ATRAUMATIC DENTAL EMERGENCIES

Question 1

DDx

Answer 1

Dental cary
Pulpitis
Gingivitis
Pericoronitis
Dental Abscess / Cellulitis
Acute Necrotizing Gingivitis
Deep Space Infection (Ludwig’s Angina, Septic Cerebral Thrombosis)
Post-extraction alveolar osteitis (Dry Socket)

Question 2

DOCUMENTATION

Answer 2

HISTORY
Pain triggers
Heat and Cold Sensitivity
Pain with chewing
Bleeding gums

RED FLAGS
Fever
Trismus
Stridor
Drooling
Severe Neck Pain / Stiffness

PHYSICAL EXAM

HEENT / NECK:
Blunting of the inferior border of the mandible
Erythema / Swelling under the chin
Neck LAD
Neck ROM

DENTITION:
Carries
Brown / Black / White staining
Tooth Elevation
Gingival Swelling
Mobile Tooth
Tooth Tap
Red / Swelling / Tender Gingiva
Fluctuance
Trismus < 2.5 cm
Elevation of the foor of the mouth

Question 3

MANAGEMENT

Answer 3

ANTIBIOTICS
Cellulitis, Abscess, Deep Space Infection

First line: Clindamycin 300mg po q8h or Penicillin VK 250-500mg po q6h
If severe infection then consider

Amoxicillin/Clavulinic acid 875/125 q12h or add metronidazole 500mg po q8h to first line

Complicated/systemic infection– Piperacillin/tazobactam or Clindamycin + Ceftriaxone

DISPOSITION
Follow up with Dentist