Management of the Paediatric Dental Emergency

Question 1

Types of infection?

Answer 1

Viral
Bacterial
Fungal

Question 2

What are children vaccinated against?

Answer 2

DTP
Polio
Men B and C
PCV
MMR
HPV
Polio booster

Question 3

Name the types of special vaccinations

Answer 3

Flu
Chicken pox
TB
Hep B

Question 4

Examples of viral infections?

Answer 4

Herpes simplex
Varicella-zoster
- Chicken pox
- Shingles

MMR: =

• Measles (impacts salivary glands) - Koplik’s spots
• Mumps
• Rubella

Cocksackie virus

• Herpangina = intraoral ulcers towards posterior hard palate (where as herpes all over the mouth)
• Hand foot and mouth disease = ulcers on oral mucosa, rash on hands and feet
• EBV (glandular fever) - swollen glands in head and neck

Question 5

Examples of bacterial infections?

Answer 5

Impetigo
Streptococcal (scarlet fever - red face and sore throat)
Cat scratch disease
ANUG = mouth hurts and necrotic papilla, halitosis
Actinomycosis
Meningitis

Question 6

When would you consider ANUG as a diagnosis?

Answer 6

If good OH and non-smoker

Question 7

When can dental abscesses become fatal?

Answer 7

Spread through fascial planes:
Sublingual
Submandibular
Pharyngeal

Bacterial spread through blood

Question 8

What questions to ask to dictate how severe an abscess is?

Answer 8

Temp over 38?
Is swelling spreading?
Trismus?
Are their eyes starting to close?

Question 9

How to examine a child pt?

Answer 9

History of complaint
- Symptoms, duration
- Pain score, effecting sleep, effecting fluid intake
Med history
Dental history
Social history

Question 10

How to do an extraoral exam on a child?

Answer 10

Symmetry, swelling
Lymph nodes
Temp
Rash

Question 11

How to do an intraoral exam on a child?

Answer 11

Soft tissues

• Ulcers
• Form (Swelling)
• Colour

Hard tissues

• Carious teeth
• Colour of teeth
• Bone

Question 12

What info to log regarding an ulcer?

Answer 12

Site
Size
Surface - smooth, rough, ulcerated
Texture
Colour

Question 13

What special investigations to do?

Answer 13

Radiographs
Vitality tests
Bloods

Question 14

Signs and symptoms of primary herpes?

Answer 14

Fever
Headache
Malaise
Mild dysphagia
Lymphadenopathy
Oral ulceration
Marginal gingivitis 
14 days duration
Dehydrated

Question 15

How to recover from primary herpes?

Answer 15

Fluids
Rest
Analgesics
Antipyretics
Chlorhexidine
Avoid cross infection
Antivirals (if admitted)

Question 16

How to treat a dental abscess?

Answer 16

Drainage - if yellow point use a scalpel, through the tooth and extraction
Extraoral or large intraoral swelling that’s spreading = Antibiotics if spreading infection
Antibiotics if systemic upset
Analgesic
Antipyretic
Follow up

Question 17

When to admit a pt?

Answer 17

Spreading infec
Trismus
Pyrexia
Malaise
Dehydration
Dysphagia

Question 18

Difficulties of LA?

Answer 18

Co-operation
Decreased effectiveness
Risk of spreading infec

Question 19

Where should you never inject with LA?

Answer 19

Into the swelling or abscess

Question 20

What to do if the child has a head injury?

Answer 20

Check for head injury

Account for lost tooth