OzEMedicine - Wiki for Australian Emergency Medicine Doctors

see also dental, faciomaxillary

• RCH guideline - dental injuries
• Wikipedia - general information on teeth and tooth structure
• drbunn.com - tooth numbering systems
• dental anaesthesia
• The Royal Dental Hospital of Melbourne

• all pts with significant dental trauma should be advised that any teeth involved may later die & require root canal Rx

• tender but firm
• review by local dentist

• tender and loose, blood around gum
• if very loose then attempt to splint in place if secondary tooth

• tooth displaced laterally
• Mx as for extrusion

• tooth displaced, partly out of socket
• if primary tooth:
  • usually extracted or expectant Mx
  • not re-positioned as risk of damage to underlying secondary tooth
• if secondary tooth:
  • reposition and splint (see under avulsion) under LA or GA

• tooth pushed into socket
• Mx as for extrusion but will usually require LA and forceps or needle holders to forcibly reposition the tooth

• complete displacement of tooth from socket
• if tooth not found:
  • consider CXR to exclude aspiration into lungs
  • consider dental XRay to exclude a fully intruded tooth into the socket
• transportation of avulsed tooth:
  • place tooth in milk
  • do not handle or wipe root of tooth
  • needs to be re-implanted within 2 hours for any reasonable likelihood of success
  • best prognosis is if dry time < 60 minutes
  • never re-implant primary teeth
• re-implantation of permanent teeth:
  • consider LA
  • irrigate socket with normal saline to remove any blood clot
  • check socket for any loose alveolar bone fragments which would restrict the tooth being replaced
  • hold by crown not the roots and insert into socket - convex to front
  • splint tooth in place, either by:
    • Blu-Tac (this is non-toxic) rolled into a sausage shape and placed over the repositioned teeth, then several layers of aluminium foil is moulded over the Blu-Tac to resemble a mouth guard, or,
    • Histoacryl glue applied to external surfaces of gum and tooth, or,
    • dental kit (see below)
      • place a horizontal roll of GC across adjacent teeth which will harden and splint tooth, or,
      • use dabs of GC on the front of each tooth and use a piece of fishing line placed horizontally across each dab of GC as a splint.
• tetanus prophylaxis

• if exposed pulp (pink and painful) then usually needs extraction
• otherwise see dentist within next few weeks

• if exposed pulp (pink and painful):
  • keep any tooth fragments in milk as they may be suitable for re-attachment
  • if dental registrar or dentist available, refer, otherwise:
    • protect tooth with dental kit (see below)
      • cover with a small amount of Dycal to try and preserve pulp vitality
• if enamel (white) or dentine (yellow) only involved, see local dentist within a few weeks

• gum is stripped from tooth to expose the roots
• requires operative cleaning and repair to minimise risk of osteomyelitis of exposed bone

• interrupted sutures (take care as gingival tissue is more delicate than skin and tears easily)
  • 3/0 or 4/0 absorbable material such as plain catgut, chromic or vicryl sutures

• available from Dr Tony Skapetis email: Tony_Skapetis@wsahs.nsw.gov.au
• contents (as at 2008):
  • emergency dental handbook for medical practitioners
  • GC Fuji IX kit powder + liquid
    • radio-opaque posterior glass ionomer restorative cement
    • primarily used by doctors as a bonding agent to splint loose teeth by creating a roll
    • follow instructions to mix the powder and liquid
  • Dycal Ca(OH)₂ base + catalyst
    • used to protect pulp in dental fractures with exposed pulp (pink and painful)
  • SS cement spatula
  • SS double ended spatula
  • microbrush applicators

• ContempoDentcare - appointment only basis
• Dental Practices in Bundoora, Broadmeadows & Preston
• 24 hour 7 day a week dental emergency service by appointment only
• 24 hour number 0421 983 283
• Patient should be advise that may be an after hour callout charge in addition to treatment costs
• Operations Manager of ContempoDentcare - (03) 9357 7050