Adult Emergency Medicine: Dental Emergencies

Monday, 12 May 2014

Dental Emergencies

Incisors grow at 6 - 10months

Canine 16 - 20months

Molars 10 - 24months

Secondary incisors grow at 7 -8 years

Canine + pre-molars at 11- 13years

Molars 6 - 25years

Abscess

Likely to be streptococcus or staph aureus.
In history ask when it started, whether antibiotics used, about presence of systemic features, and immunocompromised.

Not all patients need antibiotics - give if systemically unwell, high risk or likely complications.

Amoxicillin or metronidazole - either works.

Admit if systemically unwell, antibiotics no help, rapid spread, dysphagia or dysphonia, immunocompromise or GA needed.

Vincent's Angina

Acute necrotising ulcerative gingivitis or trench mouth

Causes pseudo-membranous infection.
Needs chlorhexidine mouthwash with metronidazole or amoxicillin.
Dental review ASAP.

Ludwig' s Angina - submandibular abscess

Mostly affects males, between 20 -60 years old
Peri-apical abscess of the 2nd or 3rd molar penetrates the inner cortex of the mandible and gains access to the area inferior of mylohyoid. The infection tracks posteriorly so the sublingual space is involved.
The tongue is forced upwards and backwards.
It causes fever, pain, drooling, trismus, dysphagia, submandibular mass and dyspnoea.

Hot potato voice.

Lemierre syndrome

Thrombophlebitis of the jugular veins with distant sepsis of oropharyngeal infection (pharyngitis / tonsilitis +/- peri tonsillar abscess). Caused by an anaerobic gram-negative bacillus.
Patients present unwell, trismus and pain behind the angle of the jaw.

USS shows thrombophlebitis of the internal jugular vein which is often the first hard evidence to suggest Lemierre's.