Dental Emergencies

Question 1

How many primary teeth do we have? How many permanent?

Answer 1

20 primary, 32 permanent
Both have central and lateral incisors, canine
Primary - 2 molars
Permanent - 2 premolars, 3 molars

Question 2

When do primary teeth erupt?

Answer 2

From 6 months to 2 years

Question 3

When do permanent teeth emerg?

Answer 3

6 years

Question 4

What is the Ellis classification of dental fractures?

Answer 4

Ellis I: enamel only
Ellis II: involves dentin
Ellis III: involves pulp
Ellis IV: alveolar fracure

Question 5

Where should you put an avulsed tooth (

Answer 5

In the primary socket

Question 6

What solutions are best for avulsed teeth?

Answer 6

Hank’s solution (right pH, can help regenerate)
Saliva
Milk
Saline (least effective)

Question 7

What is the management of dental fractures by Ellis classification?

Answer 7

Ellis I: file down (in ED or dentist)
Ellis II/III: cover with calcium hydroxide paste
Urgent dentistry F/U within 24h if Ellis III, 48-72h if II
Consider antibiotics in Ellis III

Question 8

When to consider IV abx in dental infections?

Answer 8

Facial cellulitis or spread to soft tissues, deep space neck infections

Question 9

What structure holds the tooth in place in the gum socket?

Answer 9

Periodontal ligament

connects cementum to alveolar bone

Question 10

What are 6 complications of odontogenic infections?

Answer 10

Ludwig's angina
Deep space neck infection
Cavernous sinus thrombosis
Orbital cellulitis
Periorbital cellulitis
Septic thrombophlebitis (Lemierre's syndrome)

Question 11

Which tongue lacerations should be considered for primary repair?

Answer 11

Full thickness
Significant gaping
Large lateral surface defect
Deep lacerations >1 cm into muscle layer
Significant hemorrhage
anterior split (forked)

Question 12

What physical exam finding suggests pulp involvement in dental fractures?

Answer 12

Bleeding

Question 13

What is the difference between pediatric and adults in Ellis II fractures?

Answer 13

The dentin in pediatrics is less developed that the pulp - more pulp, therefore Ellis II fractures need to be seen more urgently

Question 14

What is the name of the dental splint we use?

Answer 14

Coe-Pak

comes in 2 tubes - need to mix together

Question 15

What are important landmarks for an inferior alveolar nerve block?

Answer 15

Anterior border of mandibular ramus
Coronoid sulcus (depression) - landmarks the height of injection
Internal oblique ridge (more medial to coronoid sulcus) - go slightly medial to this
Pterygomandibular raphe (most medial structure, go lateral)
Point needle laterally, insert ~20 mm