SDCEP Management of Acute Dental Problems Flashcards
Most patients with an acute dental problem will have what symptoms?
- pain
- trauma
- swelling
- ulceration
- bleeding
- altered sensation or abnormal appearance
A patient presents to you with pain, what are the SDCEP flowchart steps that you should follow?
- Are there signs of MI or overdose?
- Is the pain due to trauma?
- Is there swelling?
- Is the pain in a tooth?
- Is the pain in an erupting tooth?
- Has analgesic been taken?
- Has analgesic controlled the pain?
What does SDCEP mean by emergency care in relevance to acute dental problems?
arrange for the pt to have contact with a clinical advisor within 60 mins & subsequent treatment within a timescale appropriate to situation severity
What does SDCEP mean by urgent care in relevance to acute dental problems?
advise the pt to seek dental or medical care as indicated within 24 hours unless condition worsens
What does SDCEP mean by non-urgent care in relevance to acute dental problems?
advise the pt to see a dentist within 7 days if required unless condition worsens
What does SDCEP mean by self care in relevance to acute dental problems?
the pt should be able to manage the problem without the need for further involvement of a HCW
A patient presents with swelling, what guidelines and pathways should you use to assess and treat this patient?
guideline = SDCEP management of acute dental problems
pathway = swelling pathway
A patient presents with swelling, what should you assess first?
- is the patient having trouble breathing?
- does the pt find it difficult to stick out/move their tongue?
- is the swelling closing the eye?
- has the swelling worsened in the last hour?
- is the swelling sudden & unexplained?
When should you contact emergency care for a pt with a swelling?
- swelling rapidly increasing
- swelling likely to obstruct airway or close eye
- pt is systemically unwell (rigors, high temp, dehydrated)
In pts with trauma, what would call for immediate emergency referral?
- head injury/loss of consciousness
- significant facial trauma
- compromised airway
- large lacerations/tongue lacerations
- altered jaw movement
- inhaled tooth/fragment
In a pt with ulceration, what would call for immediate emergency care according to SDCEP guidelines?
- signs of severe dehydration
In a pt with ulceration, what would call for urgent care according to SDCEP guidelines?
- ulcers present for > 3 weeks
- systemically unwell patients
What is an acute apical abscess, according to SDCEP guidelines?
acute inflammation of the soft tissues immediately surrounding the tip of the tooth root
- tooth decay & death of pulp
- trauma can also cause this
What is the initial management of an acute apical abscess according to SDCEP guidelines?
- determine if airway is compromised (can pt swallow their saliva & push tongue out)
Airway is compromised = emergency care via NHS 24 / 999
Airway is not compromised
- recommend optimal analgesia
- do not prescribe antibiotics unless systemic infection signs
- advise pt to seek urgent dental care
What is the subsequent care of an acute apical abscess after initial management according to SDCEP guidelines?
- drainage of abscess (either through affected tooth or incisional drainage)
- prescribe NSAIDs if unable to drain infection/pt says no
- relieving occlusion on affected tooth if appropriate
- XLA of tooth
What is acute pericoronitis according to SDCEP guidelines?
infection under the operculum (the gingiva tissue covering PE tooth)
What are the key signs & symptoms of pericoronitis according to SDCEP guidelines?
- pain
- swelling
- discomfort with swallowing
- limited mouth opening
- unpleasant taste or odour
- fever, nausea, fatigue
What is the initial management of acute pericoronitis, given that the airway is not compromised, according to SDCEP guidelines?
- optimal analgesia
- only prescribe antibiotics in cases of spreading systemic infection/immunocompromised
- advise pt rinse with 0.2% chlorhexidine mouthway
- advise pt to seek urgent dental care
What is the subsequent care of acute pericoronitis after initial management, according to SDCEP guidelines?
- ultrasonic scaling/or debridement around PE tooth under LA
- irrigate under flap with 0.2% chlorhexidine
- XLA of tooth if repeated episodes
What are the main acute periodontal conditions that patients may present to dental practises with?
- necrotising gingivitis & periodontitis
- periodontal abscess
- perio-endo lesions
What is the initial management of dentine hypersensitivity according to SDCEP guidelines?
- advise pt to avoid acidic foods or drinks & to obtain desensitising toothpaste and apply topically
- advise pt to seek non-urgent dental care to eliminate causes of other dental pain
What is the subsequent care of dentine hypersensitivity according to SDCEP guidelines?
- eliminate other causes of dental pain (e.g reversible pulpitis)
- consider topical therapies (e.g fluoride varnish, dentine bonding agents)
What is the initial management of pulpitis according to SDCEP guidelines?
- recommend optimal analgesia (NO ANTIBIOTICS)
- advise pt to seek non-urgent dental care
What is the subsequent care of reversible pulpitis according to SDCEP guidelines?
- provide a temporary dressing
- restore affected tooth
- remove worsening agents
What is the subsequent management of irreversible pulpitis according to SDCEP guidelines?
- first stage endodontic therapy
- XLA of tooth
What is alveolar osteitis (dry socket) according to SDCEP guidelines?
Osteitis (bone is exposed at extarction site & is inflamed) of a socket after a tooth is extracted. Patients who smoke are more at risk.
What is the initial management of alveolar osteitis according to SDCEP guidelines?
- recommend optimal analgesia
- advise pt to stop smoking & maintain good OH
- advise pt to seek urgent dental care
What is the subsequent care of alveolar osteitis according to SDCEP guidelines?
- irrigation with saline
- packing the socket with Alvogyl
- only prescribe antibiotics if there are signs of spreading infection, systemic infection or if immunocompromised
What is the initial management of post-extraction haemorrhage according to SDCEP guidelines?
- gently rinse mouth once with warm water to wash out excess blood
- advise pt to bite on moistened gauze for 20 mins
- if necessary repeat once (if pt taking anticoagulant send for emergency care)
- after bleeding has stopped advise pt to stop drinking alcohol, smoking or exercising for 24 hrs
- if bleeding is persistent send for emergency care
What is the subsequent care of post-extraction haemorrhage after initial management according to SDCEP guidelines?
- apply haemostatic dressing to socket (e.g oxidised cellulose Surgicell or haemocollagene sponge)
- suturing the wound
What is the initial management of oral ulceration according to SDCEP guidelines?
- if pt is dehydrated, advise emergency care
- determine how long ulcer has been present (more or less than 3 weeks)
< 3 weeks:
- advise 0.2% chlorhexidine mw
- rule out causes of trauma
> 3 weeks:
- refer to oral med
What underlying viral infections may cause oral ulceration?
- herpetic stomatitis
- hand, foot & mouth disease
- HIV
- chicken pox
- herpangina
What underlying bacterial infections may cause oral ulceration?
- syphilis
- tuberculosis
What is the initial management of cracked, fractured, loose or displaced tooth fragments and restorations according to SDCEP guidelines?
- if it is known/suspect pt has inhaled tooth, filling or restoration send pt for emergency care
- temporary dress open cavities/tooth fractures
- recommend analgesia
- advise pt to seek dental care
What serious condition can the presentation of ill-fitting or loose dentures be indicative of?
- stroke (poor muscle control)
- malignancy
What is the initial management of fixed orthodontic appliance problems according to SDCEP guidelines?
- remove any appliance components that are loose
- apply malleable wax onto any sharp parts causing trauma
- advise pt to seek orthodontic care
What is the initial management of removable orthodontic appliance problems according to SDCEP guidelines?
- take appliance out of pt’s mouth
- advise pt to seek non-urgent ortho care
