dental emergencies devin herbert, r3 sept 6, 2012
TRANSCRIPT
![Page 1: Dental Emergencies Devin Herbert, R3 Sept 6, 2012](https://reader036.vdocuments.site/reader036/viewer/2022062417/551a218f550346cb358b4b18/html5/thumbnails/1.jpg)
Dental Emergencies
Devin Herbert, R3 Sept 6, 2012
![Page 2: Dental Emergencies Devin Herbert, R3 Sept 6, 2012](https://reader036.vdocuments.site/reader036/viewer/2022062417/551a218f550346cb358b4b18/html5/thumbnails/2.jpg)
Clavulin
Percocet
See your dentist
Questions?
![Page 3: Dental Emergencies Devin Herbert, R3 Sept 6, 2012](https://reader036.vdocuments.site/reader036/viewer/2022062417/551a218f550346cb358b4b18/html5/thumbnails/3.jpg)
ObjectivesCommunication
Dental anatomy
Nontraumatic emergencies
Traumatic emergencies
Pediatric issues
![Page 4: Dental Emergencies Devin Herbert, R3 Sept 6, 2012](https://reader036.vdocuments.site/reader036/viewer/2022062417/551a218f550346cb358b4b18/html5/thumbnails/4.jpg)
premolar
![Page 5: Dental Emergencies Devin Herbert, R3 Sept 6, 2012](https://reader036.vdocuments.site/reader036/viewer/2022062417/551a218f550346cb358b4b18/html5/thumbnails/5.jpg)
![Page 6: Dental Emergencies Devin Herbert, R3 Sept 6, 2012](https://reader036.vdocuments.site/reader036/viewer/2022062417/551a218f550346cb358b4b18/html5/thumbnails/6.jpg)
TerminologyLower 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
![Page 7: Dental Emergencies Devin Herbert, R3 Sept 6, 2012](https://reader036.vdocuments.site/reader036/viewer/2022062417/551a218f550346cb358b4b18/html5/thumbnails/7.jpg)
![Page 8: Dental Emergencies Devin Herbert, R3 Sept 6, 2012](https://reader036.vdocuments.site/reader036/viewer/2022062417/551a218f550346cb358b4b18/html5/thumbnails/8.jpg)
Nontraumatic emergencies
![Page 9: Dental Emergencies Devin Herbert, R3 Sept 6, 2012](https://reader036.vdocuments.site/reader036/viewer/2022062417/551a218f550346cb358b4b18/html5/thumbnails/9.jpg)
![Page 10: Dental Emergencies Devin Herbert, R3 Sept 6, 2012](https://reader036.vdocuments.site/reader036/viewer/2022062417/551a218f550346cb358b4b18/html5/thumbnails/10.jpg)
Dental cariesSensitive to cold
Decalcification of enamel by acid producing plaque bacteria
Eventually dentin layer breached
![Page 11: Dental Emergencies Devin Herbert, R3 Sept 6, 2012](https://reader036.vdocuments.site/reader036/viewer/2022062417/551a218f550346cb358b4b18/html5/thumbnails/11.jpg)
PulpitisPain, to thermal stimulus
Reversible - Short duration of discomfort
Likely to benefit from antibiotics
Irreversible - longer duration of discomfort
Require root canal or extraction
![Page 12: Dental Emergencies Devin Herbert, R3 Sept 6, 2012](https://reader036.vdocuments.site/reader036/viewer/2022062417/551a218f550346cb358b4b18/html5/thumbnails/12.jpg)
Periapical abscessSpontaneous or unremitting pain,
reproducible with percussion
Extension of infection to periapical bone
Drainage, antibiotics, NS rinses
May have an associated parulis
![Page 13: Dental Emergencies Devin Herbert, R3 Sept 6, 2012](https://reader036.vdocuments.site/reader036/viewer/2022062417/551a218f550346cb358b4b18/html5/thumbnails/13.jpg)
![Page 14: Dental Emergencies Devin Herbert, R3 Sept 6, 2012](https://reader036.vdocuments.site/reader036/viewer/2022062417/551a218f550346cb358b4b18/html5/thumbnails/14.jpg)
