dental emergencies mangment
TRANSCRIPT
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MANAGINGMANAGINGDENTAL EMERGENCIESDENTAL EMERGENCIES
Kathy WilsonKathy Wilson(South Tyneside PCT & Newcastle Dental School & Hospital)(South Tyneside PCT & Newcastle Dental School & Hospital)
March 2007
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Aims of Presentation Aims of Presentation
Basic dental anatomyBasic dental anatomyDiagnosis and treatment planningDiagnosis and treatment planning
PulpitisPulpitisDental abscess and cellulitisDental abscess and cellulitisTrauma to teethTrauma to teethA naesthesia for dental procedures A naesthesia for dental proceduresEx tractionEx tractionDrugs in dentistryDrugs in dentistryEmergency dental kit Emergency dental kit
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Dental EmergenciesDental Emergencies
In remote or under-developed regions wherethe nearest dentist may be many days journey,
doctors and nurses frequently find themselves required to deal with pain, infection and trauma in the mouth.
Dental conditions are not usually dangerous to life,but they are often exceedingly painful
J.N.W. McCagie, Oral Surgeon
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B ASIC DENTAL ANATOMYB ASIC DENTAL ANATOMY
DentitionDentition
Soft tissuesSoft tissues
Blood and nerve supply
Blood and nerve supply
Lymphatic drainageLymphatic drainage
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Anatomy of the Tooth Anatomy of the Tooth
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Nerve & B lood Supply Nerve & B lood Supply
Red - Blood Supply
Yellow - Nerve supply
Blue - Areas where localanalgesic can bedelivered
Maxilla Mandible
Bu ccal region
Palatal region
Bu ccal region
Ling u al region
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Lymphatic DrainageLymphatic Drainage
Lymphatic drainage is to the submental,Lymphatic drainage is to the submental,sublingual and deep cervical nodes .sublingual and deep cervical nodes .
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DIAGNOSISDIAGNOSIS&&
TREATMENT PLANNINGTREATMENT PLANNING
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H ISTORY TAKINGH ISTORY TAKING
Dental H istory Dental H istory
A sk the client to voice their complaint or point to A sk the client to voice their complaint or point toarea which is hurtingarea which is hurting
O nset and duration of complaint O nset and duration of complaint
Relieving or initiating factorsRelieving or initiating factors
Type of painType of pain sharp or dull; moderate or severesharp or dull; moderate or severe
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H ISTORY TAKINGH ISTORY TAKING
Medical H istory Medical H istory
General state of health
General state of health
Current medication & whyCurrent medication & why
Particular conditionsParticular conditions Rheumatic feverRheumatic fever Drug allergy (penicillin)Drug allergy (penicillin)
Bleeding tendencyBleeding tendency
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CLINICAL EXAMINATIONCLINICAL EXAMINATION
General StateGeneral State TemperatureTemperature FatigueFatigue
Extra oral examinationExtra oral examination Swellings of faceSwellings of face Palpate lymph nodesPalpate lymph nodes Ex amine for fracturesEx amine for fractures
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CLINICAL EXAMINATIONCLINICAL EXAMINATION
Intra oralIntra oral
A good light is essential A good light is essential
Mirror and probeMirror and probe
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CLINICAL EXAMINATIONCLINICAL EXAMINATION
Intra oralIntra oral
Inspect soft tissues:Inspect soft tissues:InflammationInflammationswellingswellingTendernessTendernessulcerationulceration
Inspect the teethInspect the teethDecayDecayMobilityMobilityFractured teethFractured teeth
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DIAGNOSIS &DIAGNOSIS &
TREATMENT PLANNINGTREATMENT PLANNINGMake a diagnosisMake a diagnosis
Treatment planning for:Treatment planning for: Relief of painRelief of pain Treatment of pathologyTreatment of pathology Long term viewLong term view
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COMMON CONDITIONSCOMMON CONDITIONS
Dental cariesDental cariesPulpitisPulpitisDental A bscessDental A bscessFacial swelling and cellulitisFacial swelling and cellulitisDry socket, O steomyelitisDry socket, O steomyelitisFractured teethFractured teethFractured jawFractured jaw
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DENTAL CARIESDENTAL CARIESO ne of the most common diseasesO ne of the most common diseases
Starts in enamel, e x tends to dentine and if Starts in enamel, e x tends to dentine and if
not treated into pulpnot treated into pulp
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DENTAL CARIESDENTAL CARIES
ManagementManagementRemove decay
using an e xcavator
Place temp fillingUsing a flat plastic
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DENTAL CARIESDENTAL CARIES
Filling Materials
Cavit (temporary filling)
Glass Ionomer Cement (semi-permanent filling)
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PULPITISPULPITISInflammation of the pulpInflammation of the pulp
Dental caries e x tending into dentineDental caries e x tending into dentine
causes a sharp pain with hot and coldcauses a sharp pain with hot and cold
Early stages reversibleEarly stages reversibleRemove decayRemove decay
Cavit dressingCavit dressing
