Managing Dental Emergencies
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Transcript of Managing Dental Emergencies
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MANAGINGDENTAL EMERGENCIES
Kathy Wilson
(South Tyneside PCT & Newcastle Dental School & Hospital)
March 2007
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Aims of Presentation
Basic dental anatomy Diagnosis and treatment planning
Pulpitis Dental abscess and cellulitis Trauma to teeth Anaesthesia for dental procedures
Extraction Drugs in dentistry Emergency dental kit
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Dental Emergencies
In remote or under-developed regions wherethe nearest dentist may be many days journey,
doctors and nurses frequently find themselves requiredto 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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BASIC DENTAL ANATOMY
Dentition
Soft tissues
Blood and nerve supply
Lymphatic drainage
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Anatomy of the Tooth
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Nerve & Blood Supply
Red - Blood Supply
Yellow - Nerve supply
Blue - Areas where localanalgesic can be
delivered
Maxilla Mandible
Buccal region
Palatal region
Buccal region
Lingual region
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Lymphatic Drainage
Lymphatic drainage is to the submental,sublingual and deep cervical nodes.
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HISTORY TAKING
Dental History
Ask the client to voice their complaint or point toarea which is hurting
Onset and duration of complaint
Relieving or initiating factors
Type of pain sharp or dull; moderate or severe
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CLINICAL EXAMINATION
General State
Temperature Fatigue
Extra oral examination Swellings of face Palpate lymph nodes
Examine for fractures
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CLINICAL EXAMINATION
Intra oral
A good light is essential
Mirror and probe
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CLINICAL EXAMINATION
Intra oral
Inspect soft tissues:
Inflammation
swelling Tenderness ulceration
Inspect the teeth DecayMobility Fractured teeth
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DIAGNOSIS &
TREATMENT PLANNING Make a diagnosis
Treatment planning for:
Relief of pain Treatment of pathology
Long term view
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COMMON CONDITIONS
Dental caries Pulpitis
Dental Abscess Facial swelling and cellulitis Dry socket, Osteomyelitis Fractured teeth Fractured jaw
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DENTAL CARIES
One of the most common diseases
Starts in enamel, extends to dentine and ifnot treated into pulp
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DENTAL CARIES
Filling Materials
Cavit(temporary filling)
Glass Ionomer Cement(semi-permanent filling)
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PULPITIS
Inflammation of the pulp
Dental caries extending into dentinecauses a sharp pain with hot and cold
Early stages reversible Remove decay
Cavit dressing
When pain settled permanent fillingplaced
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DENTAL ABSCESS
Periapical abscess
Result of decay and infectionextending into pulp of tooth
Pain is severe, persistent,& throbbing
Tooth is tender to touch
If not treated pus tracks to surfaceinside or outside the mouth
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DENTAL ABSCESSTreatment
Periapical abscessdrainage
1. Open tooth into pulp chamber usingexcavator (if possible) and dressing
2. Antibiotics (Amoycillin 250mg TDS / 5 days)
3. Extraction of tooth
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DENTAL ABSCESS
Extra oral Swelling
Can spread into the tissues Leading to cellulitis
Systemic involvement
Drainage required
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DENTAL ABSCESSTreatment
Extra oral Swelling
Antibiotics
Excision and drainage Anaesthesia with topical paste or ethyl chloride
Number 11 blade for incision extra orally
Open tissues using mosquitos
Allow pus to drain/insert rubber drainsuture to keep patent
Ultimately extract tooth under LA
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DRY SOCKET
Dry Socket Localised osteitis
Severe pain 2 -4 days post extraction
TREATMENT
LA
Debride socket Dressing Alvogel
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DENTAL TRAUMA
Fractured front tooth
Dentine Dentine/Enamel
Dentine/Enamel/Pulp
Before
After Treatmentwith Glass Ionomer
Cement
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DENTAL TRAUMA
Avulsed Tooth
A good chance of the toothre-implanting into the socket
successfully if done withinan hour.
The tooth should be located& picked up by the crown orenamel portion NOT the root.
If the tooth is dirty/contaminated,it should gently be placed in wholecold milk, saline, or saliva.
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DENTAL TRAUMA
Place tooth back intosocket.
Splint the tooth tostabilize
Wire and glassionomer cement.
Dental wax and foil
Antibiotics - Amoxycillin
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FACIAL TRAUMA
Injuries to the face and jaws can occur
Maxillary FracturesMandibular Fractures
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FACIAL TRAUMA
Emergency Management of Facial Fractures
Attempt to stabilize the jaw
Give Antibiotics
Soft foods
Get to hospital ASAP
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ADMINISTERINGLOCAL ANAESTHESTIC
2% Lignocaine +/- Adrenaline
Syringe
Dental syringe and needle
5 ml syringe and needle
ADMINISTERING
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ADMINISTERINGLOCAL ANAESTHETIC
Blue - Areas where
local anaesthetic
can be delivered
Maxilla Mandible
Buccal region
Palatal region
Buccal region
Lingual region
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INFILTRATION
Maxilla Mandible
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INFILTRATION
Should achieve anaesthesia within 5 minutes
Can be safely repeated is unsuccessful
Do not give where there is grossly infected tissue
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INFERIOR DENTAL NERVEBLOCK
Mandible
Palpate the anterior ramus border at the coronoid notch.
Slide the finger or thumb posteriorlyand medially until a ridge of bone ispalpated.
This is the internal oblique ridge.
Insert until bone is contactedthen withdraw ~1 mm. The depth
of insertion is approximately 25 mm.
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DENTAL EXTRACTIONS
Indications
Severe pulpitis
Periapical abscess
Tooth fracture
Severe periodontal disease
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DENTAL EXTRACTIONS
Basic Instruments
Elevators Lower Forceps
Upper Forceps
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DENTAL EXTRACTIONS
How to hold the instruments
Elevators
Lower Forceps Upper Forceps
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DENTAL EXTRACTIONS
Upper Extractions
Incisors, Canines & PremolarsPush up, rotate, pull down
MolarsPush up, ease tooth buccally
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DENTAL EXTRACTIONS
Lower Extractions
Incisors, canines & premolars Push down, rotate, pull up
Molars Push down, figure of eight, pull up
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DENTAL EXTRACTIONS
Post operative instructions
Pressure on socket No rinsing for 24 hours
Cold food and drink for 24 hours
No smoking for 24-48 hours
HSMW after 24 hours
If bleeding pressure pack for 20 minutes
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DENTAL EXTRACTIONS
Complications
Fractured tooth Bleeding Swelling Bruising
Pain Trismus Dry Socket
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DENTAL EXTRACTIONS
ComplicationsBleeding
Apply Pressure
Pack with haemostatic agent
Suture
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COMMONLY USED DRUGS
Analgesics for toothache Paracetamol Co-Codamol
NSAID
Antibiotics
Amoxycillin Erythromycin/ClindamycinMetronidazole
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EMERGENCY DENTALKIT
Dental Mirror Tweezers
Excavator and Flat plastic Cotton pellets & Rolls Extraction forceps Syringe & needle
Sterile Dressings 11 Blade Scalpel Gloves
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EMERGENCY DENTALKIT
Cavit/Temp dressing Eugenol/Oil of cloves
Glass ionomer cement Dental Wax/Wire Topical anaesthetic
Local anaesthetic Amoxyl/Metronidazole Paracetamol/Co-
codamol
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EMERGENCY DENTAL
KIT
Life Systems Dental First Aid Kit
www.travel-stuff.com
Nitro-pak dental First-Aid Kit www.nitro-pak.com
Dentanurse www.dentanurs.com