Ep 186 Traumatic Dental Emergencies

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... Podcast production, sound design & editing by Anton Helman; voice editing by Braedon Paul; background research by Ronak Saluja & Ryan O’Reilly Written Summary and blog post by Anton Helman August, 2023 Cite this podcast as: Helman, A. Ngo, R. Nash, C. Traumatic Dental Emergencies. Emergency Medicine Cases. August, 2023. https://emergencymedicinecases.com/traumatic-dental-emergencies. Accessed December 6, 2024 Résumés EM Cases  Go to part 1 of this 2-part podcast on dental emergencies Basic dental anatomy required for dental trauma emergencies Dental structures (superficial to deep) to know for dental trauma are enamel, dentin, pulp, alveolar bone: Care of ALiEM Smiler series Primary dentition vs permanent dentition Adults most commonly have 32 teeth (permanent dentition) divided into 4 quadrants: left and right mandibular dentition and maxillary dentition. Care of ALiEM Smiler series Children most commonly have 20 primary teeth, usually present by the age of 3 which gradually are replaced by permanent teeth usually between the ages of 6 and 12. * For children between the ages of 3 and 6 who suffer a tooth avulsion, reimplantation should not be attempted. * For children between the ages of 7 and 12 who suffer a tooth avulsion, consult a dentist or oral surgeon for decision making around reimplantation, as it is difficult clinically to distinguish primary vs permanent teeth. Pitfall: One pitfall is to attempt reimplantation of a primary tooth that has been avulsed. This may lead to ankylosis and prevention of permanent tooth eruption. Categories of dental trauma: fractures, subluxations, intrusions and avulsions Dental fractures - uncomplicated vs complicated The most common traumatic dental injuries are uncomplicated fractures  of the enamel and/or dentin of crown of the tooth (do not extend to level of pulp) which require only observation and follow up with outpatient dentist for consideration of re-bonding. Re-bonding can be attempted in the ED. Complicated dental fractures involve the pulp of the tooth resulting in exposure of the dental pulp to the oral cavity. Patients often experience severe pain and tooth sensitivity and will ultimately require either a root canal or tooth extraction as an outpatient to prevent infection. In the ED calcium hydroxide should be applied to the exposed pulp that is clearly seen as pink tissue within the tooth and arrangements for fol...