Dental

Question 1

What are some causes of orofacial pain

Answer 1

• maxillary sinusitis
• TMJ
• angina pectoris
• referred pain
• **trigeminal neuralgia
• herpes zoster
• cluster headaches
• hutchinson’s sign**

Question 2

Where does dental pain of pulpal origin come from

Answer 2

nerve, vascularized connective tissues
pulpalgia: inflammatory changes to pulp

Question 3

What are some periodontal origins of dental pain

Answer 3

gingivitis, periodontitis, acute periodontal abscess

Question 4

What are some post-extraction complications (dental)

Answer 4

• infection
• bleeding
• pain
• swelling
• dry socket

Question 5

How do you treat dry socket

Answer 5

anesthesia, irrigation, packing, pain meds

Question 6

How is enamel repaired/rejuvinated

Answer 6

With fluoride

Question 7

Describe the 3 major layers of a tooth and what is inside

Answer 7

Enamel, dentine, pulp cavity

in the pulp cavity: root canal, nerve & blood vessels

Question 8

What is the function of the gums

Answer 8

keep tooth in place and to prevent cavities to the underlying dentine from food/microbes

Question 9

What are the tissues that make up the periodontium

Answer 9

gingiva, periodontal ligament, alveolar bone

Question 10

What is the function of saliva

Answer 10

• natural defense against cavities
• removes carbs & neutralizes low pH caused by acid formation

Question 11

Describe the diagnostics for dental concerns

Answer 11

Attempt to replicate dental symptoms
- percuss with tongue depressor
- palpate
- thermal (ice water)
- biting pressure

(put gloves on and then wash them off so they don’t taste gross)

Question 12

When should kids first go to the dentist

Answer 12

• 6 mos (with a tooth)
• eruption of first tooth
• or when they can sit up in the chair

Question 13

What can you store an avulsed tooth in

Answer 13

• milk
• saline
• mouth
• NOT WATER

Question 14

Describe the sxs of dry socket

Answer 14

• loss of clot/exposed bone in socket
• usually mandibular molars
• increase in acute throbbing pain after 2-5 days
• pain radiating to ear
• analgesics ineffective until irrigation procedure/packing done
• fetid odor

Question 15

What are some oral pathologies related to derm

Answer 15

• pyogenic granuloma
• oral leukoplakia
• SCC
• angular cheilitis
• tumors of the mucosa
• HSV 1

Question 16

Describe the etiology of pulpalgia

Answer 16

Inflammatory changes to pulp

Secondary to dental caries, cracked teeth, trauma, hyperocclusion (high filling), recent dental restorations

Question 17

Describe the clinical presentation of pulpalgia

Answer 17

Reversible: sharp hypersensitive reaction precipitated by thermal stimulus or function

Irreversible: prolonged, unstimulated, spontaneous, pain persisting after removal of thermal stimulus

Question 18

Describe the etiology/RF for dental caries

Answer 18

Aka tooth decay

Bacterial infection, commonly strep mutans causing destruction of the calcified tooth structure

Can lead to rampant decay (RF: children, vasoconstricting drugs, dry mouth)

Question 19

Describe the clinical presentation of dental caries

Answer 19

3 stages
1. Early: within enamel, reversible with fluoride, watch tooth in adults or fill in kids/people who don’t go to the dentist often
2. In dentine layer: needs filling, +/- symptoms
3. Into pulp: toothache, requires extraction or root canal

Question 20

Describe the treatment for dental caries

Answer 20

Fluoridated toothpaste, fillings, extraction or root canal

Extensive treatment for rampant decay

Refer to dentists

Give NSAIDs (ibuprofen 400mg q 6hr)

Question 21

Describe the treatment for a tooth avulsion

Answer 21

Wash then reposition or bite gauze until dental consult, can store in milk, saline, mouth, avoid water

Emergency dental tx within 1 hr

Tetanus booster, systemic abx (penicillin, amoxicillin)

Question 22

Describe the clinical presentation of dental abscesses

Answer 22

Acute pain to palpation, fluctuant mass, purulent exudate, bad taste in mouth

+/- sinus tract coming out to the cheek

Question 23

Describe the treatment for a dental abscess

Answer 23

Abx (PCN, amoxicillin), pain meds, I&D if appropriate

Dental consult

Question 24

Describe the etiology of odontogenic space infection

Answer 24

Can be secondary to an untreated dental abscess, usually from a mandibular molar

Sublingual, submandibular, and bilateral buccal space infections at the same time

Question 25

Describe the clinical presentation of odontogenic space infections

Answer 25

Rapid onset, severe trismus, drooling, inability to swallow, tachypnea, dyspnea, bull neck, airway compromise, minimal/no fluctuance, cavernous sinus thrombosis

Ludwig’s Angina

Question 26

Describe the treatment for odontogenic space infection

Answer 26

Aggressive!

I&D, parenteral abx, supportive care, tooth extraction

Question 27

Describe the etiology for periodontitis/periodontal disease

Answer 27

Inflammation of supporting tissues of teeth caused by different microorganisms

+/- Progression from gingivitis

Progressive destruction of periodontal ligament & alveolar bone

Exacerbated by plaque

Question 28

Describe clinical presentation of periodontal disease

Answer 28

Gingivitis, gingival hyperplasia, can cause chronic disease problems d/t bacterial flora changing from gram+ to gram- & disseminating intravascularly (CV, Endo, pregnancy, smoking implications)

Question 29

Describe the etiology of TMJ disorder

Answer 29

Malocclusion, trauma, arthritis

Usually unilateral

Question 30

Describe the clinical presentation of TMJ

Answer 30

Painful jaw movement, may be referred to face/neck, HA, clicking, popping, crepitus, locking

Question 31

Describe the treatment for TMJ

Answer 31

NSAIDs, avoid high-chew foods, stress reduction, moist heat, dental referral

May spontaneously resolve