Acute Dental Problems Flashcards
when should the timescale be for emergency care
within 60 minutes and then appropriate subsequent follow up treatment
when should the timescale be for urgent care
within 24 hours unless condition worsens
when should the timescale be for non-urgent care
within 7 days unless condition worsens
what should the timescale be for self care
patient can manage symptoms by themselves
when are antibiotics appropriate
when there is evidence of spreading or systemic infection or for a patient who is immunocompromised
what drugs that we prescribe might interact with warfarin
NSAIDs
azole antifungals
antibiotics
what type of drugs might result in myopathy if taken with azoles, erythromycin and clindamycin
statins
what disease can be exacerbated by use of NSAIDs
asthma
when a patient presents with acute dental problem what should the basic assessment entail of
medical history
clinical assessment
exam of oral mucosal tissue
encourage to attend again for review
if you did not know where to find information on drug interactions and dental drugs where could you look
SCDEP drug prescribing for dentistry
BNF drug interactions
if a patient presents with pain in the mouth or jaw what possible non-dental differential diagnosis must you consider
myocardial infarction
if a patient presents with jaw pain and has signs of MI or overdose what do you do
NHS24 or 999
if a child presents with pain in an erupting tooth what do you do
advise optimal analgesia, soft brushing and rinse after food
use self care unless it worsens
what do you do if a patient presents with pain and analgesia cannot control the pain
give urgent dental care
if an adult has pain in an erupting tooth what do you do
advise chlorhexidine mouthwash, optimal analgesia
urgent dental care
if a patient has pain due to recent extraction what is advised
analgesia
avoid smoking
maintain good OH
urgent dental care
if a patient presents with pain due to orthodontic appliance/sharp tooth or denture what is done
advise analgesia
remove sharp parts
non-urgent dental care
if a patient has pain from an ulcer what is done
advise analgesia
avoid stimuli
non-urgent dental care
why is chlorhexidine not suitable for children under 7
taste and limited ability to rinse without swallowing
what do you do if a swelling is rapidly increasing or obstructing the airway or close to the eye
emergency care 999 NHS24
what do you do if the patient is systemically unwell
emergency care 999 NHS24
what do you do if a swelling is slowly increasing in size and is hot or firm to touch
consider antibiotic prescribing
give urgent dental care
what do you do if the patient’s swelling is not increasing in size but is in pain
assess if systemic reason (MI) or consider overdose of medication
what do you do if a patient is bleeding from a recent extraction
advise rinsing with salt water
bite on wet gauze
maintain pressure for 20mins
what do you do if a patient is bleeding from recent extraction and is on blood thinners or is not on blood thinners but bleeding will not stop
emergency treatment
what do you do if a patient is bleeding but has not had an extraction/trauma
non urgent care if not persistent bleeding to assess dentally
emergency care if persistent bleeding
what do you do if a patient has had a head injury and dental trauma
emergency care
in what situations with trauma would a patient be sent to emergency care in hospital
head injuries
cannot open and close jaws
large lacerations
suspected inhalation of tooth
in trauma what situation is it best to be seen as soon as possible
avulsion of adult tooth
when would patients with ulcers be seen in emergency care
when they are dehydrated and showing signs of severe dehydration
if a patient with an ulcer for the first time is systemically unwell with multiple ulcers or is taking medication/have underlying medical condition what do we do
advise analgesia
send for urgent medical care
if a patient appears with sign of stroke what do you do
999
if the patient has altered sensation not due to dental treatment what do you do
give urgent care
if a patient has altered sensation probably due to recent dental treatment what do you do
advise to contact within 7 days if worsens
if a patient has abnormal appearance with white/red speckled lesions present for more than 3 weeks what do you do
refer to local rapid access pathway
what are the key signs and symptoms of acute apical abscess
pain
swelling of gingiva, face or neck
fever
lethargy
what is the initial management of acute apical abscess
determine if airway compromised - 999 if it is or analgesia and urgent dental care if not
what is the subsequent care of acute apical abscess
incise and drain
drain through canal and irrigate
advise analgesia (NSAIDs)
extract if appropriate
what is an acute apical abscess
acute inflammation of soft tissues surrounding the tip of the root of a tooth often caused by decay or pulp necrosis
what is acute pericoronitis
infection under operculum
what are the signs and symptoms of pericoronitis
pain
swelling
discomfort on swallowing
trismus
unpleasant taste/smell
fever
nausea
fatigue
what is the initial management of pericoronitis
determine if airway compromised
recommend analgesia
rinse with 0.2% chlorhexidine
advise to seek urgent dental care
what is the subsequent care for acute pericoronitis
debridement under operculum
irrigate with chlorhexidine
extract tooth if chronic
adjust occlusion if traumatising operculum
what are the main acute periodontal conditions
necrotising gingivitis
necrotising periodontitis
periodontal abscess
perio-endo lesions
what is a periodontal abscess
breakdown of periodontal tissues while there is closure of periodontal pocket not allowing drainage
seen in patients with untreated periodontitis
what are the signs and symptoms of necrotising periodontal disease
pain
swelling
bleeding
halitosis
ulcerated gingival tissue
loss of attachment
malaise
fever
what are the signs and symptoms of periodontal abscess
pain and tenderness
increased mobility
fever
swelling on gingiva
suppuration from gingiva
what is the care for necrotising periodontal disease
scaling
prescribe chlorhexidine