![Page 15: Dental Emergencies Devin Herbert, R3 Sept 6, 2012](https://reader036.vdocuments.site/reader036/viewer/2022062417/551a218f550346cb358b4b18/html5/thumbnails/15.jpg)
PeriodontitisTypically 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
![Page 16: Dental Emergencies Devin Herbert, R3 Sept 6, 2012](https://reader036.vdocuments.site/reader036/viewer/2022062417/551a218f550346cb358b4b18/html5/thumbnails/16.jpg)
Drainage techniqueIntraoral 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
![Page 17: Dental Emergencies Devin Herbert, R3 Sept 6, 2012](https://reader036.vdocuments.site/reader036/viewer/2022062417/551a218f550346cb358b4b18/html5/thumbnails/17.jpg)
![Page 18: Dental Emergencies Devin Herbert, R3 Sept 6, 2012](https://reader036.vdocuments.site/reader036/viewer/2022062417/551a218f550346cb358b4b18/html5/thumbnails/18.jpg)
PericoronitisPain, foul taste or odour
Involves erupting tooth, often 3rd molar
Inflammation of the gingival tissue overlying the erupting crown
Drainage, antibiotics, NS rinses
![Page 19: Dental Emergencies Devin Herbert, R3 Sept 6, 2012](https://reader036.vdocuments.site/reader036/viewer/2022062417/551a218f550346cb358b4b18/html5/thumbnails/19.jpg)
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
![Page 20: Dental Emergencies Devin Herbert, R3 Sept 6, 2012](https://reader036.vdocuments.site/reader036/viewer/2022062417/551a218f550346cb358b4b18/html5/thumbnails/20.jpg)
![Page 21: Dental Emergencies Devin Herbert, R3 Sept 6, 2012](https://reader036.vdocuments.site/reader036/viewer/2022062417/551a218f550346cb358b4b18/html5/thumbnails/21.jpg)
Deep space infectionsSpread 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
![Page 22: Dental Emergencies Devin Herbert, R3 Sept 6, 2012](https://reader036.vdocuments.site/reader036/viewer/2022062417/551a218f550346cb358b4b18/html5/thumbnails/22.jpg)
Ludwig’s anginaSwollen floor of mouth, elevated tongue
Cellulitis of bilateral submandibular spaces and sublingual space
Direct connection to parapharyngeal space
Airway at risk!
![Page 23: Dental Emergencies Devin Herbert, R3 Sept 6, 2012](https://reader036.vdocuments.site/reader036/viewer/2022062417/551a218f550346cb358b4b18/html5/thumbnails/23.jpg)
![Page 24: Dental Emergencies Devin Herbert, R3 Sept 6, 2012](https://reader036.vdocuments.site/reader036/viewer/2022062417/551a218f550346cb358b4b18/html5/thumbnails/24.jpg)
![Page 25: Dental Emergencies Devin Herbert, R3 Sept 6, 2012](https://reader036.vdocuments.site/reader036/viewer/2022062417/551a218f550346cb358b4b18/html5/thumbnails/25.jpg)
![Page 26: Dental Emergencies Devin Herbert, R3 Sept 6, 2012](https://reader036.vdocuments.site/reader036/viewer/2022062417/551a218f550346cb358b4b18/html5/thumbnails/26.jpg)
Cavernous sinus thrombosisInfraorbital or periorbital cellulitis
Retrograde spread of infection through ophthalmic veins to cavernous sinus
Meningeal signs, altered LOC to coma
![Page 27: Dental Emergencies Devin Herbert, R3 Sept 6, 2012](https://reader036.vdocuments.site/reader036/viewer/2022062417/551a218f550346cb358b4b18/html5/thumbnails/27.jpg)
![Page 28: Dental Emergencies Devin Herbert, R3 Sept 6, 2012](https://reader036.vdocuments.site/reader036/viewer/2022062417/551a218f550346cb358b4b18/html5/thumbnails/28.jpg)
