Dental Emergencies

Dental Emergencies
William Mounstephen
Introduction
  • Treatment often delayed because parents may not be able to detect seriousness of injury
  • Over one third of preschool children suffer trauma that affects their primary teeth
  • Maxillary anterior primary teeth are affected most often
Assessment
  • Systematic approach to soft tissues and teeth is required
  • Knowledge of normal sequence of primary and permanent tooth eruption is essential
History
  • Mechanism and time of injury, where injury occurred
  • Immunization status as dental trauma may coexist with soft-tissue injury; tetanus prophylaxis may be required
  • Temperature sensitivity, pain, mobility of teeth
  • Consider nonaccidental trauma if injuries inconsistent
  • Child abuse may present with maxillofacial or dental injury
  • Past dental problems and treatment
Extraoral Examination
Inspection
  • Symmetry of face, both frontal, profile, and with neck extended: asymmetry may indicate fracture of mandible or abscess
  • Skin: hematoma, bruising, lacerations
  • Mouth: range and symmetry of mandibular movement
  • Lips: color, swelling, ulceration, laceration
Palpation
  • Palpate TMJ joints as patient opens and closes mouth: look for pain and tenderness over condyles: may indicate subcondylar fracture
  • Equal movement of jaw on both sides without deviation
  • Palpate along entire mandible
  • Palpate orbital rim, zygoma, nose
  • Palpate neck for nodes/swellings/abscesses/masses
  • Test for sensation over facial skin: deficits or numbness may indicate trigeminal nerve disruption
Intraoral Examination
Good light source necessary
Inspection
  • Swelling, bleeding, inflammation, ulcers
  • Sign of foreign bodies
  • Gums, mucosa, palate, tongue, floor of mouth, teeth (hematomas or discoloration of floor of mouth may indicate fracture of mandible)
  • Subjective sensation of malalignment after traumatic displacement of teeth when mouth is closed
  • Chipped, displaced, or fractured teeth
  • Bloody socket indicates traumatic injury
  • Prior loss/loose primary tooth vs traumatic injury
Palpation
  • All teeth should be palpated for mobility, tenderness, fragmentation
  • Palpate alveolar bone: loose or floppy alveolar bone indicates fracture
  • Palpate the palate for crepitations; may indicate maxillary fracture
Percussion
Jun 22, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Dental Emergencies

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