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

 

• • Pain Control Protocol

 

• • 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