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EMERGENCY DENTAL
TREATMENT FOR CORPSMEN
CAPT JOHN BROWNING
OBJECTIVES
• Assess and Diagnose the Dental Patient
• Formulate Emergent Treatment Plans
• Handle/Place Dental Materials
• Prescribe Proper Medications for Dental
Emergencies
TOPICS of INTEREST
• Fractured Teeth
• Lost/Fractured Restorations
• Displaced Crowns
• Treatment of Dry Sockets and Pericoronitis
• Avulsed Teeth
• Dental Abscess
• Jaw Fractures
Management of Fractured Teeth:
• Enamel only
• Enamel/Dentin
• Enamel/Dentin/NERVE(pulp)
ENAMEL ONLY
Signs and Symptoms:
• Usually asymptomatic
• Tooth may be sensitive to touch/chew
• Bruised ligaments, time will heal.
• Tooth may feel sharp to tongue or cheek
Treatment:
• No emergency treatment necessary
• Fluoride varnish: half placebo, half real.
ENAMEL DENTIN
Signs and Symptoms:
• Usually somewhat symptomatic
• Tooth sensitive to changes in temperature
• Tooth may be sensitive to touch
Treatment:
• Dry tooth, cover any exposed dentin with Fuji IX
• If you see the blushing pink of pulp, dycal & fuji
• Fluoride Varnish
PULPAL EXPOSURE
Signs and Symptoms:
• Pulp Tissue Exposed
• Tooth Painful to Most All Stimuli.
Treatment:
• Remove Bulk Nerve Tissue if Possible
• Dycal covered with Fuji
• Prescribe Pain Meds as Needed
• Numb
• Remove pulp
• (if possible)
• Place dycal in chamber
• Cover with FUJI
• Pain meds
Dental Abscess
Signs and Symptoms
• Fluctuant swelling present on the gingiva,
palate, or in the buccal vestibule area.
• Painful to palpation
• Sensitive to percussion
• Patient may be feverish
• Don’t mess with lingual
Dental Abscess
Treatment
• Antibiotics indicated to control the spread
of the infection.
• Incision and drainage to help control the
spread of infection and manage pain.
Incision and Drainage
• Adequate anesthetic is important, but often
difficult to achieve profoundly in the
abscessed area.
Incision and Drainage
• Incision made into the swelling as coronal
as possible. Note: There are NO vital
structures towards the crown of the tooth.
• Incision should be approx 10ish mm
Incision and Drainage
• Scalpel down to bone
• Blunt instrument used to probe into the
swelling to facilitate the drainage
• Have suction standing by
• Compress with fingers
Incision and Drainage
• Irrigate with Saline.
• No sutures are required, we want it to continue to drain through the open wound.
Dental Abscess
Post Operative
• Antibiotics:
• Amoxicillin + Clavulunate 875mg/125mg b.i.d x7days
• PenVK 500mg q6h x7-10 days
• Penicillin Allergy Only:
• Clindamycin 300mg t.i.d. x7 days
• If no Clinda available:
• Erythromycin 500mg q6h x 7-10 days
Dental Abscess
Post Operative
• NSAIDS
• 800mg Ibuprofen q6h with supplemental acetaminophen as needed.
• If ineffective:
• Narcotics to control pain
• Observe daily condition change.
Dental Abscess - Concern
• Space Infections
• If you can’t palpate a portion of the inferior
border of the mandible, they need OMFS ASAP
Submandibular Infraorbital
Luxations & Avulations:
• Let’s talk about splinting with all the lack of
splinting materials you have!
• I heard a rumor you have a putty…
Avulsed Teeth
• The tooth is dead.
• Goal:
• Protect the periodontal ligament.
Avulsed Teeth
• Proper handling of the teeth are important
• Only handle by the crown to the tooth.
• The tooth can be rinsed lightly with saline to
remove debris, but DO NOT scrub the tooth.
• Rinse tooth socket with saline.
• Properly orientate the tooth and place back into
socket.
Avulsed Teeth
• Splinting is important to help stabilize the
tooth if possible.
• Start on antibiotic regiment.
• Advise pt to avoid chewing or biting on
tooth until further treatment can be
administered.
Avulsed Teeth
• Transport mediums may be used when the
tooth cannot be replanted immediately.
- Milk, Saline, Saliva in a cup (or mouth is
you can trust them not to swallow it)
• Time is critical in the long term success of
the tooth. Replantation within the first 15
minutes has greater long time success.
