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
Tap each tooth using end of tongue depressor or dental instrument
Pain on percussion may indicate abscessed, fractured, or traumatized toothRelated posts:
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