Dental Problems

 

History

 

  • Age
  • Past medical history
  • Medications
  • Onset of pain / injury
  • Trauma with "knocked out" tooth
  • Location of tooth
  • Whole vs. partial tooth injury

 

Signs and Symptoms

 

  • Bleeding
  • Pain
  • Fever
  • Swelling
  • Tooth missing or fractured

 

Differential

 

  • Decay
  • Infection
  • Fracture
  • Avulsion
  • Abscess
  • Facial cellulitis
  • Impacted tooth (wisdom)
  • TMJ syndrome
  • Myocardial infarction

 

Universal Patient Care Protocol

 

  • Control bleeding with pressure

 

Tooth Avulsion ?

 

  • Yes

 

 

 

    • Place tooth back in socket if feasible.
    • Secure to surrounding teeth with tape

 

  • No (not feasible)

 

 

 

    • Place tooth in milk or normal saline

 

 

 

 

    • Reassess and Monitor

 

  • Notify Destination or Contact Medical Control

 

Pearls:

 

  • Recommended Exam: Mental Status, HEENT, Neck, Chest, Lungs, Neuro
  • Significant soft tissue swelling to the face or oral cavity can represent a cellulitis or abscess.
  • Scene and transport times should be minimized in complete tooth avulsions. Reimplantation is possible within 4 hours if the tooth is properly cared for.
  • All tooth disorders typically need antibiotic coverage in addition to pain control.
  • Occasionally cardiac chest pain can radiate to the jaw.
  • All pain associated with teeth should be associated with a tooth which is tender to tapping or touch (or sensitivity to cold or hot)
  • DO NOT replace tooth if:
    • obtunded patient
    • Spinal Immobilization
    • AMS
    • Multiple Teeth missing

NREMT

National Registry Emergency Medical Technician

NREMT

National Registry Emergency Medical Technician

NRP

National Registry Paramedic