Management of the paediatric dental emergency

Question 1

What are the special vaccines?

Answer 1

Flu,
Chicken pox
TB
Hep b

Question 2

What are the different forms of the herpes virus?

Answer 2

Herpes simplex (primary herpes) and Varicella-Zoster (chicken pox and shingles)

Question 3

How does Herpes simplex present?

Answer 3

1/3 of people go on to get cold sores when exposed to certain stress
Virus lives in trigeminal ganglion

Question 4

When is chicken pox no longer infective?

Answer 4

When last scab healed up

Question 5

How does measles present?

Answer 5

Koplik’s spots
Mapular wide rash
intraorally get white spots on cheeks

Question 6

How does mumps infections present?

Answer 6

Infection of the salivary glands - painful parotids
Ears stick out
Can effect exocrine glands

Question 7

How does rubella present?

Answer 7

Feel unwell and have a rash not as dangerous as measles

If pregnant can cause damage to unborn child

Question 8

What is Cockasackie virus?

Answer 8

Herpangina, Hand foot and mouth diease

Question 9

How does herpangina and Hand foot and mouth disease present?

Answer 9

Herpangina - fell unwell, intra-oral ulcers - but dont feel as unwell as herpes simplex
Hand foot and mouth - rash in oral mucosa and elsewhere, children feel unwell adults cant feel it

Question 10

What is Epstein- Barr virus?

Answer 10

glandular fever

Malaise, swollen glands in head and neck

Question 11

What are the different bacterial dieases of children?

Answer 11

Impetigo - spots/sores on face
Streptococcal (scarlet fever) - red face and sore throat
Cat scratch disease
ANUG - from fusiform and spirocheates - pocketung heals, lose papilla, mouth hurts, bad breath
Actinomycosis - yellow exudate
Meningitis

Question 12

What is problem if have an acute abscess?

Answer 12

in children can be life threatening

Question 13

What is the problem with an abscess that spreads via fascial plains?

Answer 13

Sunlingual, sub-mandibular, pharyngeal

Can occlude airway - caused by inflammation/tissue fluid

Question 14

What is the problem with an abscess that spreads via venous route?

Answer 14

Ocular - brain abscess and die

Question 15

What do you do on examination for child presenting with an abscess?

Answer 15

History of complaint - symptoms, duration, pain score, sleep, fluid intake
MH
DH
SH

Question 16

What do you look for on extra-oral examination?

Answer 16

Symmetry, swelling, lymph nodes, temp >38

Rash, spreading infection, trismus, eye starting to close

Question 17

What do you look for on intra-oral examination?

Soft/hard tissues

Answer 17

Soft tissues: ulcers, swelling/form of abscess, colour

Hard: carious teeth colour of teeth, bone

Question 18

What do you examine specifically about the swelling?

Answer 18

Site, size, surface, texture, colour

Question 19

What special investigations do you do if child presents with abscess?

Answer 19

Radiographs
vitality tests
Bloods

Question 20

What are the symptoms of primary herpes?

Answer 20

Fever
Headache
Malaise 
Mild dysphagia
Lymphadenopathy
Oral Ulceration
Marginal gingivitis - bright red

Question 21

What is the duration of primary herpes

Answer 21

14 days

Question 22

Why would you need admission with primary herpes?

Answer 22

Dehydration - lack of fluids

Fever - temp >38

Question 23

What is the treatment for primary herpes?

Answer 23

Fluids rest, analgesics, antipyretics, chlorhexidine, avoid cross-infection, antivirals

Question 24

What is the treatment for dental abscess?

Answer 24

Drainage
Antibiotics if spreading infection 
Antibiotics if systemic upset
Analgesic
Antipyretic 
Follow up

Question 25

When need admission for abscess?

Answer 25

Spreading infection
Trismus 
Pyrexia
Malaise
Dehydration 
Dysphagia

Question 26

What are the difficulties with analgesia?

Answer 26

Co-operation
Decreased effectiveness
Risk of spreading infection - pus and bacterial infection

Question 27

When may trauma need addmission?

Answer 27

Head injury

Account for tooth loss