S19C240 - Oral and Dental Emergencies Flashcards
1
Q
Normal adult teeth
A
32 permanent teeth
-8 incisors, 4 canines, 8 premolars, 12 molars
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
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
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
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
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
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
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
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
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,
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
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
13
Q
Angular cheilitis
A
-perioral candidiasis, scaling patches of perioral facial tissue
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
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
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
