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Dental Emergencies Devin Herbert, R3 Sept 6, 2012.

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Presentation on theme: "Dental Emergencies Devin Herbert, R3 Sept 6, 2012."— Presentation transcript:

1 Dental Emergencies Devin Herbert, R3 Sept 6, 2012

2 Clavulin Percocet See your dentist Questions?

3 Objectives Communication Dental anatomy Nontraumatic emergencies Traumatic emergencies Pediatric issues

4 premolar

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6 Terminology Lower 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

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8 Nontraumatic emergencies

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10 Dental caries Sensitive to cold Decalcification of enamel by acid producing plaque bacteria Eventually dentin layer breached

11 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

12 Periapical abscess Spontaneous or unremitting pain, reproducible with percussion Extension of infection to periapical bone Drainage, antibiotics, NS rinses May have an associated parulis

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15 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

16 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

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18 Pericoronitis Pain, foul taste or odour Involves erupting tooth, often 3 rd molar Inflammation of the gingival tissue overlying the erupting crown Drainage, antibiotics, NS rinses

19 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

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21 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

22 Ludwigs angina Swollen floor of mouth, elevated tongue Cellulitis of bilateral submandibular spaces and sublingual space Direct connection to parapharyngeal space Airway at risk!

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26 Cavernous sinus thrombosis Infraorbital or periorbital cellulitis Retrograde spread of infection through ophthalmic veins to cavernous sinus Meningeal signs, altered LOC to coma

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29 Traumatic emergencies

30 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

31 (Complicated)

32 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

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36 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

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38 Pediatric pearls

39 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

40 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

41 Edmontons ED dental kit: Dycal - $55.75 Fuji I glass ionomer - $ mix pad 3x3 - $1.49 disposable spatulas pk 50 - $35.50 disposable mirrors pk 60 - $27.43 disposable instruments pk 10 - $97.50 Arista hemostatic powder - ? Price gelfoam substitute pk 24 - $56.25 cotton rolls box $25.15 dental wax - ? price

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