Abstract
This chapter describes several of the more common visits to urgent care centers related to mouth and jaw pain. Pain is often the most common presenting complaint, and the ability to narrow down the differential and diagnosis will be present within this chapter. The differential is broad, but will be clearly laid, making treatment regimens straightforward.
Keywords
candidiasis, dental pain, dental fracture, facial pain, sialolithiasis, TMJ
1
What is the anatomy of a tooth?
The crown is the visible portion of the tooth, which consists of three layers: The pulp (neurovascular supply of the tooth) is surrounded by dentin, which is covered by enamel. The root is the portion of the tooth that extends into the bone. It is covered by cementum, which adheres to the periodontal ligament.
2
How are teeth numbered? ( Fig. 4.1 )
3
Describe the types of dental fractures.
Ellis type I is a fracture of the enamel only and does not require treatment. Ellis type II fractures to the dentin are most common, and the tooth is usually sensitive to changes in temperature. Ellis type III (blood exposure) fractures expose the pulp. Types II and III require placement of a protective covering, such as calcium hydroxide base, as a delay in treatment increases the likelihood of pulpal necrosis. Patients need urgent referral to a dentist. Root fractures will have mobility of the crown (with or without Ellis fractures); radiographs will confirm. Alveolar fractures will allow multiple teeth to move together with palpation ( Fig. 4.2 ).
4
Describe and define the different types of dental trauma
See Table 4.1 .
| Concussion | Normal appearance, but will have pain with pressure (biting) |
| Subluxation | Loose tooth, without displacement; bleeding at the gumline |
| Intrusion | Tooth is driven upwards into the socket; bleeding at the gumline |
| Extrusion | Tooth is dislocated from the socket; bleeding at the gumline |
| Luxation | Tooth is displaced lateral, labial (toward lip), lingual (toward back/tongue) |
| Avulsion | Tooth is completely displaced from the socket |
5
What is the treatment for an avulsed tooth?
The best way to transport the tooth is in the patient’s tooth socket. Gently rinse (to remove debris) and replace it (only primary teeth should be reimplanted). Handle the tooth by the crown, as not to damage the periodontal ligament. It should be reimplanted within 2 hours, and stabilized with a dental dressing paste. If it cannot be reimplanted, use Hank salt-based solution or cold milk. The patient’s saliva is less ideal, and do not place the tooth in the mouth due to risk of aspiration.
Related posts:
Full access? Get Clinical Tree
