Dental

Rapid Review

• 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.

Pearls

Deep Dive

• How To Replace and Splint an Avulsed Tooth (Merck Manual)

Rapid Review

• 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.

Pearls

Deep Dive

• How To Drain a Tooth Abscess (Merck Manual)

Rapid Review

• 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

Pearls

Deep Dive

• Alveolar Osteitis: A Comprehensive Review of Concepts and Controversies (PubMed)

Rapid Review

• 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

Pearls

Deep Dive

• Mastering Minor Care: Dental Fractures (Taming the SRU)

Rapid Review

• 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).

Pearls

Deep Dive

• Temporomandibular Joint Dislocation (emDocs)