Drs. Nash and Ngo discuss traumatic dental emergencies, including reimplantation of avulsed teeth, time-sensitive dental trauma emergencies, imaging techniques, preferred solution for avulsed tooth transport, dental splinting methods, handling avulsed teeth, indications for antibiotics, chlorhexidine rinses, treatment for persistent dental hemorrhage, anatomy of teeth and fractures, signs of trauma and dental pain management, types of dental blocks for pain relief, and use of antibiotics in dental trauma.
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Quick takeaways
Proper splinting methods and stabilization techniques can help manage dental trauma effectively in the emergency department.
Collaboration with dental specialists and seeking their guidance can enhance the management of dental emergencies and improve patient care.
Deep dives
Key Point 1: Dental trauma can be managed effectively in the emergency department
Dental trauma, such as tooth fractures or evulsions, can be effectively managed in the emergency department. Local infiltrative blocks with lidocaine or bupivacaine can provide pain relief for maxillary or mandibular teeth, respectively. In cases of severe pain, judicious use of opioids may be considered. Splinting fractured teeth, either using proper dental equipment or improvising with nasal bridge of an N95 mask, can help stabilize the tooth. Antibiotics may not be necessary for most dental trauma cases, except in open fractures.
Key Point 2: Considerations for dental infections and dry socket prevention
In cases of dental infections, antibiotics may not be indicated unless there is an open mandibular fracture. For dry socket prevention, placing a medicated dry socket dressing and encouraging close follow-up with a dentist are important steps. It is essential to educate patients about post-traumatic risks, such as tooth resorption and discoloration, and the need for further dental care, including root canals or extractions, as appropriate.
Key Point 3: Non-accidental trauma and concomitant injuries should not be overlooked
Emergency physicians should be vigilant for signs of non-accidental trauma, such as lip lacerations or bruising, tongue lacerations, and fractured or missing teeth with absent or implausible history. Concomitant injuries, including mandible fractures, should be considered if patients have limited mouth opening or positive tongue blade bite tests. Chest radiography may be necessary to rule out bronchial aspiration if a tooth is potentially aspirated.
Key Point 4: Collaboration and further learning from dental specialists
Collaborating with dental specialists and seeking their guidance can enhance the management of dental emergencies. Dental specialists are often willing to teach and provide valuable insights. Emergency physicians should not hesitate to ask questions and learn from specialists to improve patient care. Resources, such as online procedural videos and ALiEMU modules on dental emergencies, can further support learning in this area.
In this part 2 of our 2-part podcast series on dental emergencies we cover traumatic dental emergencies. Dental trauma is common and often associated with facial trauma. In this episode Dr. Chris Nash and Dr. Richard Ngo answer questions like: at what age is it safe to attempt reimplantation of an avulsed tooth in the ED? What are the 3 most time-sensitive dental trauma emergencies? When is Panorex X-ray or CT indicated in dental trauma? What is the preferred solution to transport an avulsed tooth in? What are 3 dental splinting methods we should consider for dental subluxations and avulsions? How should we handle an avulsed tooth to maximize the chances of a successful reimplantation? When are antibiotics indicated after dental trauma? What role does chlorhexidine rinses play in preventing infection after dental trauma? What are the recommended first and second line treatments for persistent dental hemorrhage? and many more...
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