DENTAL EMERGENCY
Emergency - most common
condition
Tooth Ache
Pulp
Pulpitis
Reversible
•
Initially very painful but get
better quickly (i.e., 1-2 days)
• Initiated by a stimulus (i.e.,
chewing, cold or hot)
• Short duration (i.e, 30
seconds or less)
Rule out: Extreme flash of sharp
pain upon biting: possible
cracked tooth
Irreversible
•
•
•
•
•
•
•
Dull, throbbing, intense pain
Spontaneous and continuous
pain
Lingering pain with cold
Percussion pain
Pus drainage with/without
“pimple like” draining pump
Possible swollen Lymph nodes
Possible low-grade fever
Test of Vitality
Cold Test
•
Endo Ice spray refrigerant (on a cotton pellet) test first a non involved tooth.
- Normal Limits: 2-3 seconds
- Slightly prolonged: 3-5 seconds
- Prolonged: 5-30 seconds
Percussion Test
•
Tap lightly the surface of the tooth with a
handle of an instrument.
- Normal Limits: no pain
- Slightly inflammated: mild pain
- Inflammated: severe and prolonged
pain
Test of Vitality
Palpation Test
•
Palpate the gum just above and surroundings of
the painful tooth with your finger tip.
- Normal: no pain, no swollen
- Abnormal: pain, slightly tender or
swelling.
Fistula and Abscess
Acute/Chronic infection
PETERSON et al., 2000
Dental Fistulas
Intraoral Abscess
Extraoral Abscess
*This is an emergency! Can change in a day and block respiration,
situation where we would sent to ER.
Zaia & Beber
Extraoral Abscess
Zaia & Beber
Chronic Infection -Pulp Polyp
• Pulp polyps are usually asymptomatic (a fibrous growth from the pulp).
• Direct pressure during mastication may cause mild-to-moderate tenderness.
• Localized bleeding may occur when the soft tissue is manipulated or traumatized.
• All lesions are associated with a history of a long-standing carious lesion, a fractured
tooth due to trauma, or a combination or these 2 insults.
• Mobility of the tooth and sensitivity to percussion are usually absent.
• Drainage of a purulent exudate is not a characteristic finding.
Periodontitis
• It is an advanced form of gum disease that can cause tooth
loss and may be accompanied by pain.
• Gum recession, pus drainage, bleeding, dental mobility.
• Normally is not an emergency however researchers have
found that periodontitis is associated with other health
problems such as cardiovascular disease, stroke and bacterial
pneumonia. Likewise, pregnant women who have
periodontitis may be at increased risk for delivering pre-term
and/or low birth weight babies.
Healthy
Moderate
Periodontitis
Gingivitis
Severe
Periodontitis
Cases to use voucher!
Cases
Symptoms
Voucher
Reversible pulpits
Pain is not spontaneous (heat/cold); no pain
percussion; moderate to sharp pain to cold test (35s), negative palpation.
No
Irreversible pulpits
Pain is spontaneous that get worst with stimulus
and when lay down; pain percussion; severe pain to
thermal (5-30s), negative/positive palpation.
Yes
Healthy tooth with
fistula
May or may not have pain, presence of fistula
Yes
Intraoral Abscess
Intense pain, increased volume, pus drainage
Yes
Extraoral Abscess
Intense pain, increased volume (face)
Yes
Fracture
Mobility, fistula/abscess, pus drainage
Yes
Gingivitis
Bleeding, swollen gum, no pain
No
Bleeding, swollen gum, pain, light mobility, pus
Yes
Bleeding, swollen gum, pain, severe, mobility, pus
Yes
Moderate Periodontitis
Severe Periodontitis
Other common conditions
“differential diagnosis and
common sense for referral”
Gum Recession
• Characteristic:
- Recession of the gum normally caused by trauma (i.e., Overaggressive
brushing , surgery and periodontitis).
• Symptoms:
- Pain with cold, heat and citrus /acid foods
- Short duration, thirty seconds to one minute after the stimulus is
removed.
- May be misdiagnosed as reversible pulpits (clinical exposure of the root)
Canker Sore or Afta
Characteristics
•
•
•
They are recurrent and with format of a shallow individual
ulcer that is round or oval in shape (no more than a 1/4
inch in diameter).
The tissues surrounding a canker sore lesion will appear
healthy and the patient will have no distinguishing
systemic features (such as a fever or malaise).
Canker sores can usually be expected to heal within 4 to
14 days. Usually this healing is uneventful and with no
residual scarring.
Symptoms
•
Extremely painful and may cause swollen or enlargement
of the lymph nodes.
Causes:
• Emotional Stress
• Hormonal alterations
• Iron, folic Acid or vitamin B12 deficiency
• Trauma
• Burning (Heat or chemical products); could be from changed
toothpaste
• Systemic diseases
• virus infecction with fever
• Food Allergies
• Gastric disturbances
Candidiasis
Characteristics:
• Affects more people who wear dentures
• Healthy people (it is not a problem). Patient with a
weakened immune system, the symptoms may be more
severe and difficult to control.
Signs and symptoms
• Creamy, white lesions on the tongue, inner cheeks and
sometimes on the roof of the mouth, gums and tonsils
• Lesions with a cottage cheese-like appearance
• Pain
• Slight bleeding if the lesions are rubbed or scraped
• Cracking at the corners of mouth
• A cottony feeling of mouth
• Loss of taste
SEVERE CASES:
• Lesions may spread downward into the esophagus —
(Candida esophagitis).
• Symptoms: patient may complain about difficulty
swallowing or feel as if food is getting stuck in the throat.
Geographic Tongue
Characteristics:
• Red patches on the surface of the tongue
bordered by grayish white.
• The papillae are missing from the reddish
areas and overcrowded in the grayish white
borders.
• The small patches may disappear and
reappear in a short period of time (hours or
days), and change in shape or size.
Symptoms:
• While it is not common for the condition to
cause pain, it may cause a burning or stinging
sensation.
•Geographic tongue may also cause
numbness. Coexistence of fissures of the
tongue is often noticed.
• Certain foods, such as spicy or citrus foods,
chemicals, such as mouth washes and teeth
whiteners, can aggravate the condition.
Oral Cancer
• Patients with significant risk factors, especially those who
use tobacco and alcohol, should be carefully screened.
•External examination Palpate the head thoroughly,
including the temporal muscles, temporomandibular joints,
masseter muscles, and bony mandible. Next, palpate the
neck, including the parotid and submandibular glands, the
lymph nodes, and the neck musculature.
http://www.jaapa.com/oral-cancer-how-to-find-this-hidden-killer-in-2-minutes/article/130902/
Screen for Oral cancer
Eight-step examination of the mouth
http://www.jaapa.com/oral-cancer-how-to-find-this-hidden-killer-in-2-minutes/article/130902/
Oral Cancer
Leukoplakia
Generally manifests as asymptomatic,
white, macular lesions that do not
wipe off (see Figure 2). The lesions may
be isolated or diffuse in nature and
occur most commonly on the tongue,
the floor of the mouth, and the buccal
mucosa.
Erythroplakia
Manifests as a patch of macular or
ulcerated red lesions (see Figure 3). The
lesions appear in the same locations as
leukoplakia and can be asymptomatic or
mildly painful. The incidences of dysplasia
and carcinoma are higher in red lesions
than in white lesions. Biopsy is indicated
for any abnormality present for more
than 14 days without an obvious etiology,
such as trauma.
Differential Diagnosis
Squamous cell carcinoma on the floor of the mouth
Squamous cell carcinoma on the floor of the gengiva
Candidiasis
Intraoral Abscess