PAIN OF DENTAL ORIGIN ORAL TRAUMA Traumatized permanent teeth Reversible pulpitis
• Tooth is not mobile/displaced but tender on biting
• Transient pain with hot, cold or sweet stimuli
Irreversible pulpitis
• Tooth is loose with some displacement
• Tx = Repositioning, splinting, +/-root canal
• Spontaneous, prolonged, poorly localized pain
Periapical periodontitis
• Tx = Repositioning, splinting, +/-root canal
• Cavity causes pulp necrosis & periapical inflammation
Examination
• More complications than for other luxations
• Spontaneous, prolonged, localized pain, tooth
• Irrigate to remove blood, clots, and debris
Periapical abcess
- Hold tooth by crown only, DO NOT touch root
• Localized purulent form of periapical peridontitis
• Spontaneous, prolonged, localized pain, tooth
• Tx = I and D if ‘pointing’; no antibiotics unless
- Check Tetanus status; booster if necessary
- Rx Penicillin (Erythromycin if allergic)
- See dentist immediately for radiograph,
Cellulitis
Periapical periodontitis involves soft tissue
• If can’t re-implant on scene, transport in saline,
Tx = Rx Pencillin: Adults 500mg tid; Children
50mg/kg per day divided (Erythromycin if
Traumatized primary teeth
• Do not assume missing teeth are lost at scene
Pericoronitis
• Consider x-ray to determine if missing teeth are:
• Luxated teeth that are very loose or interfering with
• Food and bacteria under gum of erupting molar
• Tx = irrigation; removal of gum flap; or extraction
• Luxated teeth that are not too loose are monitored
- intruded into sinus or other structures
• Intruded teeth are variable and often grow back out;
* While waiting for definitive treatment, treat pain
should be evaluated and monitored by a dentist
adequately, and counsel to avoid aggravating
Fractured Teeth Alveolar Bone Fractures ORAL EMERGENCIES
• Often associated with gingival laceration
POCKET CARD
Palpate alveolar ridge for step-offs (can often see
teeth are at different heights in mouth)
Hugh Silk MD, Alan Douglass MD, Joanna Douglass BDS
• Segmental alveolar fractures move when assessing
A product of the STFM Group on Oral Health
• Tx = Oral surgeon referral within 1 hour. Reduction
The information on this card should not substitute for consultation with an oral health expert. Chin trauma GENERAL PRINCIPLES
Tx = Dental referral non-urgently to smooth rough
Tooth fracture (including posterior teeth)
Oral piercings
• Tx = Dental referral with 12 hours for restoration to
Treat pain with narcotics, NSAIDs and acetaminophen.
INJURY PREVENTION: MOUTH GUARDS PERMANENT TOOTH CHART
Pulp will be visible (either bleeding or pale pink)
• Mouth guards should be worn for all sports with
For describing teeth when charting or talking to
risk of high impact accidents which include:
• Tx = Immediate dental referral for root canal
treatment, restoration and long term monitoring or
• Tooth may or may not be mobile depending on
(Note: falls, violence, and MVAs are also high risk
• Other traumatic tooth injuries may be present
• Tx = Immediate dental referral for splinting, root
- Boil and Bite: better fit, best fabricated with
*If fragments available, keep hydrated in saline or milk
- Custom: most expensive; made by dentist; best
fit/protection and most likely to be worn.
IN THE TRIBUNAL OF THE PENSION FUNDS ADJUDICATOR PRELIMINARY RULING IN TERMS OF SECTION 30J OF THE PENSION FUNDS ACT OF 1956 This is a complaint lodged with the Pension Funds Adjudicator in terms ofsection 30A of the Pension Funds Act relating to the fund’s refusal to admit thecomplainant’s claim for a disability benefit. No hearings were conducted andtherefore in determining this mat
An Iranian family with congenital myasthenic syndrome caused by a novel acetylcholine receptor mutation (CHRNE K171X) P Soltanzadeh, J S Müller, A Ghorbani, A Abicht, H Lochmüller and A Soltanzadeh J. Neurol. Neurosurg. Psychiatry doi:10.1136/jnnp.2004.059436 Updated information and services can be found at: References This article cites 5 articles, 3 of which can be accessed free a
Fractured Teeth