Management of the Paediatric Dental Emergency

Question 1

Infective emergency types

Answer 1

Viral
Bacterial
Fungal
Prion
Parasitic

Question 2

Vaccinations

Answer 2

Polio
Diphtheria 
MenB, C, PCV
MMR - 90% effective 
PCV
HPV
MenACWY
Td/polio booster
TB in some ethnic populations
Pneumococcal vaccine and flu 
Shingles 
Chickenpox
Hep B

Question 3

Viral - herpes

Answer 3

Herpes simplex (primary)
Varicella-zoster - chickenpox/shingles
- stimulus can activate it

Question 4

Viral - MMR

Answer 4

Measles
Kopek’s spots
Mumps
Rubella

Question 5

Viral
Cocksackie virus
Epstein-Barr virus

Answer 5

Herpangina
Hand foot and mouth

EBV - glandular fever

Question 6

Mechanism of viral infection

Answer 6

get infected by virus - acute phase may not occur so unaware
1/3 virus not redacted - stimulated by stress, trauma, uv light
virus lives in trigeminal ganglion
cold sore shows it is active

Question 7

Measles

Answer 7

Classic macular wide rash

Kopek’s spots - white spots inside mouth

Question 8

Mumps

Answer 8

Infection in salivary glands
Swellings lead to ears sticking out
Affects other exocrine glands

Question 9

Rubella

Answer 9

Unwell
Rash
Milder than measles
Teratogenic

Question 10

Herpangina

Answer 10

Malaise

IO ulcers towards posterior, palate and pharynx

Question 11

Herpes

Answer 11

Ulcers all over mouth and on gingivae

Question 12

Hand foot and mouth

Answer 12

Widespread rashes

Question 13

Bacterial - impetigo

Answer 13

Infective rash which can cover face. Weeping sores/spots

Question 14

Bacterial - scarlet fever

Answer 14

Reared face and sore throat
Maybe caused by streptococcus mutans
May be becoming less pathogenic

Question 15

Bacterial - cat scratch disease

Answer 15

Facial wound

Question 16

ANUG

Answer 16

Trench mouth
Bacterial - spirochetes
Treated with metronidazole and chlorohexidine

Question 17

Actinomyosis

Answer 17

Yellow exudate

Question 18

Meningitis

Answer 18

Rash that doesn’t go away with pressure

Question 19

Dental abscess

Answer 19

5% of 5 year olds have one

Question 20

Spread of abscess

Answer 20

Fascial plains - cellulitis from neutrophils is leaking --> oedema into tissues 
Sub lingual 
sub mandibular 
pharyngeal 
venous - bacterial 
ocular

Question 21

Examination

Answer 21

History of c/o
Symptoms, duration, pain score, sleep, fluids
MH
DH
SH
E/o - symmetry. swelling, lymph nodes, temperature, rashes
I/O
- soft tissues - swellings - towards eye - lateral incisor
- ulcers
- form
- colour
- hard tissues - carious teeth, colour and bone

Question 22

Swelling/ulcer

Answer 22

Site 
Size 
surface 
Texture
Colour

Question 23

Special investigations

Answer 23

Radiographs
Vitality tests
Bloods

Question 24

e.g1 Primary herpes

Symptoms

Duration

Treatment

Answer 24

Fever
Headache 
Malaise
Mild dysphagia 
Lymphadenopathy 
Oral ulceration - 100s
Marginal gingivitis - bright red 

14 days
Recurrent herpes labialis
Admission for dehydration and fever

Fluids
Rest 
analgesics 
antipyretics
chlorhexidine
avoid cross infection 
antivirals - only for those admitted

Question 25

Dental abscess

Tooth is non vital if abscessed

Answer 25

Drainage
Antibiotics if spreading infection 
Antibiotics if system upset
analgesic 
antipyretic
follow up

Question 26

Admission for?

Answer 26

Infection spread risk 
Trismus 
Pyrexia
Malaise 
Dehydration 
Dysphagia

Question 27

Difficulties of local analgesia

Answer 27

Co-operation
Decreased effectiveness
risk of spreading infection
In acidic environment, less likely to work as solution cannot dissociate
Injecting into area of infection can build pressure and send infection into blood stream
e.ginfected D - inject into mesial and distal

Question 28

Trauma

Head injury?

Answer 28

Account for missing tooth