Dental Emergencies
William Mounstephen
Introduction
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Treatment often delayed because parents may not be able to detect seriousness of injury
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Over one third of preschool children suffer trauma that affects their primary teeth
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Maxillary anterior primary teeth are affected most often
Assessment
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Systematic approach to soft tissues and teeth is required
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Knowledge of normal sequence of primary and permanent tooth eruption is essential
History
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Mechanism and time of injury, where injury occurred
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Immunization status as dental trauma may coexist with soft-tissue injury; tetanus prophylaxis may be required
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Temperature sensitivity, pain, mobility of teeth
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Consider nonaccidental trauma if injuries inconsistent
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Child abuse may present with maxillofacial or dental injury
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Past dental problems and treatment
Extraoral Examination
Inspection
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Symmetry of face, both frontal, profile, and with neck extended: asymmetry may indicate fracture of mandible or abscess
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Skin: hematoma, bruising, lacerations
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Mouth: range and symmetry of mandibular movement
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Lips: color, swelling, ulceration, laceration
Palpation
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Palpate TMJ joints as patient opens and closes mouth: look for pain and tenderness over condyles: may indicate subcondylar fracture
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Equal movement of jaw on both sides without deviation
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Palpate along entire mandible
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Palpate orbital rim, zygoma, nose
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Palpate neck for nodes/swellings/abscesses/masses
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Test for sensation over facial skin: deficits or numbness may indicate trigeminal nerve disruption
Intraoral Examination
Good light source necessary
Inspection
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Swelling, bleeding, inflammation, ulcers
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Sign of foreign bodies
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Gums, mucosa, palate, tongue, floor of mouth, teeth (hematomas or discoloration of floor of mouth may indicate fracture of mandible)
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Subjective sensation of malalignment after traumatic displacement of teeth when mouth is closed
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Chipped, displaced, or fractured teeth
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Bloody socket indicates traumatic injury
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Prior loss/loose primary tooth vs traumatic injury
Palpation
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All teeth should be palpated for mobility, tenderness, fragmentation
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Palpate alveolar bone: loose or floppy alveolar bone indicates fracture
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Palpate the palate for crepitations; may indicate maxillary fracture
Percussion
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Tap each tooth using end of tongue depressor or dental instrument
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Pain on percussion may indicate abscessed, fractured, or traumatized tooth
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