Tuesday, 20 May 2014

Dental Fractures


The first step is to have a look at the tooth and work out what tooth it is.

Then have a look and try and work out what is wrong with it. See what it looks like. See if it's sore. See if it wobbles.

Concussed
 - no obvious displacement. Tender to touch.
- not wobbly.
 - soft food for a week


Subluxation
- Increased mobility and pain
- Some associated bleeding
- Increased mobility
- Soft food, clean carefully, chlorhexidine mouthwash.

Extrusion
- Partial displacement of the tooth out of its socket
- Partial or total separation of the peridontal ligament resulting in loosening and displacement of the tooth.
- Tooth appears elongated
- If <3mm in an immature developing tooth, needs careful repositioning.

Intrusion
- May or may not intersect the secondary tooth bud.
- May penetrate into the nasal cavity.
- Often associated with alveolar fracture.
- Needs repositioning and careful advice.

Avulsion
- Empty socket
- Do not replace
- Consider x-ray to check not aspirated. Soft food for a week.

In adults
- Wash briefly
- Reposition
- Bite on a hankerchieft to hold it in position
- Glass of milk for storage.
- Flexible splint for two weeks

Infraction
Crack - No follow up needed

Enamel Fracture
Smooth sharp edges

Alveolar Fracture
Manual repositioning + stabilising of the segment
Monitor
Soft diet


Tooth Fractures
These need things done to them. You can catagorise them using the Ellis staging system. I'm going to refer them all to max fax/ a dentist.

Post Extraction Problems

Bleeding - rolled up piece of gauze in the socket for 10min. May need horizontal matress suture - use lidocaine + adrenaline. 

Dry socket pain - if bone exposed. Typically 3- 8 days later. Irrigate with warm saline, oral antibiotics, analgesia and dentist. 



http://www.annemergmed.com/article/S0196-0644%2809%2901141-X/abstract
http://emin5.com/2014/04/07/dental-fractures/
http://www.dentaltraumaguide.org/Permanent_Alveolar_fracture_Description.aspx

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