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Tintinalli Section 19 - Eyes, ENT, and oral surgery > S19C240 - Oral and Dental Emergencies > Flashcards

S19C240 - Oral and Dental Emergencies Flashcards

1
Q

Normal adult teeth

A

32 permanent teeth

-8 incisors, 4 canines, 8 premolars, 12 molars

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2
Q

pericoronitis

A
  • inflammation of the operculum (gingival tissue) overlying the occlusal surface of an erupting tooth
  • can get food/debris beneath operculum that can result in infxn
  • tx: penicillin V 500mg PO QID
    • or clindamycin 300mg PO QID
    • irrigate food/debris from under operculum
    • saline mouth rinses
    • NSAIDS, opiates for pain
    • refer to dentist 24-48h
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3
Q

caries

A
  • erosion of tooth enamel by plaque bacteria
  • sensitive to cold/sweet stimulus
  • can spread along dentist the dental pulp leading to pulpitis
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4
Q

pulpitis

A
  • reversible: short pain lasting seconds
  • irreversible pulpits: pain lasts for minutes to hours
  • worse with heat/cold sweet/sour
  • tx: pcn 500mg PO QID or clinda if pcn allergy (may not help if irreversible and no obvious infection)
  • irreversible: root canal or dental extraction
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5
Q

periradicular periodontitis

A
  • extension of pulpitis into the root or apex of tooth
  • widening of periodontal ligament space, thinning of lamina dura, radiolucent area at root apex on XR
  • percuss tooth, may see swelling of gingiva with a draining fistula adjacent to the affected tooth (parulis)
  • tx: pcn V 500mg PO QID or clindamycin 300mg PO QID and analgesia
    • root canal or extraction
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6
Q

postextraction alveolar osteitis (dry socket

A
  • tx:
    • local/topical anesthesia
    • irrigate dental socket with NS
    • remove fluid with suction
    • inspect socket
    • pack with packing soaked in oil of cloves or eugenol (1/2inch ribbon gauze)
    • Abx: PCN V 500mg PO QID or clinda 300mg PO QID
    • refer to dentist w/in 24h for packing change
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7
Q

-postextraction bleeding

A
  • firm pressure is usually adequate, place gauze and have pt bite down for 20min
  • can apply absorbable gelatine sponge (gel foam) or surgical (regenerated cellulose), sutures, inject soft tissue with lido and epi, cautery with silver nitrate
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8
Q

Gingivitis

A
  • inflm and bleeding of gums from plaque accumulation along gingival margins
  • RF: hormonal variations (pregnancy, lpuberty), phenytoin, HIV, DM, Downs
  • gingival sulcus deepens causing periodontal pockets and periodontitis, more plaqye and calculus occur, bone loss occurs and tooth is lost
  • often painless but can have tender swollen gums
  • tx: plaque removal, Abx, dentist
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9
Q

Periodontal Abscess

A
  • severe pain
  • small abscess: warm saline rinse and pcn 500mg QID or clinda
  • large: I+D
  • can use chlorhexidine mouth wash (0.1%) short term, may discolor teeth long-term
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10
Q

ANUG - acute necrotizing gingivitis

A

-trench mouth (Vincent dz)
-ulceration of gingiva, can spread to adjacent structures
-dx triad: pain, ulcerations (punched out inerdental papillae), and gingival bleeding
-Sx: fetid breath, pseudomembrane formation, wooden teeth, foul metallic taste, tooth mobility, lymphadenopathy, fever, malaise
-ddx:
herpes usually has smaller vesicular eruptions, less bleeding, lack of interdental papilla involvement
-cause: treponema, fusobacterium, prevotella
-RF: HIV, poor hygience, stress, poor diet, poor sleep, caucasian,

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11
Q

Trigeminal neuralgia

A
  • 30-60yo, F>M
  • unilateral
  • excruciating, electric shocklike pain, short duration, pain-free inbetween
  • tic douloureux - contraction of facial and masticatory muscles
  • tirgger: physical stimulation of a trigger point
  • dx: clinical (exclude acoustic neuroma, aneurysm, nasopharyngeal carcinoma)
  • tx: carbamazepine (100mg BID and titrate up)
    others: phenytoin, gabapentin, baclofen, surgery
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12
Q

