PAIN OF DENTAL ORIGIN ORAL TRAUMA Traumatized permanent teeth Reversible pulpitis Triage Subluxation Cavity approaching pulp 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 pulp necrosis & periapical More complications than for other luxation inflammation 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 dental emergency!
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* Malocclusion 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 root canal treatment. 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 Pericoronitis - 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 dentin ● 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 infection ● Gingival recession ● Sinusitis ● Otitis media / otitis externa sensitivity* ● Oral ulcerations ● Temporomandibular joint 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.