Dental Emergencies Mangment

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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