• May need to agitate socket to remove blood
clot in order to place tooth back in.
What about luxations?
• Displaced, but still in the socket...
• Is the periodontal ligament protected?
Management of Dry Sockets
• Diagnosis is the key to the treatment of this emergency.
• Constant throbbing pain approx. 4-5 days post extraction is the typical symptom identified by patient.
• Patient may complain of radiating pain to his ear.
• Treatment consist of local anesthetic, irrigation with chlorhexidine and saline or sterile water, followed by the placement of a strip of Nu-Gauze dipped in eugenol.
Eugenol…
• What might you want to look for in the dental record before placing eugenol in the socket?
Management of Dry Sockets
• Remove excess eugenol and place gauze into
extraction socket.
• May need to anesthetize.
• Look in record for signs of nerve exposure at time
of surgery – No Eugenol !
• Replace gauze every 1-2 days until symptoms
subside. No antibiotics needed.
Management of Pericoronitis
• Pericoronitis is the inflammation of the
tissue surrounding the crown of the tooth.
This usually involves the third molars that
have not completely erupted into the mouth.
• The area will appear reddened and is tender
to touch. Patient will have a difficult time
chewing on the affected area.
Management of Pericoronitis
• Antibiotics should be used to help control the
spread of infection.
• Irrigation under the flap of tissue should be
performed if possible.
• Pt should avoid eating on that side of the mouth
and warm salt water soak every 3-4hrs is advised.
• NSAIDs for pain
Displaced Crowns
• The temporary or permanent crown has
come off the tooth.
• Before replacement, clean the internal and
external surface.
• Proper orientation is the key to proper
recementation. Try the crown on the tooth
to insure proper alignment.
Displaced Crowns
• Isolate the mouth with gauze to prevent pt
for swallowing the crown, if it slips out
your hand during recementation.
Displaced Crowns
• Dycal can function as tempoary cement.
• So can toothpaste :D
• Place a “small amount” in the crown.
Displaced Crowns
Fill crown approximately 1/3 full with dycal.
Drag material up to edges.
Excess spill can be cleanup up easily enough.
Displaced Crowns
• Place crown over tooth and hold with pressure,
can have patient bite & hold on cotton roll.
• Remove excess from around the tooth.
• WORK QUICKLY once mixed
What if the crown is broken, lost,
won’t stay on no matter how
many times I try?...
• Fuji IX bonds to dentin, to solve debilitating
sensitivity, you could cover the entire tooth
in Fuji.
• Do not try and rebuild a functioning tooth,
simply cover for pain relief.
Lost or Fractured Restorations
• The location of the tooth is important in
determining the type of temporary
coverage.
• Fuji fuji fuji fuji... Unless there’s some
pulpal show... Fuji fuji fuji fuji...
Lost or Fractured Restorations
• Isolation is extremely important in the
placement of the temp material. Place gauze
in the mouth on both sides of the involved
tooth.
Lost or Fractured Restorations
• Look at the tooth closely prior to placement
to determine were the Fx is and only place
temp in that area. It is not necessary to build
the tooth back to normal function. Leave
the tooth out of occlusion.
Jaw Fractures
Important Points
• Obvious trauma thus C-spine considerations
• Airway maintenance
• Hemorrhage control
• Prevent/control shock
Jaw Fractures
Clinical Diagnosis• Palpation:
Look for steps, depressions, crepitus, pain
• Exam for lacerations both intra- and extraorally
• Evaluate for Asymmetry
• Note any Discharge
• Nerve parathesia
Jaw Fractures
Clinical Diagnosis
Malocclusion: DO THE TEETH FIT TOGETHER
Jaw Fractures
Clinical Diagnosis
Sublingual ecchymosis (mandibular fx)
Jaw Fractures
Clinical Diagnosis
Easy Do-It Yourself Test:
•Mandible - Put finger on
lower arch, push down
while patient tries to
close
•Maxilla - Hold patient’s
nose, grab front teeth and
try to move them
Can’t bite.
Can’t fight.
Jaw Fractures
Jaw Fractures
• Antibiotics
• Fluids/Pain Management
• Apply Barton’s bandage
• Transport for definitive care
Jaw Fractures
Barton’s Bandage
My tooth hurts so bad doc, can’t
you just take it out?
QUESTIONS/COMMENTS
QUESTIONS/COMMENTS