Dental emergency Flashcards
what do you use to take a pain history
socrates
If there is an periapical radiolucency, no normal response to EPT, pain on precussion, no localised deep pocketing and intra oral swelling
what is the diagnosis
acute apical abscess
If there is an periapical radiolucency, no normal response to EPT, pain on precussion, no localised deep pocketing and no intra oral swelling
what is the diagnosis
symptomatic apical periodontitis
If there is an periapical radiolucency, no normal response to EPT, pain on precussion, localised deep pocketing and localised vertical bone loss
what is the diagnosis
primary endodontic lesion or root fracture
If there is an periapical radiolucency, no normal response to EPT, no pain on precussion, swelling or draining sinus tract
what is the diagnosis
chronic apical abscess
If there is an periapical radiolucency, no normal response to EPT, no pain on precussion, no swelling or draining sinus tract
what is the diagnosis
asymptomatic apical periodontitis
If there is an periapical radiolucency, normal response to EPT, no pain on precussion
what is the diagnosis
potential cracked tooth
If there is an periapical radiolucency, normal response to EPT, pain on precussion, and suppuration from pocket
what is the diagnosis
periodontal abscess
If there is an periapical radiolucency, normal response to EPT, pain on precussion, and no suppuration from pocket
what is the diagnosis
occlusal trauma
what is the first line of antibiotic for periapical abscess
- amoxicillin 500mg TDS for 5 days
- metronidazole (allergy to penicillin) 400mg TDS for 5 days
what is the second line of antibiotic for periapical abscess
- clindamycin 150mg QDS for 5 days
- co-amoxiclav 375mg TDS for 5 days
- clarithromycin 250mg BD for 7 days
what is the first line of antibiotic for periodontal abscess
- metronidazole 400mg TDS for 5 days
- amoxicillin (allergy to metronidazole) 500mg TDS for 3 days
what is the second line of antibiotics for periodontal abscess
- clindamycin 150mg QDS for 5 days
- co-amoxiclav 375mg TDS for 5 days
- clarithromycin 250mg BD for 7 days
what is the first line of antibiotic for necrotising periodontal disease or pericoronitis
- metronidazole 400mg TDS for 3 days
- amoxicillin (allergy to metronidazole) 500mg TDS for 3 days
what is the first line of antibiotic for sinusitis, dry socket, oro-antral communication and sialadenitis
- metronidazole 400mg TDS for 7 days
- doxycycline (allergy to metronidazole) 100mg 2 caps 1st day the OD for 7 days
what are some indications for antibiotics
limited mouth opening, facial swelling, systemic infection, immunocompromised patient, elevated temperature >38 degrees
what are the immediate management of adults with dental infections
establish drainage, extirpate, debride pockets, prescribe antibiotics, recommend appropriate analgesia routine, consider extraction
when would you refer to A&E/maxillofacial department
difficulty breathing, involvement of orbital area/closure of eye, difficultly in swallowing/unable to stick tongue out, swelling rapidly increasing in size, evidence of infection of facial spaces
what are the differential diagnosis for pain after extraction
dry socket, retained root/bone fragment, infection, LA related trauma, haematoma, MRONJ, OAC, ORN, fractured maxillary tuberosity, step deformation, dislocated/fractured mandible
what is the management of a cracked tooth when the crack doesn’t extend to the pulp chamber floor
restore with composite, copper bond or temporary crown with occlusal reduction, assess after 2-3 months or earlier if symptomatic, if symptomatic, RCT +/- crown or XLA if hopeless prognosis
what is the management of a cracked tooth when the crack is subgingival and insufficient coronal tissue
extract
what is the management of a cracked tooth when the crack extends to pulp chamber floor but is restorable
RCT +/- crown
what are the symptoms of pericoronitis
pain on biting, localised, pyrexia
what are the signs of pericoronitis
inflammed operculum, sigsn of trauam (keratosis, ulceration), trauma from opposing tooth, intra/extra oral swelling, lymphodenopathy
what are the treatment/management options
debride area around inflamed tooth, irrigate with saline and instruct patient on OH routine, consider adjusting traumatic occlusion or removing operculum or opposing tooth, prescribe antibiotics if indicated, extract tooth
what are the risk factors of dry socket
smoking, alcohol, immunocompromised, oral contraceptive, mandibular teeth, posterior teeth, previous dry socket, poor compliance with POI, traumatic extraction
what are the signs and symptoms of dry socket
pain 24-48 hours after extraction, inflamed non-healing socket, lost. blood clot, trapped food debris or bad taste/odour
what is the treatment/management of dry socket
curettage the socket, irrigate with saline and instruct targeted OH, pack the socket with a eugenol based dressing (alvogyl) review after 1 week
