no Clinda available:

• Erythromycin 500mg q6h x 7-10 days

Dental Abscess

Post Operative

• NSAIDS

• 800mg Ibuprofen q6h with supplemental acetaminophen as needed.

• If ineffective:

• Narcotics to control pain

• Observe daily condition change.

Dental Abscess - Concern

• Space Infections

• If you can’t palpate a portion of the inferior

border of the mandible, they need OMFS ASAP

Submandibular Infraorbital

Luxations & Avulations:

• Let’s talk about splinting with all the lack of

splinting materials you have!

• I heard a rumor you have a putty…

Avulsed Teeth

• The tooth is dead.

• Goal:

• Protect the periodontal ligament.

Avulsed Teeth

• Proper handling of the teeth are important

• Only handle by the crown to the tooth.

• The tooth can be rinsed lightly with saline to

remove debris, but DO NOT scrub the tooth.

• Rinse tooth socket with saline.

• Properly orientate the tooth and place back into

socket.

Avulsed Teeth

• Splinting is important to help stabilize the

tooth if possible.

• Start on antibiotic regiment.

• Advise pt to avoid chewing or biting on

tooth until further treatment can be

administered.

Avulsed Teeth

• Transport mediums may be used when the

tooth cannot be replanted immediately.

- Milk, Saline, Saliva in a cup (or mouth is

you can trust them not to swallow it)

• Time is critical in the long term success of

the tooth. Replantation within the first 15

minutes has greater long time success.

• May need to agitate socket to remove blood

clot in order to place tooth back in.

What about luxations?

• Displaced, but still in the socket...

• Is the periodontal ligament protected?

Management of Dry Sockets

• Diagnosis is the key to the treatment of this emergency.

• Constant throbbing pain approx. 4-5 days post extraction is the typical symptom identified by patient.

• Patient may complain of radiating pain to his ear.

• Treatment consist of local anesthetic, irrigation with chlorhexidine and saline or sterile water, followed by the placement of a strip of Nu-Gauze dipped in eugenol.

Eugenol…

• What might you want to look for in the dental record before placing eugenol in the socket?

Management of Dry Sockets

• Remove excess eugenol and place gauze into

extraction socket.

• May need to anesthetize.

• Look in record for signs of nerve exposure at time

of surgery – No Eugenol !

• Replace gauze every 1-2 days until symptoms

subside. No antibiotics needed.

Management of Pericoronitis

• Pericoronitis is the inflammation of the

tissue surrounding the crown of the tooth.

This usually involves the third molars that

have not completely erupted into the mouth.

• The area will appear reddened and is tender

to touch. Patient will have a difficult time

chewing on the affected area.

Management of Pericoronitis

• Antibiotics should be used to help control the

spread of infection.

• Irrigation under the flap of tissue should be

performed if possible.

• Pt should avoid eating on that side of the mouth

and warm salt water soak every 3-4hrs is advised.

• NSAIDs for pain

Displaced Crowns

• The temporary or permanent crown has

come off the tooth.

• Before replacement, clean the internal and

external surface.

• Proper orientation is the key to proper

recementation. Try the crown on the tooth

to insure proper alignment.

Displaced Crowns

• Isolate the mouth with gauze to prevent pt

for swallowing the crown, if it slips out

your hand during recementation.

Displaced Crowns

• Dycal can function as tempoary cement.

• So can toothpaste :D

• Place a “small amount” in the crown.

Displaced Crowns

Fill crown approximately 1/3 full with dycal.

Drag material up to edges.

Excess spill can be cleanup up easily enough.

Displaced Crowns

• Place crown over tooth and hold with pressure,

can have patient bite & hold on cotton roll.

• Remove excess from around the tooth.

• WORK QUICKLY once mixed

What if the crown is broken, lost,

won’t stay on no matter how

many times I try?...

• Fuji IX bonds to dentin, to solve debilitating

sensitivity, you could cover the entire tooth

in Fuji.

• Do not try and rebuild a functioning tooth,

simply cover for pain relief.

Lost or Fractured Restorations

• The location of the tooth is important in

determining the type of temporary

coverage.

• Fuji fuji fuji fuji... Unless there’s some

pulpal show... Fuji fuji fuji fuji...

Lost or Fractured Restorations

• Isolation is extremely important in the

placement of the temp material. Place gauze

in the mouth on both sides of the involved

tooth.

Lost or Fractured Restorations

• Look at the tooth closely prior to placement

to determine were the Fx is and only place

temp in that area. It is not necessary to build

the tooth back to normal function. Leave

the tooth out of occlusion.

Jaw Fractures

Important Points

• Obvious trauma thus C-spine considerations

• Airway maintenance

• Hemorrhage control

• Prevent/control shock

Jaw Fractures

Clinical Diagnosis• Palpation:

Look for steps, depressions, crepitus, pain

• Exam for lacerations both intra- and extraorally

• Evaluate for Asymmetry

• Note any Discharge

• Nerve parathesia

Jaw Fractures

Clinical Diagnosis

Malocclusion: DO THE TEETH FIT TOGETHER

Jaw Fractures

Clinical Diagnosis

Sublingual ecchymosis (mandibular fx)

Jaw Fractures

Clinical Diagnosis

Easy Do-It Yourself Test:

•Mandible - Put finger on

lower arch, push down

while patient tries to

close

•Maxilla - Hold patient’s

nose, grab front teeth and

try to move them

Can’t bite.

Can’t fight.

Jaw Fractures

Jaw Fractures

• Antibiotics

• Fluids/Pain Management

• Apply Barton’s bandage

• Transport for definitive care

Jaw Fractures

Barton’s Bandage

My tooth hurts so bad doc, can’t

you just take it out?

QUESTIONS/COMMENTS

QUESTIONS/COMMENTS