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GP ACRRM > Dental in GP > Flashcards

Dental in GP Flashcards

1
Q

What is bruxism

A

Teeth grinding/clenching/gnashing

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2
Q

Management of bruxism

A

Education of patient and management of stress/anxiety can help with daytime bruxism
Night time bruxism is likely to require a dental mouthguard

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3
Q

Anatomy of tooth

A

Crown: enamel (insensate), dentine (sensate), pulp chamber (neurovascular nest)
Root: cementum (attaches to periodontal ligament and alveolar bone)
Periodontal tissues: periodontal ligament, alveolar bone, gingiva

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4
Q

Identification of permanent teet

A

32 teeth in adults
Identify with double digit (1st being 1-4 depending on quadrant counted clockwise from upper left looking at patient, 2nd being 1-8 medial-lateral)

Common names: central and lateral incisors, canines, 1st/2nd premolar, 1st/2nd/3rd molars

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5
Q

Primary teeth - permanent teeth

A

AKA deciduous teeth
Up to 20
First tooth (central incisor) at 8-12 months, full set of teeth by 3y
Primary teeth identified using quadrants 5-8

Permanent teeth begin to erupt around 6y with first molar being the first. All permanent teeth by 13y except 3rd molars (17-21y if at all)

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6
Q

Important history to elicit in patients who present with dental injury

A

Tetanus status
Missing teeth
History of dental trauma
Previous orthodontics, root canals or fillings
Reported pain, sensitivity or mobility on presentation

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7
Q

Important features of examination in someone with dental injury

A

Altered occlusion on biting down - ?jawbone fracture

Examine oral cavity for lacerations, embedded teeth, degloving injuries

Tooth by tooth examination for tenderness, sensitivity and mobility

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8
Q

Types of injuries to tooth itself

A

Fracture
- may or may not affect pulp (red tissue visible in the tooth)
If advanced, may be infection present

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9
Q

Management of dental fractures

A

Analgesia
Refer to dentist ASAP
- may require root canal and restoration
- if pulp is involved, likely will need intra-oral xrays

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10
Q

Types of injuries to periodontal tissues

A
  • Concussion (inflammation of periodontal ligament)
  • Subluxation (abnormally mobile tooth WITHIN the socket)
  • Intrusion (displacement of tooth INTO socket)
  • Extrusion (displacement of tooth OUT of socket)
  • Luxation (lateral, labial or lingual displacement, root may be visible - often associated with alveolar bone fracture)
  • Avulsion (complete disarticulation of tooth from socket)
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11
Q

General management of most dental injuries

A

Simple analgesia
Stabilise tooth if mobile with splint
Soft diet
Review by dentist ASAP

If indicated (and trained) - nerve block and reposition tooth so anatomically correct

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12
Q

Management of avulsed permanent tooth in ED/GP

A
  • chest imaging if unsure of location of tooth (check not aspirated)
    DO NOT handle tooth by root
  • Dental block if trained and required
  • gently irrigate tooth and socket with saline
  • replace with correct tooth and orientation
  • apply splint
  • antibiotic (amoxil) + chlorhex mouthwash
  • urgent referral to dentist for better immobilisation - soft diet until then if not seen immediately
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13
Q

First aid management of avulsed tooth

A

Don’t handle root
Only wipe/wash away obvious contaminants, otherwise don’t touch with water
Store in socket if clean, or side of cheek/milk/saline

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14
Q

Time limit for successful reimplantation of avulsed tooth

A

Ideally within 15 minutes

Definitely within 2h

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15
Q

Best storage mediums for avulsed teeth

A
  1. Commercial dental storage medium
  2. Contact lens solution
  3. Milk
  4. Held inside patient’s cheek/in plastic with patient’s saliva

DO NOT put in tap water as this will rapidly cause damage (within 20 minutes)

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16
Q

Presentation and treatment of injuries to dental supporting bone

A

Presents with pain, supporting bone visible (either on avulsed tooth or in tooth socket)
Segment mobility and dislocation

Treatment:
- urgent referral to dentist (if alveolar fracture only) or maxfac/tertiary ED

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17
Q

Presentation and treatment of injuries to gingival or oral mucosa

A

Presentation: visible breach of oral mucosa areas with variable degrees of bleeding

Treatment: haemostasis (pressure +/- adrenaline soaked gauze)
Closure - sutures only required if larger laceration or gaping

18
Q

Materials to fashion a dental splint in ED/GP

A
  1. Blu tack
  2. Aluminium foil
  3. Skin glue + pre-moulded piece of malleable metal from Hudson mask
  4. Chewing gum
19
Q

Progression of a dental infection

A

Begins as pulpitis (contained in tooth structure)

