Dental Fractures
Definition
• Ellis I: Enamel; Ellis II: Enamel + dentin; Ellis III: Involves pulp (+ bleeding)
Evaluation: Consider CXR in trauma pt for aspirated fragments
Management
• Dental blocks & oral analgesia
• Ellis I: Smooth sharp edges if needed, dental f/u in 2–3 d
• Ellis II: Cover w/ calcium hydroxide paste, zinc oxide paste, glass ionomer composites (pulp necrosis 1–7%), dental f/u in 24 h
• Ellis III: Cover w/ calcium hydroxide paste, zinc oxide paste, glass ionomer composites (pulp necrosis 10–30%)
• High risk infection. Rx abx.
• Need urgent (<24 h) dental f/u
• If bleeding → gauze soaked in epinephrine, inject lidocaine w/ epinephrine into pulp
Tooth Subluxation and Avulsion
Definition: Loose teeth or loss of teeth due to trauma
Evaluation: X-ray if mobility suggests alveolar fracture
Management
• Dental blocks & oral analgesia
• Minimal mobility: Soft diet 1–2 wk, dental f/u in 2–3 d
• Grossly mobile: Stabilize w/ periodontal paste or splint, dental f/u in 24 h
• Avulsion: Transport tooth in Hank’s solution or milk (preserves up to 8 h), do not clean tooth, replace tooth to socket w/ stabilization if w/i <60 min. Immediate dental consult w/ f/u in 24 h.
Dental Caries
Definition: Bacterial infection of hard tooth structure (enamel, dentin, & cementum)
Presentation: Tooth pain, poor dentition
Management: Dental block & oral analgesia, dental f/u in 1–2 d
Periapical Abscess
Definition: Bacterial infection of alveolar space
Presentation: Severe tooth pain, often fluctuant abscess
Management: Dental block. I&D if fluctuant. Abx (penicillin V or clindamycin), warm saline rinses, dental f/u in 1–2 d.
Acute Necrotizing Ulcerative Gingivitis (Trench Mouth)
Definition
• Polymicrobial infection of gums causing bleeding, deep ulcers, & necrotic gums
• RFs: Poor oral hygiene, local trauma, smoking, immunodeficiencies
Presentation
• Rapid onset diffuse mouth pain, halitosis, fever, gum bleeding
• Gingival erythema/edema, interdental papillae ulceration, gray pseudomembrane
Management: Oral anesthetic solution (viscous lidocaine), dilute hydrogen peroxide rinses QID, abx if extensive or systemic (penicillin, erythromycin), dental f/u in 1–2 d
Alveolar Osteitis (Dry Socket)
Definition: Irritation of bone exposed to the oral cavity after premature disintegration of blood clot 3–4 d after tooth extraction
History: Sudden onset, severe pain after dental extraction, foul odor/taste
Management: Dental block, oral analgesia, irrigate socket, pack w/ iodoform gauze soaked in medicated dental paste or eugenol. Abx (penicillin, clindamycin). Dental f/u in 1–2 d.