Dental Emergencies

BY:-Dr.S.K.RAJPUROHIT

Clavulin

Percocet

See your dentist

Questions?

Objectives

Communication

Dental anatomy

Nontraumatic emergencies

Traumatic emergencies

Pediatric issues

premolar

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

Nontraumatic emergencies

Dental caries

Sensitive to cold

Decalcification of enamel by acid producing plaque bacteria

Eventually dentin layer breached

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

Periapical abscess

Spontaneous or unremitting pain, reproducible with percussion

Extension of infection to periapical bone

Drainage, antibiotics, NS rinses

May have an associated parulis

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

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

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

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

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

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!

Cavernous sinus thrombosis

Infraorbital or periorbital cellulitis

Retrograde spread of infection through ophthalmic veins to cavernous sinus

Meningeal signs, altered LOC to coma

Traumatic emergencies

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

(Complicated)

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

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

Pediatric pearls

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

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

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