paeds dental emergency

Question 1

What are infective causes of emergencies?

Answer 1

VIRAL- herpes simplex (primary), varicella-zoster (chicken pox, shingles), MMR (measles- kopliks spots in mouth), cocksackie (herpangina, hand foot and mouth disease, Epstein Barr)

BACTERIAL- impetigo (ulcer continually weeps- spreads easily), streptococcal (scarlet fever), cat scratch disease, ANUG (v bad halitosis, usually smoking), meningitis

FUNGAL

Question 2

What is a dental abscess?

Answer 2

Facial swelling, pain, acute/long-standing

Can spread to fascial plains (sublingual, submandibular, pharyngeal) or venous (ocular, intracranial)

Question 3

How do you do an examination for an abscess?

Answer 3

HPC
MH
DH
SH

EO- symmetry, swelling, lymph nodes, temp, rash
IO- ulcers, form, colour, carious teeth, colour of teeth, bone

Swelling/ulcer- site, size, surface, texture, colour

Special investigations- radiographs, vitality, bloods

Question 4

How does a child present with primary herpes?

Answer 4

Pyrexia- >38C concerning
Headache
Malaise
Mild dysphasia (important to drink lots of fluids)
Lymphadenopathy
Oral ulceration (small all over mouth)
Marginal gingivitis

14 days duration
Recurrent herpes labialis (1/3)
Admission (dehydrated, <38C fever)

Question 5

How do you manage primary herpes?

Answer 5

Fluids (sugary)
Rest
Analgesics
Antipyretics
Chlorhexidine (not nice)
Avoid cross infection
Antivirals (acyclovir)

Question 6

How do you manage a dental abscess?

Answer 6

Drain (gingival incision, immediate relief, access tooth)
Antibiotics if spreading infection/systemic upset (only if significant)
Analgesics
Antipyretics
Follow up

Question 7

When should you admit a pt with dental abscess?

Answer 7

Spreading infection
Trismus
Pyrexia >38C
Malaise
Dehydration
Dysphasia

Question 8

What are difficulties with local analgesia for x when there’s infection?

Answer 8

Cooperation
Decreased effectiveness (doesn’t work as well in acidic environment)
Risk of spreading infection (due to pressure- block don’t infiltrate or infiltrate around site)

Question 9

What do you do with dental trauma?

Answer 9

Have they got head injury (dizziness, feeling sick, period of unconsciousness, confusion)
Account for lost tooth (could have gone into lung, if unconscious)