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Northern ED Registrar Teaching Program Dr Louisa Lee (Acknowledgement – Dr Tony Skapetis)

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Presentation on theme: "Northern ED Registrar Teaching Program Dr Louisa Lee (Acknowledgement – Dr Tony Skapetis)"— Presentation transcript:

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2 Northern ED Registrar Teaching Program Dr Louisa Lee (Acknowledgement – Dr Tony Skapetis)

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!

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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

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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

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

15 Injuries to hard dental tissues of mouth Dental fractures Injuries to periodontal tissues or supporting tissues of teeth Luxations & Avulsions

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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

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19 Its all about the pulp!

20 Through enamel only: Not an emergency Pulp necrosis unlikely (0-3%) File down sharp edges with nail file Non urgent dental follow up

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 hours

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 (<24 hours)

23 (Wobbly & Dislodged Teeth)

24 Concussion – injury to supporting structures without abnormal loosening/displacement Subluxation – tooth loosening without displacement Intrusive luxation – tooth is pushed into socket, towards gum Extrusive luxation – tooth is pushed away from socket but not yet avulsed Avulsion – complete dislodgement from socket

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29 Local anaesthetic Finger reduction & splinting Do NOT manipulate primary teeth Soft diet Dental review hours

30 Never reimplant a primary tooth For near avulsions, if the tooth is interfering with bite or risk of being swallowed/aspirated, extract it

31 Time is tooth! You lose 1% chance of successful replant for every minute out of socket Within 30 minutes ideal, OK to try up to 3/24 Storage medium is 2 nd most important factor Milk (not flavoured or soy) or saline best Never let the tooth dry out No replanting if alveolar ridge fracture present

32 Local anaesthetic Handle tooth from crown Do NOT touch root surface Irrigate socket with saline & check for bone fragments from socket wall Rinse tooth using tap water or saline Insert into socket ASAP Check occlusion Splint with GIC ADT if appropriate Soft diet Antibiotics Doxycycline 100mg BD for 7/7 (Penicillin V if < 12 yo) Chlorhexidine (0.1%) mouthwash BD for 7/7 Non urgent Dental review (<2 weeks)

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35 Tooth block (Supraperiosteal infiltration) Front teeth 25G needle Rule of 2s – 2mm penetration, 2ml volume of 2% lignocaine Infraorbital nerve block Upper front teeth (up to tooth 5) Also good for suturing facial & lip lacerations 23G needle Intra-oral approach or direct infiltration Inferior alveolar nerve block Mandibular back teeth

36 1 level teaspoon of powder to 1 drop of liquid Mix with a tongue depressor Do NOT mix with metal (will stain GIC) Setting time 2-3 minutes use GIC on pad as guide Maintain tooth position with finger pressure until GIC sets

37 Any questions or comments?


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