Oral Candidiasis

A
  • RF: extremes of age, dentures, malnourished, infection, Abx, immunocompromised, AIDS
  • pseudomembranous: white curd plaques, when scraped are erythematous base
  • atrophic/erythematous: dorsum of tongue (atrophy of filliform papillae)
  • hyperplastic candidiasis: raised white plaques that can only be partially removed
    tx: swich and swallow 500,000 units nystatin QID, or clotrimazole 10mg troches 5x daily, or fluconazole 100mg OD
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13
Q

Angular cheilitis

A

-perioral candidiasis, scaling patches of perioral facial tissue

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14
Q

Aphthous Stomatitis

A
  • cause: immune imbalance, breach of mucosa, allergic response
  • fibropurulent eschar, 2mm-2cm, painful, resolve spontaneously in 10-14d
  • tx: betamethasone syrup , 0.01% dexamethasone elixir as mouth rinse, or fluocinonide 0.05% gel applied topically
  • intralesion steroid injection
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15
Q

HSV

A
  • primary infection: herpes gingivostomatitis
  • may have fever and LA 3d prior to vesicles
  • tx: acyclovir 75mg/kg/d div 5 doses x7d (NMT 2g/d)
  • secondary infection: mostly lips affected
  • prodrome of burning and tingling, vesicles ruptures after 2-3d, ulcer heals in 6-10d
  • tx: acylcovier 400mg PO TID-5x d x5d OR valacyclovir 2g BID x1d
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16
Q

Varicella-zoster (chicken pox)

A

-primary infection: oropharynx vesicles may precede skin

  • herpes zoster: trigeminal nerve distribution 15-20% of time
  • prodrome of pain (toothache)
  • unilateral, don’t cross midline, lasts 7-10d
17
Q

Herpangina

A
  • coxsackievirus group A (1,6,8,10,22)
  • summer and autumn
  • sudden onset high fever, sore throat, h/a, malaise then 24-48h later oral vesicles 1-2mm in size which rupture and leave ulcers behind on soft palate, uvula, posterior pharynx and tonsillar pillars
  • buccal mucosa, tongue and gingiva normally spared
  • lasts 7-10d
  • distinguished from herpetic gingivostomatitis (HSV) by lack of gingival involvement
18
Q

Hand-foot-and-mouth Dz

A
  • coxsackie A16 and A4/5/9/10
  • development of a few small vesicles on tongue, gingiva, soft palate and buccal mucosa,rupture and create shallow painful ulcers with a surrounding red halo
  • buttocks, palms and plantar surfaces may also be affected
  • fever short duration
  • dz lasts 5-8d
  • supportive tx
19
Q

Pyogenic granuloma

A
  • benign proliferation of connective tissue from trauma/irritation on the gingiva
  • accumulation of granulation tissue
  • pyogenic granuloma in pregnancy = pregnancy tumor , if it does not resolve w/in 2-3mo postpartum it should be surgically removed
20
Q

Gingival hyperplasia

A

-phenytoin, nifedipine, cyclosporine, erythema multiforme

21
Q

Oral gonorrhea

A

-pharyngitis involving uvula and tonsils, may present w/o pustules/exudates

22
Q

Oral syphilis

A
  • chancre can occur
  • usually involves lips, may involve tongue or tonsils
  • secondary syphilis: oral lesions accompany skin lesions, multiple oval-shaped raised ulcers/erosions covered in gray membrane
23
Q

Geographic tongue

A
  • 1-3% of popn
  • well demarcated zones of erythema caused by atrophy of filiform papillae
  • asymptomatic
  • cause: stress
  • if symptomatic: fluocinonide gel (Topical steroid) several times daily
24
Q

strawberry tongue

A
  • strep pyogenes
  • prominent red spots on white-coated background
  • tx: abx
25
Q

leukoplakia

A
  • white patch that can not be scraped off
  • common oral precancer
  • RF: smoking, alcohol, UV, candidiasis, HPV, tertiary syphilis, trauma
  • commonly involves buccal mucosa
  • bx mandatory
  • lesions on floor of mouth, tongue, vermilion border are most likely to be cancerous