  • > local alveolar bone invasion = periapical abscess
  • > erosion through cortical plate -> spread into tissue planes of face and neck (can cause cellulitis)

Deep extension (more likely in mandibular teeth)
-> submasseteric or submandibular space -> sublingual or submental space
Maxillary -> infraorbital -> periorbital cellulitis or cavernous sinus thrombosis OR encephalitis/meningitis

20
Q

Presentation of early dental infection

A

Localised pain
Facial swelling
Halitosis
General malaise

21
Q

Symptoms of extensive dental infection

A

Trismus
Inability to protrude tongue or swallow saliva (extension to sublingual space)
Dysphagia, dyspnoea, stridor, hoarse voice(extension to parapharyngeal space ?airway patency)

22
Q

Important examination findings in dental infections

A

IS AIRWAY PATENT

  1. facial swelling/induration - has it crossed the lower border of the mandible
  2. how far can patient open their mouth (<20-30mm = intubation difficulty)
  3. ask to protrude tongue and swallow ?sublingual extension
  4. is there buccal swelling or visible punctum
  5. examination of individual teeth
  6. examination for other causes of presenting complaint (e.g. sinus, tonsils, salivary glands)
23
Q

Indications for inpatient management/maxfac referral for dental infections

A 
Airway compromise
Significant facial swelling
Trismus
Systemically unwell
Significant medical comorbidities (e.g. immunosuppressed, poorly controlled DM etc. )
24
Q

Appropriate outpatient management for dental infections

A

ALL NEED TO SEE DENTIST PROMPTLY FOR DEFINITIVE MANAGEMENT, ANTIBIOTICS ALONE IS INADEQUATE
If cannot see dentist same day, commence antibiotics (cover aerobic + anaerobic e.g. Augmentin, amox + metro, or clindamycin)

If possible, make the dentist appointment yourself to improve compliance

25
Q

How long should you treat a dental infection BEFORE referring for extraction/definitive management

A

Should not delay at all! Delay may cause life-threatening infection, definitive surgical management should be provided ASAP

26
Q

Definitive management for dental infections

A

Incision and drainage of abscess
+
Tooth-saving techniques, root canal or extraction

27
Q

Likely cause of dental pain presenting with sensitivity to hot/cold/sweet stimuli

A

pulpitis

  • reversible if disappears on removal of stimulus
  • irreversible if does not disappear on removal of stimulus
28
Q

Presentation of pulpitis

A

Localised tooth pain with sensitivity to hot/cold/sweet stimuli

29
Q

Management of pulpitis in GP

A

Arrange for patient to see dentist ASAP

Avoid triggers
Analgesics (NSAIDs)
Cover if obvious cavity (e.g. with chewing gum, temporary filling material)
Toothache drops
Dental nerve block if pain severe

NO antibiotics

30
Q

Likely dental management of pulpitis

A

May be able to restore tooth if reversible

Root canal therapy or extraction if irreversible pulpitis

31
Q

Presentation of a non-viable tooth

A

Localised pain with no sensitivity to hot/cold/sweet stimuli

32
Q

Management of non-viable tooth

A

Simple analgesia

Urgent dental review

33
Q

Likely cause of dental pain with associated pressure tenderness

A

Likely early abscess

34
Q

Likely cause of dental pain with swelling in area of recent toothache

A

Dental abscess

35
Q

Likely cause of tooth pain that is worsened when leaning forward

A

Likely sinusitis and not dental at all

36
Q

Likely cause of dental pain persisting in days after dental extraction

A

Alveolar osteitis AKA “dry socket”

  • temporary exposed jawbone following extraction
37
Q

Management of alveolar osteitis

A

NO ANTIBIOTICS
flush socket with sterile saline
Apply sedative dressing if available
Urgent review by dentist

38
Q

Local analgesia options for dental pain

A

Cover any cavity (eg. with chewing gum)

Nyal toothache drops (contain benzocaine) apply via cotton bud for 1 minute

39
Q

Signs that may indicate dental or orofacial pain in a patient with demetia/unable to communicate

A
  • resistance to oral hygiene cares
  • having difficulty with eating or maintaining weight
  • behavioural change, agitation, unsettled without explanation

Most likely sign is treating for dental pain and seeing that behaviours change

40
Q

Management of tooth socket bleeding

A

Local pressure with gauze (+/- adrenaline soaked) for 30 minutes

41
Q

Assessment of post-dental surgery swelling

A

Swelling may take 3 days to develop fully
Check for demonstrable signs of infection
Check for any high risk features in patient (e.g. immunocompromised)

Generally need no antibiotics
Check that patient has post-op instructions and ability to contact treating dentist

GP ACRRM (14 decks)

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