Dental Injuries



Dental on-call Cover for the Emergency Department

  • Dental cover is separate from plastics cover.
  • If the patient requires admission for a dental related problem the dental SHO should be bleeped.
  • A dental SHO is on-call from home via switch. They are covered by a dental consultant also on call from home. They will be happy to give advice or come in to see the following:

Accessing Emergency Dental Care

Registered Dental Patients

    • Patients, who are registered with a dentist and have seen them within the last 13 months, should contact their own dentist.
    • Their dentist should see them within 24 hours if they are in pain.

There is an emergency dental service run at CUH each day. There is no appointment system.


Clinical assessment


Concussion

  • Injury to tooth supporting structures without displacement of tooth.
  • Pain on tooth percussion.
  • Tooth stable.
  • No displacement.
  • Soft food for a week, gentle brushing.
  • Own dentist during week.

Subluxation

  • Injury to tooth support structures with tooth mobility but no displacement.
  • Local gum (sulcus) bleeding.
  • Tooth tender to percussion and may be mobile.
  • Analgesia, soft food, gentle brushing.
  • Will need a splint for a week so refer local dentist tomorrow or dental clinic.

Extrusion

  • Injury to peridontal ligament so loosening and displacement of tooth.
  • Tooth looks longer, off line with others.
  • Tender, mobile (be gentle!).
  • If root exposed, clean with saline flush then reposition tooth in socket (usually painless) then;
  • Refer dental clinic (or on-call dentist) for splint.

Intrusion

  • Tooth pushed into socket - must have alveolar fracture.
  • Often associated tooth neurovascular supply damage.
  • Tooth shortened.
  • Usually stable.
  • All need urgent (not emergency) dental review.
  • If minor closed intrusion (3-7mm) may not need surgery, others will.
  • Open intrusion usually needs corrective orthodontic surgery.

Avulsion

  • Tooth knocked out of socket.
  • Hold tooth by crown (white part).
  • Wash briefly under cold water.
  • Replace tooth and bite on cloth to hold in place.
  • If can't replace, store in milk or patient's mouth (not children who may swallow the tooth).
  • Dentist opinion / review now please.

Alveolar fracture

  • Mobile (± surprisingly painless) tooth or several teeth with displacement.
  • Mal-occlusion.
  • Beware confusing alveolar # with mandibular or le-Fort facial #.

Enamel chip/#

  • Visible chip.
  • Tooth stable, not tender, normal sensation / sensitivity.
  • If fragment available can be glued (dental opinion please).
  • If # involves dentine (deeper #) will need nerve to be covered (dental opinion please).
  • Otherwise regular dentist review.

Content by Dr Íomhar O' Sullivan 11/03/2004. Reviewed by Dr ÍOS 08/05/2005, 15/03/2007, 22/08/2009. Last review Dr ÍOS 15/08/14.