Dental Emergencies

Mark Greenwood is an NHS Consultant in Oral and Maxillofacial Surgery as well as Honorary Clinical Professor of Medical Education in Dentistry at at the School of Dental Sciences at Newcastle University. Qualified in both medicine and dentistry, he has been published in many peer reviewed journals and has co-authored two books on general medicine and surgery for dental practitioners. Ian Corbett is a Clinical Lecturer in Oral and Maxillofacial Sciences and Honorary Specialist Registrar in Oral Surgery at the School of Dental Sciences at Newcastle University.

• List of Contributors ix Preface xiAcknowledgements xiii1 Introduction, Infection Control and Prescribing 1M. GreenwoodIntroduction to the dental emergency clinic 1Infection and infection control 2Prescribing 8Conclusions 12Further reading 122 History Taking and Clinical Examination of Patients on a Dental Emergency Clinic 13I.P. Corbett, C.B. Hayward and M. GreenwoodIntroduction 13History taking 13Patient examination 18Special tests 24Record keeping 25Consent 25Conclusions 28Further reading 283 Radiology and the Dental Emergency Clinic 29R.I. MacleodIntroduction 29Patients in pain 33Trauma radiology 35Looking at radiographs 36Conclusions 38Further reading 384 Acute Oral Medical and Surgical Conditions 39P.J. ThomsonIntroduction 39Oro-facial swelling 39Blistering disorders of the oral mucosa 45Oral ulceration 47Disturbed oro-facial sensory or motor function 49Haemorrhage 50Other acute conditions 51Bony pathology 52Summary 55Further reading 555 Restorative Dental Emergencies 57A. Moufti and C.B. HaywardIntroduction 57General principles 59Pain management 59Infections and soft tissue problems 65Crack, fracture and mobility of teeth and dental restorations 71Fractured and loose implants 81Fractures and swallowing of removable prostheses 82Conclusions 83Further reading 836 Acute Presentations of Chronic Oro-Facial Pain Conditions 85J. DurhamIntroduction 85Oro-facial pain history 86Examination of patients with oro-facial pain 89Special investigations for oro-facial pain 90Presentation, investigations and initial management of acute non-odontogenic oro-facial pain 92Further reading 1027 Traumatic Injuries to the Teeth and Oral Soft Tissues 103U. Chaudhry and I.C. MackieAssessment of the traumatised patient 103Management of traumatic dental injuries 105Injuries to the hard dental tissues and the pulp 105Injuries to the hard dental tissues, the pulp and the alveolar process 112Injuries to the periodontal tissues 116Dento-alveolar fractures 127Conclusions 127Further reading 1288 Pain Relief in the Dental Emergency Clinic 129U.J. MooreIntroduction 129General mechanism of pain 129Distribution of pain fibres in the mouth and jaws 134Sources of pain in the mouth and jaws 135Control of pain 136Psychology of pain 137Medication 139The ladder of analgesia 144Avoiding problems in prescribing analgesics 144Further reading 1479 Management of the Special Needs Patient 149T. NugentIntroduction 149Commonly seen conditions 151Assessment 152Medical history in the patient with special needs 153Informed consent 154Examination 155Factors to consider in treatment 155Conclusion 15810 Making a Referral 159I.P. Corbett and J. GreenleyIntroduction 159When to refer 159How to refer 160Where to refer 161The referral letter 161Urgency 164Cancer referrals 165Copies of the referral letter 167Summary 169Further reading 17011 Medical Emergencies in the Dental Emergency Clinic – Principles of Management 171M. GreenwoodIntroduction 171Contents of the emergency drug box 171The ‘ABCDE’ approach to an emergency patient 174Airway (A) 175Use of defibrillation 180Principles of management after the initial treatment of a medical emergency 181Conclusions 182Further reading 18212 Examples of Specific Medical Emergency Situations 183M. GreenwoodIntroduction 183Vasovagal syncope (simple faint) 184Hyperventilation 184Asthma 185Cardiac chest pain 187Epileptic seizures 188Diabetic emergencies 190Allergies/hypersensitivity reactions 192Adrenal insufficiency 196Stroke 197Local anaesthetic emergencies 197Problems with haemostasis 200Conclusions 203Further reading 203Appendix 1 Normal Reference Ranges 205Appendix 2 Changes in Vital Signs in Patients with Infection 207Appendix 3 Warfarin Protocol 209Appendix 4 Aspects Relating to Local Anaesthetics 213Appendix 5 NICE Guidelines for the Removal of Wisdom Teeth 215Appendix 6 Protocol for Surgical Dental Treatment of Patients Taking Bisphosphonates 217Appendix 7 Common ‘Recreational’ Drugs 221Index 229