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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Intra oral

A good light is essential

Mirror and probe


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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

Managing Dental Emergencies

Documents

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