16: Dental Emergencies

CHAPTER 16 Dental Emergencies

Chapter points

In the context of dental emergencies, for the purpose of the dental nurse qualification, the NEBDN syllabus specifically mentions having an understanding of:
• Dental haemorrhage
• Aetiology and progression of dental caries.
However, we believe it will be helpful for you and others to have background knowledge of the commonplace dental emergencies covered in this chapter. This will help you care better for the patients who present with these conditions. Therefore, we recommend that you read this chapter to learn about the diagnosis and management of commonplace dental emergencies.

Introduction

Most dental emergencies relate to trauma or pain from a tooth affecting a person at home, work, while studying, or while doing leisure activities. The conditions that commonly cause dental pain are listed in Table 16.1 and these appear to be increasing.

TABLE 16.1 Overview of Common Dental Emergencies

image

Other dental emergencies such as bleeding are usually related to operative procedures (pp. 46, 61). These are also discussed in this chapter. Allergies are discussed in Chapter 2 (see p. 56).

Key Point

With all emergencies, it is essential to keep clear and accurate records, including records of the time of events and procedures; not least because medico-legal proceedings are increasingly common.

Trauma

• Trauma is especially common in young males, particularly those who have been using alcohol or other recreational drugs. The face, mouth and teeth are often involved.
• Avoiding alcohol and drugs, and routinely using safety measures such as seat belts and child safety harnesses, can reduce the risk of trauma as a result of road traffic accidents.
• Many other injuries occur in contact sports or recreational activities and could be prevented through the use of protective safety equipment such as helmets.
• Mouth guards made of soft plastic adapted to fit the shape of the upper teeth, protect both the lips and teeth. Pre-formed guards are available, or a clinician can create a custom-fit guard.

General Management of a Patient with Trauma

In all cases of trauma, the medical team should assess the patient if there has been any serious injury. First the clinician will:

• Ensure that the patient is breathing freely
• Exclude head injury (particularly assessing any change of consciousness) or other serious injuries.

It is also important to exclude non-accidental injury (NAI, e.g. child abuse); images (X-ray and photographic) can help enormously when the aftermath is being resolved.

Term to Learn

Non-accidental injury: an injury that is not consistent with the account given about how it occurred. It is usually seen as part of physical abuse in children.

Examination then focuses on signs of jaw injury (displacement or fracture), soft tissue injuries, and the dentition. The teeth are examined for any loosening, displacement, fracture or complete loss. In addition, the location of any lost tooth or other fragments should be noted.

A proper diagnosis invariably requires at least one dental radiograph and may also require tooth vitality testing. Photographs may also be needed. A soft diet may have to be recommended.

Maxillofacial Injuries

Key Points

Keeping the patient alive is the main priority, especially ensuring they can breathe.

Basic life support (BLS) can be provided by dental nurses (see Chapter 2).

General Examination

Immediate life-threatening problems in a patient with a jaw injury include:

• Airway (breathing) difficulties – ensure the airway is clear.
• Damage to the neck (cervical spine) – take care not to extend the head or the patient may become paralysed or die.
• Severe blood loss – medical attention would be urgently needed.
• Bleeding into the brain (intracranial bleeding) – medical attention would be urgently needed.

All traumatised patients should also be assessed by the clinician following the advanced trauma life support (ATLS) scheme:

A Airway
B Breathing
C Cardiovascular circulation and control of haemorrhage
D Disability and neurological assessment including pupils
E Environmental control and exposure.

Records taken immediately, and every 15 minutes, include:

• State of consciousness
• Blood pressure
• Pulse rate
• Respiration
• Temperature.

Management of Maxillo-Facial Injuries

Jaw fractures

Jaw fractures can be severely disfiguring and can cause the patient a lot of anxiety. However, management of injuries such as these is only undertaken after the patient’s general condition has been assessed and stabilised by a clinician.

Jaw fractures include:

• Fractures of the mandible – these are among the commonest jaw fractures after trauma. Patients with fractures of the mandible rarely have serious injuries to other parts of their body; however, alcohol or other drugs may be involved.
• Fractures of the middle or upper third of facial skeleton – these are more common after severe trauma (particularly road accidents or war injuries). They are more likely to be associated with life-threatening problems because of:

image Airway obstruction
image Head injury
image Serious trauma to other body parts, particularly chest injuries, ruptured organs (e.g. liver or spleen), eye injuries, fractured cervical or lumbar spine, and fractured long bones with serious internal bleeding.
image Alcohol or other drug use.

Jaw fractures are usually managed by open reduction and internal fixation (ORIF).

Term To Learn

ORIF: this is a surgical procedure to set and fix a fractured bone in certain situations (not all fractures require ORIF). First, the site of fracture is opened by making an incision in the skin and tissues overlying the bone (open surgery) and the displaced segments of a fractured bone are set in place. Second, the segments are rigidly fixed in place with screws and/or plates to prevent any movement and allow healing to occur.

Soft tissue injuries

Any lacerations in or around the mouth and face usually bleed heavily because of the rich supply of blood to the area. However, the injuries may not be as severe as they seem at first sight. Cleaning the area with weak aqueous chlorhexidine or hydrogen peroxide solution (one part hydrogen peroxide and one part water) often reassures the patient, relatives, and healthcare staff.

If there is bleeding, apply pressure with a clean gauze for at least five minutes under supervision. If the lip is swollen or bruised, apply a cold compress to limit swelling, bleeding, and discomfort. To do this, wrap crushed ice in a clean gauze or a clean piece of cloth, and hold it inside the cheek or lip.

It is particularly important that an experienced surgeon closes (usually with stitches) cuts that cross the vermilion border, or the patient may be left with a very obvious cosmetic problem.

Injuries to teeth

Teeth, usually the maxillary anterior teeth, can readily be injured in violence or play, especially in young males. Care, and the use of mouthguards, can help prevent or minimise damage.

Tooth injuries are classified as:

• Avulsion (complete displacement of the tooth from its socket)
• Luxation (lateral or extrusive)
• Subluxation (loosening and displacement of the tooth)
• Intrusion (the tooth is pushed vertically into the alveolar bone)
• Fracture.

Avulsed Tooth

• Avulsed primary teeth should not be replanted.
• Avulsed permanent anterior teeth may be replanted successfully in a child, particularly if the root apex is not completely formed (under 16 years); It is best to replant immediately. Teeth replanted within 15 minutes stand a 98% chance of being re/>

Related posts:

  1. 12: Dental Drugs, Materials, Instruments and Equipment
  2. 6: Patient Care and Special Groups
  3. 2: Medical Emergencies and First Aid in the Dental Surgery
  4. 5: Oral Disease
  5. 10: Surgical Procedures
  6. 17: Human Diseases and Health Promotion

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Jan 8, 2015 | Posted by in Dental Nursing and Assisting | Comments Off on 16: Dental Emergencies

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