Dental Emergencies

This book is a clear and comprehensive guide to the treatment and management of dental emergencies in clinical practice. Written and edited by experts in the field, the book provides succinct step by step advice for dealing with a range of emergency situations. Beginning with examination and patient histories, it covers restorative emergencies, traumatic injuries and pain management with advice for treatment options including analgesia, surgery, and referrals. Dental Emergencies also includes chapters that focus on the treatment of special needs patients and the management of medical emergencies in the course of dental treatment with reference to specific case examples. Providing practical, clear advice and highly illustrated throughout, this book is an invaluable reference for all dental practices. KEY FEATURES • A concise guide to managing dental emergencies in clinical practice • Contains step–by–step procedures and clinical examples • Provides thorough coverage of presentations of pain and pain management • Includes key chapters on treating patients with special needs and dealing with medical emergencies occurring during dental treatment • Fully illustrated throughout with colour photos 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. Contents List of Contributors ix Preface xi Acknowledgements xiii 1 Introduction, Infection Control and Prescribing 1 M. Greenwood Introduction to the dental emergency clinic 1 Infection and infection control 2 Prescribing 8 Conclusions 12 Further reading 12 2 History Taking and Clinical Examination of Patients on a Dental Emergency Clinic 13 I.P. Corbett, C.B. Hayward and M. Greenwood Introduction 13 History taking 13 Patient examination 18 Special tests 24 Record keeping 25 Consent 25 Conclusions 28 Further reading 28 3 Radiology and the Dental Emergency Clinic 29 R.I. Macleod Introduction 29 Patients in pain 33 Trauma radiology 35 Looking at radiographs 36 Conclusions 38 Further reading 38 4 Acute Oral Medical and Surgical Conditions 39 P.J. Thomson Introduction 39 Oro–facial swelling 39 Blistering disorders of the oral mucosa 45 Oral ulceration 47 Disturbed oro–facial sensory or motor function 49 Haemorrhage 50 Other acute conditions 51 Bony pathology 52 Summary 55 Further reading 55 5 Restorative Dental Emergencies 57 A. Moufti and C.B. Hayward Introduction 57 General principles 59 Pain management 59 Infections and soft tissue problems 65 Crack, fracture and mobility of teeth and dental restorations 71 Fractured and loose implants 81 Fractures and swallowing of removable prostheses 82 Conclusions 83 Further reading 83 6 Acute Presentations of Chronic Oro–Facial Pain Conditions 85 J. Durham Introduction 85 Oro–facial pain history 86 Examination of patients with oro–facial pain 89 Special investigations for oro–facial pain 90 Presentation, investigations and initial management of acute non–odontogenic oro–facial pain 92 Further reading 102 7 Traumatic Injuries to the Teeth and Oral Soft Tissues 103 U. Chaudhry and I.C. Mackie Assessment of the traumatised patient 103 Management of traumatic dental injuries 105 Injuries to the hard dental tissues and the pulp 105 Injuries to the hard dental tissues, the pulp and the alveolar process 112 Injuries to the periodontal tissues 116 Dento–alveolar fractures 127 Conclusions 127 Further reading 128 8 Pain Relief in the Dental Emergency Clinic 129 U.J. Moore Introduction 129 General mechanism of pain 129 Distribution of pain fibres in the mouth and jaws 134 Sources of pain in the mouth and jaws 135 Control of pain 136 Psychology of pain 137 Medication 139 The ladder of analgesia 144 Avoiding problems in prescribing analgesics 144 Further reading 147 9 Management of the Special Needs Patient 149 T. Nugent Introduction 149 Commonly seen conditions 151 Assessment 152 Medical history in the patient with special needs 153 Informed consent 154 Examination 155 Factors to consider in treatment 155 Conclusion 158 10 Making a Referral 159 I.P. Corbett and J. Greenley Introduction 159 When to refer 159 How to refer 160 Where to refer 161 The referral letter 161 Urgency 164 Cancer referrals 165 Copies of the referral letter 167 Summary 169 Further reading 170 11 Medical Emergencies in the Dental Emergency Clinic – Principles of Management 171 M. Greenwood Introduction 171 Contents of the emergency drug box 171 The ‘ABCDE’ approach to an emergency patient 174 Airway (A) 175 Use of defibrillation 180 Principles of management after the initial treatment of a medical emergency 181 Conclusions 182 Further reading 182 12 Examples of Specific Medical Emergency Situations 183 M. Greenwood Introduction 183 Vasovagal syncope (simple faint) 184 Hyperventilation 184 Asthma 185 Cardiac chest pain 187 Epileptic seizures 188 Diabetic emergencies 190 Allergies/hypersensitivity reactions 192 Adrenal insufficiency 196 Stroke 197 Local anaesthetic emergencies 197 Problems with haemostasis 200 Conclusions 203 Further reading 203 Appendix 1 Normal Reference Ranges 205 Appendix 2 Changes in Vital Signs in Patients with Infection 207 Appendix 3 Warfarin Protocol 209 Appendix 4 Aspects Relating to Local Anaesthetics 213 Appendix 5 NICE Guidelines for the Removal of Wisdom Teeth 215 Appendix 6 Protocol for Surgical Dental Treatment of Patients Taking Bisphosphonates 217 Appendix 7 Common ‘Recreational’ Drugs 221 Index 229