-erythroplakia (red patch) also very associated with cancer

26
Q

Oral Cancer

A
  • 90% of oral cancer is SCC
  • others: lymphoma, kaposi, melanoma
  • RF: tobacco, EtoH, UV, malnutrition, iron-deficiency, candidiasis, HIV, HPV, HSV
  • most common site is posterolateral border of tongue
  • bx anything that lasts >14d
27
Q

Dental fracture

A
  • goal: maintain pulpal vitality
  • tx: seal dentinal tubules and creat barrier b/w pulp and oral environment
  • 1-2% of pulps will necrose
  • Ellis I: enamel only, no tx indicated except to smooth charp corners, cosmetic concern only
  • Ellis II: involves dentin, sensitivity, can see exposed dentin (creamy yellow color), cover exposed dentin with gloss ionomer dental cement (place on dried dentin) and refer to dentist in 24h
  • Ellis III: blood can be seen from pup of tooth, pulp is exposed, cover pulp with calcium hydroxide base (dycal) and then cover remaining dentin with cement, dentist w/in 24h, may require root canal
28
Q

Dental #: root #

A
  • tenderness to percussion
  • may require XR to identify # (by dentist)
  • reposition coronal segment to original position and stabilize with a splint, refer to dentist w/in 24h, splint x4w
  • if
29
Q

Luxation of tooth

A
  • loosening of tooth

- 5 types: concussion, subluxation, extrusive luxation, lateral luxation, intrusive luxation

30
Q

Concussion of tooth

A
  • injury to supporting structures of tooth
  • tender but no mobility
  • minor, no need for splint, give NSAIDS, soft diet, refer to dentist
31
Q

Subluxation of tooth

A
  • injury resulting in mobility w/o XR evidence
  • no splint required, higher risk of subsequent pulpal necrosis
  • NSAIDs, soft diet, dentist
32
Q

Extrusive luxation

A
  • partial avulsion or dislodgement of tooth from alveolar bone
  • reposition tooth, splint, may require block
  • splint: noneugenol zinc oside (coe-pak) , try not to place on occlusal surface, or use a ribbon or calcium hydroxide paste, dentist w/in 24h, bond to 2 teeth to either side
33
Q

Lateral luxation

A
  • displacment of tooth laterally with concomitant # of alveolar bone
  • requires stabilization x4w
  • reduce tooth
  • refer to oral surgeon
34
Q

Intrusive luxation

A
  • displacement of tooth into its socket and associated alveolar fracture
  • damage to alveolar socket and periodontal ligament occur
  • root resorption occurs
  • allow tooth to erupt on its own or orthodontically extrude the tooth if no eruption in 3w
  • most serious of luxations
35
Q

Tooth Avulsion: care of tooth

A
  • reimplant ASAP (w/in 2-3h)
  • rinse tooth with NS or tap water
  • touch only crown portion of tooth
  • replace immediately into socket
  • transport media: salt solutions, NS, milk, saliva
36
Q

Tooth reimplantation

A
  • rinse clean, do not scrub or disrupt periodontal fibers
  • if apex was dry for 60min the periodontal cells are dead and goal is to reduce root resorption
  • remove clot from socket, irrigate gently, local anesthesia, reimplant with firm pressure
  • Abx: doxy 100mg BID or if
37
Q

Avulsion/Luxation primary teeth

A
  • avulsed primary teeth are NEVEr reimplanted
  • severe luxation often requrie extraction
  • avoid repositioning or reimplantation of primary teeth b/c it can affect permament teeth
  • let intruded teeth re-erupt
38
Q

Frenulum laceration

A
  • laceration of maxiallary labial frenulum only need repair if larger
  • lingual frenulum usually do need repair, 4.0 chromic

Tintinalli Section 19 - Eyes, ENT, and oral surgery (7 decks)

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