Management of the Paediatric Dental Emergency

Question 1

Infective agent

Answer 1

Viral
Bacterial
Fungal

Question 2

Vaccinations

Answer 2

DTP/ polio/ Hib (3 shots)
PCV, Rota virus
MenC
MenB
MMR
PCV
HPV
Men ACWY - 13-18yr
19-25 students Men ACWY
65 up PPV vaccine and flu
70 years shingles
Special:
-flu
-chickenpox
-TB
-hep B

Question 3

Herpes

Answer 3

Viral infection
Herpes simplex (primary herpes)
-virus lives in trigeminal ganglia
-tiny tiny ulcers all over mouth especially gingivae
** encore
Varicella-zoster
-chickenpox (lives in dorsal root ganglia)
–> no longer infectious until the last scar has dried up
-shingles (odd to get in a young person)

Question 4

MMR

Answer 4

Viral infection
Measles
-intraoral Koplok's spots (white)
-wide rash
Rubella
-dangerous to pregnant women
Mumps
-infection of salivary glands

Question 5

Cocksackie virus

Answer 5

Herpangina
-malaise
-intra-oral ulcers towards back of mouth, palate, pharynx
Hand foot and mouth disease
-rash hands, feet, buttock, and mouth
-ulcers?
-feel a bit unwell

Question 6

Epstein-Barr virus

Answer 6

Causes glandular fever

Swollen glands in head and neck

Question 7

Bacterial infections

Answer 7

Impetigo
Streptococcal (scarlet fever)
Cat scratch disease
ANUG
Actinomycosis
Meningitis

Question 8

Impetigo

Answer 8

Presents with red weeping sores on face
Infective
Easily treatable with steroid and antibacterial

Question 9

Scarlet fever

Answer 9

Red face

Strep throat

Question 10

ANUG

Answer 10

Acute necrotising ulcerative gingivitis
Used to be trench mouth
Fusiform spriochaetes
Lose dental papillae
Pocketing that heals
Really bad breath
Treatment: metronidazole and chlorhexidine
Immunocopromised/ malnourished: can be extremely damagaing and destructive

Question 11

Meningitis

Answer 11

Rash that doesn’t disappear with glass on it

Can be mistaken for teething

Question 12

Teething

Answer 12

Does it hurt?
Mystery - why would it
60% of parents report symptoms

Question 13

Dental abscess

Answer 13

5% of 5 year old population have one
Acute - potential to be life threatening
-spread through fascial planes and occluding airway
–> sublingual, submandibular, pharyngeal
-spread through blood (venous - ocular)
Extra-oral swelling/ big intra-oral swelling is a concern
Anyone with T over 38 degrees should be considered admitting to hospital

Question 14

Is the infection spreading?

Answer 14

Is eye starting to close?
Is the infection getting bigger
Trismus

Question 15

Examination

Answer 15

History of complaint
-symptoms, duration
-pain score, sleep, fluids
Medical history
Dental history
Social history

Question 16

Extraoral examination

Answer 16

Symmetry, swelling
Lymph nodes
Temperature
Rash

Question 17

Intraoral examination

Answer 17

Soft tissues
-ulcers
-form (swelling)
Colour
Hard tissues
-carious teeth
-colour of teeth
-bone

Question 18

Swelling/ ulcer

Answer 18

Site
Size
Surface
Texture
Colour

Question 19

Special investigation

Answer 19

Radiographs
Vitality tests
Bloods

Question 20

Infection tracking towards eye

Answer 20

Usually D

Permanent dentition: usually lateral incisor

Question 21

Age of child and systemic problems

Answer 21

In general the younger the child the more

likely they are to have systemic problems

Question 22

Primary herpes symptoms (covers herpangina and foot and mouth as they present similarly but not as severely)

Answer 22

• Fever
• Headache
• Malaise
• Mild dysphagia
• Lymphademopathy
• Oral ulceration (100s)
• Marginal gingivitis (bright red)

Question 23

Primary herpes severity

Answer 23

14 days duration
Recurrent herpes labialis (in 1/3 people)
Usually caught from mum at young age
Admission:
-dehydration
-fever

Question 24

Treatment for primary herpes

Answer 24

Fluids
Rest
Analgesics
Antipyretics
Chlorhexidine (tastes horrible so might be a problem giving to child)
Avoid cross-infection (difficult in household but fine because infection is self-limiting)
Antivirals

Question 25

Treatment of dental abscess

Answer 25

Drainage
Antibiotics if spreading infection
Antibiotic if systemic upset
Analgesic
Antipyretic
Follow-up
Does not require antibiotics

Question 26

Admission

Answer 26

Spreading infection
Trismus
Pyrexia
Malaise
Dehydration
Dysphagia

Question 27

Trauma

Answer 27

Head injury

Account for lost tooth

Question 28

Difficulties of local analgesia

Answer 28

Co-operation
< effectiveness - can’t dissociate in acid environment (infection)
-have to give a block instead
Risk of spreading infection
Must never inject into area of swelling where there may be pus
-increase pressure and could cause extrusion of pus/ bacteria into blood stream