Managing emergencies

Question 0

What are some of the indications for relative aneasthesia?

Answer 0

Older than 3 years
Able to cope with taking bitewings
Mild to moderate anxiety only
Previous unpleasant experience
Able (and willing) to co-operate

Question 1

What should be done in an emergency situation involving a child?

Answer 1

Access and determine what management is needed

Provide the service comfortably at the practice or organise referral ass required

Question 2

What are the indications for general aneasthesia?

Answer 2

Too young to treat in dental chair
Multiple extensive carious lesions
Requiring multiple extractions
Unco-operative
Previous traumatic experience

Question 3

If a quick decision needed to be made, how should a deciduous tooth exhibiting signs of irreversible pulpitis be treated?

Answer 3

Extraction.

If sensitive to stiimulation and close to pulp with no radiographical radiolucency, a pulpotomy is indicated.

Question 4

HOw should an abcess or swelling be managed?

Answer 4

Take B/Ws or PA
1) If co-operative: extract
2) If anxious but potentially co-operative: Find out about RA options for extraction
3) If extraction not possible: Refer for management under RA/GA
Depending on the extent of the infection, can consider Ab.

Question 5

How should dental pain and infection be managed?

Answer 5

1) Irreversible pulpitis: Exo
2) Dental abcss: Exo
3) Buccal swelling: Exo +/- antibiotics
4) Facial swelling: Exo +/- antibiotics. Also check if suitable for referral to AWCH.
5) Facial swelling with systemic involvement:
Hospital admission, iv Ab, exo (possibly undder GA)

Question 6

What antibiotics to prescribe to a child with a severe superficial odontogenic infection?

Answer 6

Amoxycillin 12.5mg/kg up too 500mg oral tds 5 days
if sensitive to penicillin:
Clindamycin 7.5mg/kg up to 300mg orally tds 5 days
If unresponsive, add:
Metronidazole 10mg/kg up to 400mg orally bds 5 days

Question 7

How can pain management be achieved in a child suupposing hes to be reffered to AWCH?

Answer 7

NSAIDs
Ibuprofen (e.g. Nurofen):
-> 5-10mg/kg every 6-8 hours to a maximum of 2400mg
-> Take with food
Do not use aspirin in children under 15 (possible Reyes syndrome)

Question 8

What are the types of intra-oral soft tissue injjuries that can present?

Answer 8

1) Contusions (bruising)
2) Lacerations/ abrasions
- check for tooth remnants, debris needs to be carefully scrubbed off with antiseptic.
- Suture intra-oral lacerations and skin lacerations
3) Degloving
- Full thickness periosteal flap striped off the bone

Question 9

What can chin bruising indicate?

Answer 9

Degloving injiuries
Condylar fractures
Fracture of posterior teeth