OHI
metronidazole possibly
what is the care for periodontal abscess
scaling
irrigating pocket
extraction
what is the initial management of dentine hypersensitivity
advise to avoid acidic foods and drinks, use desensitising toothpaste
seek non-urgent dental care
what is the subsequent care of dentine hypersensitivity
eliminate other causes of pain
apply desensitising toothpaste, consider fluoride varnish or dentine bonding agents
what is the care of reversible pulpitis
provide temporary dressing
restore affected tooth
what is the care of irreversible pulpitis
provide first stage endodontic therapy
extract tooth
what is the care of dry socket
irrigate with saline
pack with alvogyl
advise against smoking
what is the management of post-extraction haemorrhage
rinse and pressure on damp gauze
haemostatic dressing - surgicell
sutures
when an ulcer has been present for more than 3 weeks what do you do
refer to urgent care for cancer assessment
when an ulcer has been present for less than 3 weeks what do you
chlorhexidine mouthwash
consider medication causes/conditions
consider trauma
what is the initial management of fractured teeth
if inhaled 999
if open cavity buy temp dressing at pharmacy
recommend analgesia
urgent care if pain not relieved
what is the subsequent care for fractured teeth
smooth rough edges
provide palliative dressing
pulp therapy
extract if unrestorable
what is the care for fractured indirect restorations
recement restoration with temp
make replacement
provide new crown for a primary tooth
what is the initial management for trauma from fixed appliances
remove loose components
apply wax onto sharp bites
advise to seek care from orthodontist
what is the initial management for sinusitis
recommend analgesia
determine if bacterial - consider antibiotics if it is
if not bacterial then steam inhalation and see GP
if a patient presents with jaw fracture or lacerations inside the mouth what do you do
send to hospital
advise good OH and chlorhexidine
if a patient has TMJ pain what is initial management
recommend analgesia
consider diazepam
advise local heat packs/ice packs
have soft diet
seek non-urgent dental care
what is the subsequent management for TMJ pain
make splint
monitor symptoms
refer for specialist opinion if symptoms do not improve
what is the initial management of bells palsy
rule out stroke
protect eye with patch
advise to seek urgent medical care
what is the subsequent care of bells palsy
prednisolone (25mg 2x per day for 10 days)
refer to GMP
what do you do if you suspect salivary gland infection
analgesia
seek urgent medical care
what do you do if you suspect mumps
analgesia
stay at home
refer for urgent medical care
what do you do if there is an obstruction of a major gland without infection
analgesia
drink fluids
seek urgent dental care
what is the initial management of oral thrush
consider if they use steroid inhaler
systemic fluconazole or miconazole gel
what is the subsequent care of oral thrush
monitor symptoms
if does not respond send to GMP or specialist
what is the care of prolonged anaesthesia/altered sensation
treat if known cause
refer to specialist or monitor symptoms
what is angioedema
sudden swelling affecting areas of skin and mucous membranes
what is the initial management of angioedema
determine airway compromisation
what is the subsequent care of angioedema
follow up medical care to identify cause of angioedema and establish underlying medical condition
what can angioedema be caused by
allergic like response
what is osteonecrosis
exposed avascular bone
what is the initial management of osteonecrosis
recommend analgesia
advise patient to rinse with 0.2% chlorhexidine
advise to seek care
what is the subsequent care of osteonecrosis
minimise need for extractions and avoid MOS
refer to oral surgeon
what is peri-implantitis
inflammation affecting soft and hard tissues around implants leading to loss of bone support
what is the initial management of peri-implantitis
recommend analgesia
recommend good OH
advise to seek dental care
what is the subsequent treatment of peri-implantitis
assess patients progress including radiographic assessment
give appropriate OHI
consider debridement and irrigate with chlorhexidine
what is temporal arteritis
inflammation and damage to medium and large blood vessels of the head, typically affecting the superficial temporal arteries
what is the initial management of temporal arteritis
if visual disturbance refer for emergency medical care because high dose corticosteroid prescription without delay is likely to be required
what is trigeminal neuralgia
severe facial pain in the distribution of the trigeminal nerve
what is the initial management of trigeminal neuralgia
prescribe carbamazepine
seek medical care
what is the subsequent care of trigeminal neuralgia
monitor symptoms and response to medication at follow up appointments
refer to specialist
what is the prescription for paracetamol for mild to moderate odontogenic or post-operative pain
paracetamol 500mg
send 40 tablets
take 2 tablets 4 times daily
what is the prescription for ibuprofen
ibuprofen tablets 400mg
send 20 tablets
1 tablet four times daily, preferably after food
what is the carbamazepine prescription for trigeminal neuralgia
carbamazepine tablets 100mg
send 20 tablets
1 tablet twice daily
what is the prescription for benzydamine mouthwash for oral ulceration
benzydamine mouthwash 0.15%
send 300ml
rinse using 15ml every 1.5 hours as required
what is the benzydamine oromucosal spray prescription for oral ulceration
benzydamine oromucosal spray 0.15%
send 30ml
4 sprays onto affected area every 1.5hrs
what is the lidocaine ointment prescription for oral ulceration
lidocaine ointment 5%
send 15g
rub sparingly and gently on affected areas
what drugs can cause black hairy tongue
penicillin
tetracyclines
what drugs can cause gingival overgrowth
phenytoin
ciclosporin
nifedipine
what drugs can cause osteonecrosis of the jaw
bisphosphonates
what drugs can cause oral thrush
broad spectrum antibiotics
corticosteroids
immunosuppressants
what drugs can cause tooth discolouration
chlorhexidine
fluoride
iron
tetracyclines
