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1. POST OPERATIVE BLEEDING
2. FACIAL SWELLINGS
3. AVULSED TEETH
4. LUXATED TEETH
5. FRACTURED TEETH
6. FACIAL FRACTURES
IN ALL CASES, WE NEED THE
FOLLOWING

1. HISTORY OF PRESENTATION
Time of incident
Extent of swelling/trauma/bleeding
Current clinical description/symptoms
2. MEDICAL HISTORY
3. HCC/PCC HOLDER
Eligibility for QH follow up care
POST OPERATIVE BLEEDING
POST OPERATIVE BLEEDING

1. Clean area, evacuate clot/blood with suction and
visualise socket
2. Apply pressure with sterile gauze ( finger or
patient biting) for at least 20 mins
3. Not stopped, soak gauze in transexamic acid
and apply pressure as before
4. If still no haemostasis, call on call dentist
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FACIAL SWELLINGS

1.WILL NEED SOME INTERVENTIONAL
TREATMENT BY A DENTIST USUALLY
TOOTH EXTRACTION
2.IF SEVERE WILL NEED SURGICAL
DRAINAGE
WHAT TO DO AT A&E

1. If affecting airway ² management by emergency staff to
ensure airway maintained and contact Maxillo Facial
Unit at RBH
2. If affecting eye, generally admit and put on IV
antibiotics ( Amoxycillin and Metronidazole)
WHAT TO DO AT A&E

1. If affecting airway ² management by emergency staff to
ensure airway maintained and contact Maxillo Facial
Unit at RBH
2. If affecting eye, generally admit and put on IV
antibiotics ( Amoxycillin and Metronidazole) and call
dental clinic the next day to assess and treat. In patients
are automatically eligible for public dental care.
3. If not affecting eye or airway, then oral antibiotics and
advise to see dentist ã
4. If eligible for public sector treatment, then get an OPG
for patient before sending them to see dental clinic
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First Aid Advice

1. Make sure it is a permanent tooth ² don·t
reimplant deciduous teeth
2. Keep patient calm and find the knocked out
tooth. Pick it up only by the crown.
First Aid Advice To Parents
1. Make sure it is a permanent tooth ² don·t reimplant
deciduous teeth
2. Keep patient calm and find the knocked out tooth. Pick
it up only by the crown. Avoid touching the root.
3. If tooth dirty, wash it briefly ( 10 secs) under cold
running water and reposition it. Try and encourage
parent/patient to reimplant tooth.
4. Bite on a handkerchief to hold it in position
5. If this is not possible, place the tooth in a suitable storage
medium eg milk or saline, not water
6. Get emergency treatment immediately i.e. A&E or
private dentist. If you know a patient is coming in, call
on call dentist.
ON PRESENTATION AT A&E

1. If tooth has already been reimplanted, then check
position is OK and call on call dentist
2. Organise tetanus shot if needed
3. If tooth hasn·t been reimplanted, then immediately
reimplant tooth and then call on call dentist. To do
this, rinse out the socket with saline and then
reimplant. Sometimes LA may be needed.
LUXATED TEETH
1. Clinical exam ² check for
‡ Teeth out of position with respect to their
adjacent teeth. Patients are usually the best
judge of that ² doesn·t feel right. Can be subtle
or blindingly obvious!
LUXATED TEETH
1. Clinical exam ² check for
‡ Teeth out of position with respect to their
adjacent teeth. Patients are usually the best
judge of that ² doesn·t feel right. Can be subtle
or blindingly obvious!

2. Contact on call dentist with history and extent
of displacement. Generally we will want to
reposition and splint immediately.
FRACTURED TEETH

1. Clinical exam ² check for
‡ Tooth mobility ² if excessive, contact on call dentist
‡ Pulp exposure ² bleeding from inside the tooth, not
the gum.
FRACTURED TEETH

1. Clinical exam ² check for
‡ Tooth mobility ² if excessive, contact on call dentist
‡ Pulp exposure ² bleeding from inside the tooth, not
the gum.
2. If pulpal exposure, call on call dentist. If not, advise
to see dentist next morning ² improved outcome if
treated earlier. Also, need radiographic assessment
to see if there is a root fracture.
3. Worth saving the broken fragment in water ²
sometimes it can be bonded back on.
MANDIBULAR FRACTURES

1. History of trauma
2. Extra ² orally
‡ Possible paraesthesia ² lip/cheek
‡ Deformity in bony contour
‡ Unnatural mobility and bony crepitus
‡ Limitation of mandibular movements depending on the
site and degree of displacement of the fractures
‡ Pain during opening, protrusion and lateral excursions
MANDIBULAR FRACTURES
INTRA-ORALLY

‡Bruising and gingival lacerations are common

‡Sublingual haematoma is characteristic of mandibular
fractures
MANDIBULAR FRACTURES
INTRA-ORALLY

‡Bruising and gingival lacerations are common

‡Sublingual haematoma is almost pathognomonic of
mandibular fractures

‡Derangement of the occlusion and that depends on the
site and degree of displacement of the fracture ²
classically displaced fractures of the condylar area lead
to the typical anterior open bite.