Other oral health risk assessment
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.
Source: http://oralhealth.uchc.edu/files/Pocket%20Card%20Oral%20Emergencies.pdf
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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