Dentistry

Question 1

Review the layers of a tooth.

Answer 1

Outermost: enamel (white, hard)
Middle: dentin (gray, soft)
Innermost: pulp (pink, soft)

Question 2

What is the Ellis classification of tooth injury?

Answer 2

Ellis I: chipped enamel
Ellis II: chipped enamel with involvement of the dentin
Ellis III: chip that goes through the enamel and dentin and involves the pulp

Question 3

Why is an Ellis III tooth injury more serious (other than because it’s deeper)?

Answer 3

There can be pulpitis, or infection of the pulp. These usually involve consulting or urgent referral to dentistry.

Question 4

The medical term for misalignment of the bite is ______________.

Answer 4

malocclusion

Question 5

Acute pain 3-5 days after a tooth extraction in an otherwise healthy patient (i.e., normal vitals) is likely what?

Answer 5

alveolar osteitis (aka dry socket)

This occurs when the healing clot is dislodged and the root of the tooth is exposed to air. Local osteomyelitis can develop.

Question 6

How do you treat alveolar osteitis?

Answer 6

Irrigate, cover with dental paste, and pack with iodoform gauze (and give them more to take home)

If it seems infected (extra foul odor, pus) then cover with antibiotics.

Question 7

At which layer of tooth depth do you need to add antibiotics if chipped?

Answer 7

Pulp

Question 8

Review the presentations of periapical abscess, periosteitis, alveolar osteiitis, and dental caries.

Answer 8

• Periapical abscess: pain with manipulation of a tooth +/- purulent gingiva swelling. This is a mild, localized infection of the tooth.
• Periosteitis: localized pain after tooth extraction. Occurs within the first 3-4 days after extraction.
• Alveolar osteitis: “dry sockets” – a local infection after a tooth extraction caused by premature removal of a socket clot. Malodorous discharge and pain.
• Dental caries: chronic decalcification the tooth. Mild pain.

Question 9

Review the presentations of periapical abscess, periosteitis, alveolar osteiitis, and dental caries.

Answer 9

• Periapical abscess: pain with manipulation of a tooth +/- purulent gingiva swelling. This is a mild, localized infection of the tooth.
• Periosteitis: localized pain after tooth extraction. Occurs within the first 3-4 days after extraction.
• Alveolar osteitis: “dry sockets” – a local infection after a tooth extraction caused by premature removal of a socket clot. Malodorous discharge and pain.
• Dental caries: chronic decalcification the tooth. Mild pain.

Question 10

Oral SCC usually presents as what?

Answer 10

Ulcerated lesions of varying depth

Question 11

Review the management of post-extraction bleeding (assuming no coagulopathy).

Answer 11

1: direct pressure for 30 minutes
2: injectable lidocaine w/ epinephrine
3: absorbable hemostatic dressing with overlying figure-of-8 stitch

Question 12

After what time is tooth reimplantation rarely successful?

Answer 12

1 hour, maybe more if soaked in saline or milk