PAIN OF DENTAL ORIGIN ORAL TRAUMA Traumatized permanent teeth Reversible Triage Subluxation  Cavity approaching of tooth  Tooth is not mobile/displaced but tender on biting  Airway  Transient pain with hot, cold or sweet stimuli  Tx = Monitoring with dentist  Other systemic injuries  Tx = filling*  Neurologic exam Extrusive or Lateral Luxation Irreversible pulpitis  Primary vs. permanent teeth  Tooth is loose with some displacement  Cavity into pulp of tooth  Availability of dental care  Tx = Repositioning, splinting, +/-root canal  Spontaneous, prolonged, poorly localized pain  Pain management  Tx = root canal or extraction*  Check Tetanus status Intrusive Luxation  Tooth is pushed deeper into its socket Periapical periodontitis Examination  Tx = Repositioning, splinting, +/-root canal  Cavity causes & periapical  More complications than for other luxation Assess in following order:  Spontaneous, prolonged, localized pain, tooth  Irrigate to remove blood, clots, and debris Avulsion tender to percussion  Soft tissues  Tooth is knocked out  Tx = root canal or extraction*  Teeth  Tx = A true !

Periapical abscess  Bony structures - Hold tooth by crown only, DO NOT touch root - Rinse off debris with saline or milk  Localized purulent form of periapical periodontitis - Re-implant immediately  Spontaneous, prolonged, localized pain, tooth Check for: - Bite on gauze or hold tooth in place tender to percussion  Tenderness, swelling, lacerations - Check Tetanus status; booster if necessary  Tx = I and D if ‘pointing’; no antibiotics unless  Damaged or mobile teeth - Rx Penicillin or doxycycline (for >12 years cellulitis; root canal or extraction*   Mobile jaw segments old only) (Erythromycin if allergic) Cellulitis  Pain or limitation on opening - See dentist immediately for radiograph,  Periapical periodontitis involves soft tissue splinting, and .  Tx = Rx Penicillin: Adults 500mg tid; Children If missing teeth:  If can’t re-implant on scene, transport in saline, 50mg/kg per day divided (Erythromycin if  Do not assume missing teeth are lost at scene milk, or buccal sulcus (not water!)

allergic); root canal or extraction  Consider x-ray to determine if missing teeth are: Traumatized primary teeth - Swallowed  Luxated teeth that are very loose or interfering with  Food and bacteria under gum of erupting molar - Aspirated occlusion are extracted - Intruded into sinus or other structures  Tx = irrigation; removal of gum flap; or  Luxated teeth that are not too loose are monitored

extraction; associated cellulitis requires antibiotics  Intruded teeth are variable and often re-erupt;

should be evaluated and monitored by a dentist

* While waiting for definitive treatment, treat pain  Avulsed teeth are NOT re-implanted

adequately, counsel to avoid aggravating

food/drinks.

Fractured Teeth Alveolar Bone Fractures

 Often associated with gingival laceration  Palpate alveolar ridge for step-offs (can often see teeth are at different heights in mouth)  Segmental alveolar fractures move when assessing ORAL EMERGENCIES tooth mobility POCKET CARD

 Tx = Oral surgeon referral within 1 hour. Hugh Silk MD, Alan Douglass MD, Joanna Douglass BDS Reduction easier before swelling occurs Smiles for Life Oral Health Curriculum

www.smilesforlifeoralhealth.org October 2011 Chin trauma Suspect and inspect for: Creation of this product was funded by:  Mandibular condyle fracture National Interprofessional Initiative on Oral Health Enamel only  Tooth fracture (including posterior teeth) The information contained in this card should not

 Tx = Dental referral non-urgently to smooth substitute for consultation with an oral health expert. Oral piercings rough edges and long term monitoring High risk for: GENERAL PRINCIPLES Enamel plus ● Tooth fracture or injury ● Stud aspiration Locate origin of oral pain.  Tx = Dental referral with 12 hours for ● Allergic reaction ● Speech impediment Consider non-dental origin: restoration to protect pulp and decrease ● Gum/tongue ● Gingival recession ● Sinusitis ● Otitis media / otitis externa sensitivity* ● Oral ulcerations ● PERMANENT TOOTH CHART For describing teeth when charting or talking to Assess and treat origin of problem. Enamel, dentin and pulp Treat pain with NSAIDs, acetaminophen and opioids.  Pulp will be visible (either bleeding or pale consultants: Consult as needed. pink)  Pain can be severe INJURY PREVENTION: MOUTH GUARDS  Tx = Immediate dental referral for root canal Mouth guards should be worn for all sports with treatment, restoration and long term monitoring risk of high impact accidents, which include: or extraction.* Soccer Bicycling Skiing Lacrosse Boxing Ice Hockey Root fracture Inline Skating Skateboarding Wrestling  Tooth may or may not be mobile depending on Basketball Field Hockey Baseball fracture location (Falls, violence, and MVAs are also high risk events)  Other traumatic tooth injuries may be present Mouth Guard types:  Radiograph mandatory for diagnosis  Stock: inexpensive, fair protection  Tx = Immediate dental referral for splinting,  Boil and Bite: better fit, best fabricated with aid root canal therapy or extraction* of dentist. *If fragments available, keep hydrated in saline  Custom: most expensive; made by dentist; best or milk. Dentist may be able to reattach fit/protection and most likely to be worn.