When pain settled permanent fillingWhen pain settled permanent fillingplacedplaced
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DENTAL A B SCESSDENTAL A B SCESS
Periapical abscessPeriapical abscess
Result of decay and infectionResult of decay and infectionex tending into pulp of toothex tending into pulp of tooth
Pain is severe, persistent,Pain is severe, persistent,& throbbing& throbbing
Tooth is tender to touchTooth is tender to touch
If not treated pus tracks to surfaceIf not treated pus tracks to surfaceinside or outside the mouthinside or outside the mouth
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DENTAL A B SCESSDENTAL A B SCESS Tr eatment Tr eatment
Periapical abscessPeriapical abscess dra ina ge dra ina ge
1. O pen tooth into pulp ch am be r using1. O pen tooth into pulp ch am be r usingexca vat or (if possible) an d d r essi n gexca vat or (if possible) an d d r essi n g
2. A nt ibiot ics ( A m oycillin 250 m g T DS / 5 d a ys)2. A nt ibiot ics ( A m oycillin 250 m g T DS / 5 d a ys)
3. Ex tra ct ion of t oo t h3. Ex tra ct ion of t oo t h
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DENTAL A B SCESSDENTAL A B SCESS
Extra oral SwellingExtra oral Swelling
Can spread into the tissuesCan spread into the tissues Leading to cellulitisLeading to cellulitis Systemic involvement Systemic involvement
Drainage requiredDrainage required
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DENTAL A B SCESSDENTAL A B SCESS
Tr eatm ent Tr eatm ent Extra oral SwellingExtra oral Swelling
A nt ibiot ics A nt ibiot ics
Ex cision an d d ra ina geEx cision an d d ra ina geA na es t hesi a wit h t opica l pa st e o r e t hyl chlo r ide A na es t hesi a wit h t opica l pa st e o r e t hyl chlo r ide
Num be r 11 bl a de fo r in cision ex tra ora llyNum be r 11 bl a de fo r in cision ex tra ora lly
O pe n t issues usi n g m osqui t osO pe n t issues usi n g m osqui t os
A llow pus t o d ra in /i n se rt r ubbe r dra in A llow pus t o d ra in /i n se rt r ubbe r dra in su t ur e t o keep p at ent su t ur e t o keep p at ent
Ult imat ely e x tra ct t oo t h u n de r LA Ult imat ely e x tra ct t oo t h u n de r LA
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DRY SOCKETDRY SOCKET
Dry SocketDry Socket Localised osteitisLocalised osteitis
Severe pain 2Severe pain 2 - -4 days post e x traction4 days post e x traction
TREA TMENTTREA TMENTLA LA
Debride socket Debride socket DressingDressing A lvogel A lvogel
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DENTAL TRAUMADENTAL TRAUMA
Fractured front toothFractured front tooth
DentineDentineDentine/ EnamelDentine/ EnamelDentine/ Enamel/PulpDentine/ Enamel/Pulp
B efore After Treatment
with Glass Ionomer
Cement
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DENTAL TRAUMADENTAL TRAUMAA vulsed Tooth A vulsed Tooth
A good chance of the tooth A good chance of the toothrere--implanting into the socket implanting into the socket successfully if done withinsuccessfully if done within an ho u ran ho u r ..
The tooth should be locatedThe tooth should be located& picked up by the crown or& picked up by the crown orenamel portionenamel portion NO TNO T the root . the root .
If the tooth is dirty/contaminated,If the tooth is dirty/contaminated,it should gently be placed in wholeit should gently be placed in wholecold milk, saline, or saliva .cold milk, saline, or saliva .
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DENTAL TRAUMADENTAL TRAUMA
Place tooth back intoPlace tooth back intosocket .socket .
Splint the tooth toSplint the tooth tostabilizestabilize
Wire and glassWire and glassionomer cement .ionomer cement .
Dental wa x and foilDental wa x and foil
A ntibiotics A ntibiotics -- A mo x ycillin A mo x ycillin
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FACIAL TRAUMAFACIAL TRAUMA
Injuries to the face and jaws can occurInjuries to the face and jaws can occur
Max illary FracturesMandibular Fractures
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FACIAL TRAUMAFACIAL TRAUMA
Emergency Management of Facial FracturesEmergency Management of Facial Fractures
A ttempt to stabilize the jaw
A ttempt to stabilize the jaw
G ive A ntibioticsG ive A ntibiotics
Soft foodsSoft foods
Get to hospital A S A PGet to hospital A S A P
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ADMINISTERING ADMINISTERING
LOCAL ANAEST H ESTICLOCAL ANAEST H ESTIC2% Lignocaine +/2% Lignocaine +/- - A drenaline A drenaline
SyringeSyringe
Dental syringe and needleDental syringe and needle
5 ml syringe and needle5 ml syringe and needle
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ADMINISTERING ADMINISTERINGLOCAL ANAEST H ETICLOCAL ANAEST H ETIC
Blue - Areas wherelocal anaestheticcan be delivered
Maxilla Mandible
Bu ccal region
Palatal region
Bu ccal region
Ling u al region
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INFILTRATIONINFILTRATION
MaxillaMaxilla MandibleMandible
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INFILTRATIONINFILTRATION
Should achieve anaesthesia within 5 minutesShould achieve anaesthesia within 5 minutes
Can be safely repeated is unsuccessfulCan be safely repeated is unsuccessful
Do not give where there is grossly infected tissueDo not give where there is grossly infected tissue
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INFERIOR DENTAL NERVEINFERIOR DENTAL NERVE
B LOCKB LOCKMandibleMandible
Palpate the anterior ramus border at the coronoid notch .Palpate the anterior ramus border at the coronoid notch .
