Dental

  • Avulsed Tooth Reimplantation/Splinting
  • Dental Abscess I&D
  • Dry Socket Management
  • Fractured Tooth Management
  • Temporomandibular Joint Dislocation Reduction

Avulsed Tooth Reimplantation/Splinting

  • Background
    • Avulsed teeth are those that are completely dislodged from the socket. An avulsed tooth should be manually reinserted into it’s socket and immobilized with a temporary splint in order to promote restoration of the periodontal ligament. Every minute that the tooth is not reimplanted, viability reduces by 1%.
  • Indications
    • Avulsed permanent tooth.
  • Contraindications
    • Primary tooth involvement, significant socket damage, grossly decayed tooth, intruded tooth (pushed deeper into socket)
  • Complications
    • Unsuccessful reimplantation, tooth contaminated with dirt may cause tetanus.
Video Credit: The Dental Box

*Deep Dive: How To Replace and Splint an Avulsed Tooth (Merck Manual)



Dental Abscess I&D

  • Background
    • Dental abscesses may be periapical (root of the tooth) or periodontal (in the gum). Incision and drainage helps provide analgesia and limit deeper spread of the infection.
  • Indications
    • Periapical or periodontal abscess
  • Contraindications
    • Airway obstruction, infection spreading to skin surface (needs oral and maxillofacial surgeon). Relative contraindications include coagulopathy and pregnancy.
  • Complications
    • Inadequate drainage, spread of infection, local anesthetic complications.
Video Credit: Larry Mellick

*Deep Dive: How To Drain a Tooth Abscess (Merck Manual)



Dry Socket Management

  • Background
    • Alveolar osteitis, also known as “dry socket”, is inflammation of the alveolar bone that typically occurs when a blood clot fails to form or is lost following tooth extraction. Management in the ED typically includes analgesia, irrigation, and application of iodoform gauze soaked in anesthetic ointment (lidocaine, tetrocaine, eugenol) or application of dental paste, such as Coe-pak.
  • Indications
    • Dry socket
  • Contraindications
    • None
  • Complications
    • Inadequate analgesia, infection
Video Credit: Larry Mellick

*Deep Dive: Alveolar Osteitis: A Comprehensive Review of Concepts and Controversies (PubMed)



Fractured Tooth Management

  • Background
    • Dental fractures can be classified as Ellis I (Involving only enamel), Ellis II (involvement of enamel and dentin), and Ellis III (involvement of enamel, dentin, and pulp). Treatment involves covering the exposed dentin with zinc oxide or calcium hydroxide and ensuring follow-up with dentist within 24 hours.
  • Indications
    • Ellis II or Ellis III fractures; fractures involving only the enamel can be repaired cosmetically at the patient’s convenience. 
  • Contraindications
    • None
  • Complications
    • Long-term calcium hydroxide dressings may cause cervical root fractures
Video Credit: The Dental Box

*Deep Dive: Mastering Minor Care: Dental Fractures (Taming the SRU)



Temporomandibular Joint Dislocation Reduction

  • Background
    • Displacement of the mandibular condyle from the articular groove in the temporal bone. Dislocation may be anterior (most common), posterior, lateral, or superior. Most dislocations can be managed in the emergency department with manual reduction.
  • Indications
    • Acute TMJ dislocations (unilateral or bilateral
  • Contraindications
    • Dislocations associated with fractures or chronic dislocations
  • Complications
    • Mandibular fracture, injury to clinician, injury to facial nerve or external carotid artery (rare).
Video Credit: Core EM

*Deep Dive: Temporomandibular Joint Dislocation (emDocs)


Brandon Simpson, PA-C
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