Anatomy
Name that Diagnosis
What to do next?
Miscellaneous
100
What tooth number is my cursor pointing at?
19
100
Pain that occurs 48-72 hours after a tooth extraction, when the clot from the socket is displaced.
Postextraction Alveolar Osteitis (Dry Socket)
Associated with smoking, carbonated beverage consumption, and drinking with straws
Treatment: Gentle irrigation, analgesia (often dental blocks), pack socket with eugenol-impregnated gauze (which will relieve the pain). Penicillin VK 500 mg QID. Daily packing changes and daily Chlorhexidine mouth rinses
100
How to treat Ellis Class II and III dental fractures?
Cover with calcium hydroxide
Class I: File down sharp edges
Class II/III: Dry the dentin and cover the lesion (calcium hydroxide or cement). All patients should see dentist within 24 hours.
100
Nerve block that can be used for individual teeth
Supraperiosteal blocks
200
Most common source for anterior epistaxis?
Kiesselbach's plexus
200
Name the Diagnosis (be specific)
Sudden dental pain lasting minutes to hours , often triggered by heat or cold
Irreversible Pulpitis
-Reversible Pulpitis: sudden, transient pain lasting few seconds
-Both conditions are result of untreated dental carries
-Treatment is Analgesia (NSAIDs , dental blocks) +/- Penicillin
200
A 20-year-old man with human immunodeficiency virus presents with severe oral pain and gingival bleeding. Oral examination is shown above. There is no facial edema, erythema, or fever. What is the next best step in management?
A. Admission for IV clindamycin
B. Discharge with Keflex
C. Discharge with Chlorhexidine, Metronidazole, and dental referral
D. Discharge home with Nystatin
C. Treatment for ANUG
200
Most common source for posterior epistaxis?
Sphenopalatine artery
300
Name the 3 layers of the tooth from top to bottom
Enamel, Dentin, Pulp
300
Name the diagnosis and Treatment:
Cellulitis involving both submandibular spaces and the sublingual space that can spread to the neck and mediastinum, causing airway compromise, overwhelming infection, and even death
Ludwig's Angina
-Treatment: IV antibiotics (Unasyn) and emergent surgical consultation
-Dental infections can spread readily to the facial spaces, therefore it is imperative to exclude deep-space involvement whenever dental infection is encountered.
300
Replant permanent teeth that have been avulsed for less than _____ hours immediately, to attempt to save the periodontal ligament fibers.
3 Hours
If replantation at the scene is not possible at the scene due to risk of aspiration, quickly rinse the tooth and place in a nutrient solution.
Do not delay replantation while waiting for the specialist to arrive.
Steps:
1. Gently irrigate the tooth root clean with sterile salie
2. Soak tooth for 5 minutes in doxycycline solution (doxy 1mg/20ml saline)
3. Administer local anesthetic
4. Remove coagulum from the socket with a steam of saline. Examine the socket
5. Firmly replant tooth and verify the tooth position clinically and radiographically
6. Flexible splint for 2 weeks
300
A 50-year-old alcoholic man presents to the ED with left lower dental pain. He has poor dentition without facial swelling, asymmetric pharyngeal masses, uvula deviation, or submental erythema or induration. He has percussive tenderness on his left mandibular molar with no identifiable periapical abscess. Ulcerative gingivostomatitis does not appear to be present. Which nerve block should be offered at this time?
Inferior Alveolar Nerve Block
Landmarks: Coronoid notch, Pterygomandibular raphae
https://www.youtube.com/watch?v=5VaYoFbjXIg
400
What is a Ellis grade 2 dental fracture
Involves the Enamel and Dentin
400
The tooth is partially displaced from its socket. It may involve the periodontal ligament and alveolar bone
Luxation: Tooth is partly avulsed out from the alveolar bone. Treatment is repositioning and splinting with zinc oxide periodontal dressing. Dentist evaluation within 24 hours.
** Intrusive luxation: Tooth is forced below the gingiva. Usually found on Xray, refer to Dentist, usually grown back out on own
400
If dental infections spread to the infraorbital space, a ________________ may result.
This condition may present with limitation of lateral gaze, meningeal signs, sepsis, and coma.
What is the treatment?
Cavernous Sinus Thrombosis
1. IV Antibiotics
2. Anticoagulations
3. Emergent Surgical consultation
400
What nerve block would you use to block the ipsilateral maxillary molars?
Posterior Superior Alveolar nerve block
-Height of the mucobuccal fold
-Over the second molar
-45-45 angle (medial and superior)
https://www.youtube.com/watch?v=MCvQPegojM0
500
Name the side of the tooth nearest the cheek
Buccal
500
Painful lesions, which are frequently multiple, involve the labial and buccal mucosa, and measure from 2mm to several centimeters in diameter
Aphthous stomatitis or Aphthous ulcer
Treatment: 0.1% Triamcinolone acetone dental paste BID OR 0.12% chlorhexidine BID.
Lesions often heal within 7 - 10 days
500
What is the best solution for an avulsed tooth to be placed in?
Hank's balanced salt solution > Milk > Saliva > Saline
**Underneath the tongue of an alert, sober, cooperative patient or parent (if the patient is a child)
500
If patient arrives to the ED with an empty socket and the tooth cannot be located, search adjacent tissue for the tooth. IF missing tooth cannot be found or if partial tooth is found, what is the next best step?
Order face, neck, or chest radiographs to exclude a displaced or aspirated tooth.