Slide the finger or thumb posteriorlySlide the finger or thumb posteriorlyand medially until a ridge of bone isand medially until a ridge of bone ispalpated . palpated . This is the internal oblique ridge .This is the internal oblique ridge .
Insert until bone is contactedInsert until bone is contactedthen withdraw ~1 mm . The depththen withdraw ~1 mm . The depth
of insertion is approx
imately 25 mm .of insertion is approx
imately 25 mm .
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DENTAL EXTRACTIONSDENTAL EXTRACTIONS
IndicationsIndications
Severe pulpitisSevere pulpitis
Periapical abscessPeriapical abscess
Tooth fractureTooth fracture
Severe periodontal diseaseSevere periodontal disease
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DENTAL EXTRACTIONSDENTAL EXTRACTIONS
B asic Instr u mentsB asic Instr u ments
Elevators Lower Forceps
Upper Forceps
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DENTAL EXTRACTIONSDENTAL EXTRACTIONSH ow to hold the instr u mentsH ow to hold the instr u ments
Elevators
Lower Forceps Upper Forceps
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DENTAL EXTRACTIONSDENTAL EXTRACTIONS
Upper ExtractionsUpper Extractions
Incisors, Canines & Premolars Push up, rotate, pull down
Molars Push up, ease tooth buccally
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DENTAL EXTRACTIONSDENTAL EXTRACTIONS
Lower ExtractionsLower Extractions
Incisors, canines & premolars Push down, rotate, pull up
Molars Push down, figure of eight, pull up
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DENTAL EXTRACTIONSDENTAL EXTRACTIONS
Post operative instr u ctionsPost operative instr u ctions
Pressure on socket Pressure on socket No rinsing for 24 hoursNo rinsing for 24 hours Cold food and drink for 24 hoursCold food and drink for 24 hours No smoking for 24No smoking for 24- -48 hours48 hours HSMW after 24 hoursHSMW after 24 hours If bleeding pressure pack for 20 minutesIf bleeding pressure pack for 20 minutes
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DENTAL EXTRACTIONSDENTAL EXTRACTIONS
ComplicationsComplications
Fractured toothFractured toothBleedingBleedingSwellingSwellingBruisingBruising
PainPainTrismusTrismusDry Socket Dry Socket
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DENTAL EXTRACTIONSDENTAL EXTRACTIONS
ComplicationsComplications BleedingBleeding
A pply Pressure A pply Pressure
Pack with haemostatic agent Pack with haemostatic agent
SutureSuture
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COMMONLY USED DRUGSCOMMONLY USED DRUGS
A nalgesics for toothache A nalgesics for toothacheParacetamolParacetamolCoCo--CodamolCodamolNS A IDNS A ID
A ntibiotics A ntibiotics A
mox
ycillin A
mox
ycillinErythromycin/ClindamycinErythromycin/ClindamycinMetronidazoleMetronidazole
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EMERGENCY DENTALEMERGENCY DENTAL
KITKITDental MirrorDental MirrorTweezersTweezersEx cavator and Flat plasticEx cavator and Flat plasticCotton pellets & RollsCotton pellets & RollsEx traction forcepsEx traction forcepsSyringe & needleSyringe & needleSterile DressingsSterile Dressings11 Blade Scalpel11 Blade ScalpelG lovesG loves
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EMERGENCY DENTALEMERGENCY DENTAL
KITKITCavit/Temp dressingCavit/Temp dressingEugenol/ O il of clovesEugenol/ O il of cloves
G lass ionomer cement G lass ionomer cement Dental Wa x /WireDental Wa x /WireTopical anaestheticTopical anaesthetic
Local anaestheticLocal anaestheticA mo x yl/Metronidazole A mo x yl/MetronidazoleParacetamol/CoParacetamol/Co- -codamolcodamol
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EMERGENCY DENTALEMERGENCY DENTAL
KITKIT
Life Systems Dental First Aid KitLife Systems Dental First Aid Kit www.travelwww.travel- -st u ff.comst u ff.com
NitroNitro- -pak dental Firstpak dental First- -Aid Kit Aid Kit www.nitrowww.nitro- -pak.compak.com
Dentan u rseDentan u rse www.dentan u rs.comwww.dentan u rs.com