Management of the Paediatric Dental Emergency Flashcards
Infective agent
Viral
Bacterial
Fungal
Vaccinations
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
Herpes
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)
MMR
Viral infection Measles -intraoral Koplok's spots (white) -wide rash Rubella -dangerous to pregnant women Mumps -infection of salivary glands
Cocksackie virus
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
Epstein-Barr virus
Causes glandular fever
Swollen glands in head and neck
Bacterial infections
Impetigo Streptococcal (scarlet fever) Cat scratch disease ANUG Actinomycosis Meningitis
Impetigo
Presents with red weeping sores on face
Infective
Easily treatable with steroid and antibacterial
Scarlet fever
Red face
Strep throat
ANUG
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
Meningitis
Rash that doesn’t disappear with glass on it
Can be mistaken for teething
Teething
Does it hurt?
Mystery - why would it
60% of parents report symptoms
Dental abscess
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
Is the infection spreading?
Is eye starting to close?
Is the infection getting bigger
Trismus
Examination
History of complaint -symptoms, duration -pain score, sleep, fluids Medical history Dental history Social history
Extraoral examination
Symmetry, swelling
Lymph nodes
Temperature
Rash
Intraoral examination
Soft tissues -ulcers -form (swelling) Colour Hard tissues -carious teeth -colour of teeth -bone
Swelling/ ulcer
Site Size Surface Texture Colour
Special investigation
Radiographs
Vitality tests
Bloods
Infection tracking towards eye
Usually D
Permanent dentition: usually lateral incisor
Age of child and systemic problems
In general the younger the child the more
likely they are to have systemic problems
Primary herpes symptoms (covers herpangina and foot and mouth as they present similarly but not as severely)
- Fever
- Headache
- Malaise
- Mild dysphagia
- Lymphademopathy
- Oral ulceration (100s)
- Marginal gingivitis (bright red)
Primary herpes severity
14 days duration Recurrent herpes labialis (in 1/3 people) Usually caught from mum at young age Admission: -dehydration -fever
Treatment for primary herpes
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
Treatment of dental abscess
Drainage Antibiotics if spreading infection Antibiotic if systemic upset Analgesic Antipyretic Follow-up Does not require antibiotics
Admission
Spreading infection Trismus Pyrexia Malaise Dehydration Dysphagia
Trauma
Head injury
Account for lost tooth
Difficulties of local analgesia
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
