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Slide 2 Northern ED Registrar Teaching Program Dr Louisa Lee (Acknowledgement Dr Tony Skapetis) Slide 3 Be able to describe and classify dental injuries Know how to manage simple avulsion and luxation injuries in the ED Be familiar with the ED Dental Trauma Kit Not all patients need to go to the Royal Dental Hospital! Slide 4 Slide 5 Slide 6 Slide 7 Slide 8 Slide 9 Slide 10 Facial part of tooth seen when a person smiles Labial facial surface of incisors & canines Buccal facial surface of molars & premolars Oral part of tooth that faces the tongue/palate Lingual toward the tongue, oral surface of mandibular teeth Palatal toward the palate, oral surface of maxillary teeth Approximal/interproximal contacting surfaces between 2 adjacent teeth Mesial interproximal surface facing anteriorly/closest to midline Distal interproximal surface facing posterior/away from midline Occlusal biting/chewing surface of molars & premolars Incisal biting/chewing surface of incisors & canines Slide 11 Slide 12 Slide 13 Airway compromise Associated injuries Facial & mandibular fractures Tongue blade test Soft tissue injuries e.g mucosal, tongue lacerations Brain & C spine injuries Full inspection of oral cavity Percuss with tongue depressor for sensitivity Palpate with fingers/tongue depressor for mobility Missing teeth or pieces of teeth where are they? Aspirated? Check bite Slide 14 Identify (account for) all fracture fragments and mobile teeth OPG, CXR may be necessary Note if any mandibular fracture open or closed Give adequate analgesia/anaesthesia Dont forget tetanus status Pathology only if clinically indicated e.g. coagulopathy, liver failure Slide 15 Injuries to hard dental tissues of mouth Dental fractures Injuries to periodontal tissues or supporting tissues of teeth Luxations & Avulsions Slide 16 X Slide 17 Crown infraction Incomplete # of the enamel without loss of tooth structure Uncomplicated crown # Crown # without pulp exposed Complicated crown # Crown # with pulp exposed Uncomplicated crown-root # Crown # extending below gum line & involving root, but not exposing the pulp Complicated crown-root # Crown # extending below gum line & involving root, but also exposing the pulp Slide 18 Slide 19 Its all about the pulp! Slide 20 Through enamel only: Not an emergency Pulp necrosis unlikely (0-3%) File down sharp edges with nail file Non urgent dental follow up Slide 21 Dentin Exposed: Risk of pulp necrosis 1- 7% Analgesia Tooth block Cover exposed dentin with CaOH or GIC Soft diet Prophylactic antibiotics Dental review within 24- 48 hours Slide 22 True dental emergency Pulp necrosis 10-30% Analgesia Avoid OTC topical analgesics Control haemorrhage Cover exposed pulp & dentin Liquid diet Antibiotics Urgent dental review (