![Page 29: Dental Emergencies Devin Herbert, R3 Sept 6, 2012](https://reader036.vdocuments.site/reader036/viewer/2022062417/551a218f550346cb358b4b18/html5/thumbnails/29.jpg)
Traumatic emergencies
![Page 30: Dental Emergencies Devin Herbert, R3 Sept 6, 2012](https://reader036.vdocuments.site/reader036/viewer/2022062417/551a218f550346cb358b4b18/html5/thumbnails/30.jpg)
Dental crown fracturesEllis 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
![Page 31: Dental Emergencies Devin Herbert, R3 Sept 6, 2012](https://reader036.vdocuments.site/reader036/viewer/2022062417/551a218f550346cb358b4b18/html5/thumbnails/31.jpg)
(Complicated)
![Page 32: Dental Emergencies Devin Herbert, R3 Sept 6, 2012](https://reader036.vdocuments.site/reader036/viewer/2022062417/551a218f550346cb358b4b18/html5/thumbnails/32.jpg)
Dental trauma terminologyConcussion - 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
![Page 33: Dental Emergencies Devin Herbert, R3 Sept 6, 2012](https://reader036.vdocuments.site/reader036/viewer/2022062417/551a218f550346cb358b4b18/html5/thumbnails/33.jpg)
![Page 34: Dental Emergencies Devin Herbert, R3 Sept 6, 2012](https://reader036.vdocuments.site/reader036/viewer/2022062417/551a218f550346cb358b4b18/html5/thumbnails/34.jpg)
![Page 35: Dental Emergencies Devin Herbert, R3 Sept 6, 2012](https://reader036.vdocuments.site/reader036/viewer/2022062417/551a218f550346cb358b4b18/html5/thumbnails/35.jpg)
![Page 36: Dental Emergencies Devin Herbert, R3 Sept 6, 2012](https://reader036.vdocuments.site/reader036/viewer/2022062417/551a218f550346cb358b4b18/html5/thumbnails/36.jpg)
AvulsionWhere 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
![Page 37: Dental Emergencies Devin Herbert, R3 Sept 6, 2012](https://reader036.vdocuments.site/reader036/viewer/2022062417/551a218f550346cb358b4b18/html5/thumbnails/37.jpg)
![Page 38: Dental Emergencies Devin Herbert, R3 Sept 6, 2012](https://reader036.vdocuments.site/reader036/viewer/2022062417/551a218f550346cb358b4b18/html5/thumbnails/38.jpg)
Pediatric pearls
![Page 39: Dental Emergencies Devin Herbert, R3 Sept 6, 2012](https://reader036.vdocuments.site/reader036/viewer/2022062417/551a218f550346cb358b4b18/html5/thumbnails/39.jpg)
Pediatric dental emergency pearlsPrimary 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
![Page 40: Dental Emergencies Devin Herbert, R3 Sept 6, 2012](https://reader036.vdocuments.site/reader036/viewer/2022062417/551a218f550346cb358b4b18/html5/thumbnails/40.jpg)
SummaryED management is temporizing
Communicate clearly to consultants
Consider sealing, splinting and drainage of accessible infections
Recognize true dental emergencies
Recognize true medical emergencies
Floss
![Page 41: Dental Emergencies Devin Herbert, R3 Sept 6, 2012](https://reader036.vdocuments.site/reader036/viewer/2022062417/551a218f550346cb358b4b18/html5/thumbnails/41.jpg)
Edmonton’s ED dental kit:Dycal - $55.75 Fuji I glass ionomer - $135.00mix pad 3x3 - $1.49 disposable spatulas pk 50 - $35.50disposable mirrors pk 60 - $27.43 disposable instruments pk 10 - $97.50 Arista hemostatic powder - ? Pricegelfoam substitute pk 24 - $56.25 cotton rolls box 2000 - $25.15 dental wax - ? price
![Page 42: Dental Emergencies Devin Herbert, R3 Sept 6, 2012](https://reader036.vdocuments.site/reader036/viewer/2022062417/551a218f550346cb358b4b18/html5/thumbnails/42.jpg)