dental emergencies
TRANSCRIPT
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Dental Emergencies
BY:-Dr.S.K.RAJPUROHIT
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Clavulin
Percocet
See your dentist
Questions?
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Objectives
Communication
Dental anatomy
Nontraumatic emergencies
Traumatic emergencies
Pediatric issues
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premolar
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TerminologyLower aka Mandibular
Upper aka Maxillary
Lingual - mandibular teeth toward tongue
Palatal - maxillary teeth toward tongue
Labial - anterior teeth toward lips
Buccal - posterior teeth toward cheeks
Interproximal - surface between two adjacent teeth
Occlusal/Incisal - biting surface
Cervical - junction of crown and root
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Nontraumatic emergencies
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Dental caries
Sensitive to cold
Decalcification of enamel by acid producing plaque bacteria
Eventually dentin layer breached
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Pulpitis
Pain, to thermal stimulus
Reversible - Short duration of discomfort
Likely to benefit from antibiotics
Irreversible - longer duration of discomfort
Require root canal or extraction
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Periapical abscess
Spontaneous or unremitting pain, reproducible with percussion
Extension of infection to periapical bone
Drainage, antibiotics, NS rinses
May have an associated parulis
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Periodontitis
Typically less pain
Inflammation of the tooth attachment apparatus
Often will drain spontaneously
Can form periodontal abscess (can be difficult to differentiate from periapical abscess)
Drainage, antibiotics, NS rinses
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Drainage technique
Intraoral vs. extraoral
Local or regional anesthesia
No. 11 blade incision
Mosquito hemostat to disrupt loculations
NS irrigation
Packing gauze, sutured to mucosa
Antibiotics, NS rinses
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Pericoronitis
Pain, foul taste or odour
Involves erupting tooth, often 3rd molar
Inflammation of the gingival tissue overlying the erupting crown
Drainage, antibiotics, NS rinses
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Alveolar osteitis (dry socket)
Pain, foul taste or odour
Inflammation of exposed alveolar bone
2-5 days post tooth extraction
Clot dislodged prematurely
Can progress to osteomyelitis
Packing, antibiotics
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Deep space infections
Spread of odontogenic infection
Maxillary teeth to upper face
Mandibular teeth to lower face
Fascial planes of head, neck, mediastinum
Airway at risk if altered voice, stridor, drooling
Parenteral antibiotics, CT, admission
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Ludwig’s angina
Swollen floor of mouth, elevated tongue
Cellulitis of bilateral submandibular spaces and sublingual space
Direct connection to parapharyngeal space
Airway at risk!
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Cavernous sinus thrombosis
Infraorbital or periorbital cellulitis
Retrograde spread of infection through ophthalmic veins to cavernous sinus
Meningeal signs, altered LOC to coma
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Traumatic emergencies
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Dental crown fractures
Ellis I - enamel only, painless White fracture surface
Ellis II - enamel and dentin, painful Yellow fracture surface
Ellis III (complicated) - pulp involved, painful Red fracture surface
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(Complicated)
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Dental trauma terminology
Concussion - pain but stable, nondisplaced
Subluxation - loose, nondisplaced
Luxation - loose, displaced, malocclusion Can be intrusive, extrusive or lateral
Avulsion - completely removed from socket
Intrusion - forced into alveolar bone
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Avulsion
Where is the tooth?
Consider XR if “missing”
Reimplant or place tooth in physiologic medium ASAP
Avoid traumatizing periodontal ligament
Chance of successful reimplantation inversely proportional to time out of socket
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Pediatric pearls
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Pediatric dental emergency pearls
Primary dentition consists of 20 teeth (2 incisors, 1 canine, 2 molars per quadrant)
Eruption begins ~ 6 months complete by ~ 2 years
Permanent dentition begins ~ 6 years
Avulsed primary teeth should NOT be reimplanted
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Summary
ED management is temporizing
Communicate clearly to consultants
Consider sealing, splinting and drainage of accessible infections
Recognize true dental emergencies
Recognize true medical emergencies
Floss
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Edmonton’s ED dental kit:
Dycal - $55.75 Fuji I glass ionomer - $135.00
mix pad 3x3 - $1.49 disposable spatulas pk 50 - $35.50disposable mirrors pk 60 - $27.43 disposable instruments pk 10 - $97.50 Arista hemostatic powder - ? Pricegelfoam substitute pk 24 - $56.25 cotton rolls box 2000 - $25.15 dental wax - ? price
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