MANAGING

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March 2007

• MANAGING
• DENTAL EMERGENCIES
• Kathy Wilson
• (South Tyneside PCT Newcastle Dental School
  Hospital)

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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 where
the nearest dentist may be many days journey,
doctors and nurses frequently find themselves
required to 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
Mandible
Buccal region
Buccal region

Palatal region
Lingual region
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Lymphatic Drainage

• Lymphatic drainage is to the submental,
  sublingual and deep cervical nodes.

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DIAGNOSIS TREATMENT PLANNING
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HISTORY TAKING

• Dental History
• Ask the client to voice their complaint or point
  to area 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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HISTORY TAKING

• Medical History
• General state of health
• Current medication why
• Particular conditions
• Rheumatic fever
• Drug allergy (penicillin)
• Bleeding tendency

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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
• Decay
• Mobility
• 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 if not
  treated into pulp

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DENTAL CARIESManagement
Remove decay using an excavator
Place temp filling Using a flat plastic
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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 dentine
• causes a sharp pain with hot and cold
• Early stages reversible
• Remove decay
• Cavit dressing
• When pain settled permanent filling placed

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DENTAL ABSCESS

• Periapical abscess
• Result of decay and infection
  extending into pulp of tooth
• Pain is severe, persistent,
  throbbing
• Tooth is tender to touch
• If not treated pus tracks to surface
• inside or outside the mouth

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DENTAL ABSCESS Treatment

• Periapical abscess drainage
• 1. Open tooth into pulp chamber using
  excavator (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 drain
  suture 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

After Treatment with Glass Ionomer Cement
Before
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DENTAL TRAUMA

• Avulsed Tooth
• A good chance of the tooth
  re-implanting
  into the socket
  successfully if done within an
  hour.
• The tooth should be located
  picked up
  by the crown or
  enamel portion NOT the root.
• If the tooth is dirty/contaminated,
  it
  should gently be placed in whole
  
  cold milk, saline, or saliva.

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DENTAL TRAUMA

• Place tooth back into socket.
• Splint the tooth to stabilize
• Wire and glass ionomer cement.
• Dental wax and foil
• Antibiotics - Amoxycillin

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FACIAL TRAUMA

• Injuries to the face and jaws can occur

Mandibular Fractures
Maxillary 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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ADMINISTERING LOCAL ANAESTHESTIC

• 2 Lignocaine /- Adrenaline
• Syringe
• Dental syringe and needle
• 5 ml syringe and needle

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ADMINISTERING LOCAL ANAESTHETIC
Mandible
Buccal region
Buccal region

Palatal 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 NERVE BLOCK

• Mandible
• Palpate the anterior ramus border at the coronoid
  notch.
• Slide the finger or thumb posteriorly
  and medially
  until a ridge of bone is
  palpated.
  
  This is the internal oblique ridge.
• Insert until bone is contacted
  then 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

Upper Forceps
Elevators
Lower Forceps
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DENTAL EXTRACTIONS

• How to hold the instruments

Lower Forceps
Upper Forceps
Elevators
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DENTAL EXTRACTIONS

• Upper Extractions

Incisors, Canines Premolars Push up, rotate,
pull down Molars Push 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

• Complications Bleeding
• Apply Pressure
• Pack with haemostatic agent
• Suture

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COMMONLY USED DRUGS

• Analgesics for toothache
• Paracetamol
• Co-Codamol
• NSAID
• Antibiotics
• Amoxycillin
• Erythromycin/Clindamycin
• Metronidazole

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EMERGENCY DENTAL KIT

• 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 DENTAL KIT

• 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