Dental Emergencies Edited

8/8/2019 Dental Emergencies Edited

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EMERGENCY DENTAL

PRESENTATIONS WHAT TO DO

Adapted from source


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COMMON EMERGENCY DENTALPRESENTATIONS

1. POST OPERATIVE BLEEDING

2. FACIAL SWELLINGS

3. AVULSED TEETH

4. LUXATED TEETH

5. FRACTURED TEETH

6. FACIAL FRACTURES


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IN ALL CASES, WE NEED THEFOLLOWING

1. HISTORY OF PRESENTATION

Time of incidentExtent of swelling/trauma/bleeding

Current clinical description/symptoms

2. MEDICAL HISTORY3. HCC/PCC HOLDER

Eligibility for QH follow up care


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POST OPERATIVE BLEEDING


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POST OPERATIVE BLEEDING

1. Clean area, evacuate clot/blood with suction andvisualise socket

2. Apply pressure with sterile gauze ( finger orpatient biting) for at least 20 mins

3. Not stopped, soak gauze in transexamic acidand apply pressure as before

4. If still no haemostasis, call on call dentist


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F ACIAL SWELLINGS


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1.WILL NEED SOME INTERVENTIONALTREATMENT BY A DENTIST USUALLY

TOOTH EXTRACTION2.IF SEVERE WILL NEED SURGICAL

DRAINAGE

FACIAL SWELLINGS


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WHAT TO DO AT A&E

1. If affecting airway management by emergency staff toensure airway maintained and contact Maxillo FacialUnit at RBH

2. If affecting eye, generally admit and put on IVantibiotics ( Amoxycillin and Metronidazole)


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WHAT TO DO AT A&E

1. If affecting airway management by emergency staff toensure airway maintained and contact Maxillo FacialUnit at RBH

2. If affecting eye, generally admit and put on IVantibiotics ( Amoxycillin and Metronidazole) and calldental clinic the next day to assess and treat. In patientsare automatically eligible for public dental care.

3. If not affecting eye or airway, then oral antibiotics andadvise to see dentist n ext day.

4. If eligible for public sector treatment, then get an OPG

for patient before sending them to see dental clinic


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AVULSED TEETHDetermi n e whether tooth lost is perma n en t or

deciduous. If deciduous n o treatme n t required.Defi n itely do n t try a n d replace it!


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AVULSED TEETHIf a perma n en t tooth, as a ge n eral rule the tooth should

be replaced ASAP. The aim is to get somereattachme n t u n likely if out of mouth time greatertha n 60 mi n s.


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First Aid Advice

1. Make sure it is a permanent tooth dontreimplant deciduous teeth

2. Keep patient calm and find the knocked out

tooth. Pick it up only by the crown.


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First Aid Advice To Parents1. Make sure it is a permanent tooth dont reimplant

deciduous teeth2. Keep patient calm and find the knocked out tooth. Pick

it up only by the crown. Avoid touching the root.

3. If tooth dirty, wash it briefly ( 10 secs) under coldrunning water and reposition it. Try and encourageparent/patient to reimplant tooth.

4. Bite on a handkerchief to hold it in position

5. If this is not possible, place the tooth in a suitable storagemedium eg milk or saline, not water

6. Get emergency treatment immediately i.e. A&E orprivate dentist. If you know a patient is coming in, call

on call dentist.


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ON PRESENTATION AT A&E

1. If tooth has already been reimplanted, then checkposition is OK and call on call dentist

2. Organise tetanus shot if needed3. If tooth hasnt been reimplanted, then immediately

reimplant tooth and then call on call dentist. To dothis, rinse out the socket with saline and then

reimplant. Sometimes LA may be needed.


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LUXATED TEETH1. Clinical exam check for

Teeth out of position with respect to theiradjacent teeth. Patients are usually the best judge of that doesnt feel right. Can be subtleor blindingly obvious!


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LUXATED TEETH1. Clinical exam check for

Teeth out of position with respect to theiradjacent teeth. Patients are usually the best judge of that doesnt feel right. Can be subtleor blindingly obvious!

2. Contact on call dentist with history and extentof displacement. Generally we will want toreposition and splint immediately.


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FRACTURED TEETH

1. Clinical exam check for

Tooth mobility if excessive, contact on call dentist

Pulp exposure bleeding from inside the tooth, notthe gum.


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FRACTURED TEETH

1. Clinical exam check for

Tooth mobility if excessive, contact on call dentist

Pulp exposure bleeding from inside the tooth, notthe gum.

2. If pulpal exposure, call on call dentist. If not, adviseto see dentist next morning improved outcome if

treated earlier. Also, need radiographic assessmentto see if there is a root fracture.

3. Worth saving the broken fragment in water sometimes it can be bonded back on.


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MANDIBULAR FRACTURES

1. History of trauma

2. Extra orally

Possible paraesthesia lip/cheek

Deformity in bony contourUnnatural mobility and bony crepitus

Limitation of mandibular movements depending on the

site and degree of displacement of the fracturesPain during opening, protrusion and lateral excursions


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MANDIBULAR FRACTURESINTRA-ORALLY

Bruising and gingival lacerations are common

Sublingual haematoma is characteristic of mandibular

fractures


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MANDIBULAR FRACTURESINTRA-ORALLY

Bruising and gingival lacerations are common

Sublingual haematoma is almost pathognomonic of

mandibular fracturesDerangement of the occlusion and that depends on the

site and degree of displacement of the fracture classically displaced fractures of the condylar area leadto the typical anterior open bite.


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Dental Emergencies Edited

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