DENTAL EMERGENCIES

Presented by House Surgeon-Chan Nyein and John Han Saw

Date - 5.2.2024
Contents
• Introduction
• Dental anatomy
• Categories
I. Pain
II. Infection
III. Haemorrhage
IV. Traumatic injuries
• Conclusions
• References
Introduction
• The American Dental Association (ADA) defines dental
emergencies as a collection of potentially life-threatening diagnoses
requiring immediate treatment to stop bleeding, remedy the
infection, and alleviate severe pain.
• A dental emergency also refers to any problem affecting teeth or
supporting tissues that require immediate action to prevent
biological, functional, or aesthetic complications.
Dental anatomy

Deciduous dentition

• 20 primary teeth;8 incisors, 4 canines and 8 molars

Permanent dentition

• 32 permanent teeth; 8 incisors, 4 canines, 8 premolars and 12

molars
• The teeth are made up of four different types of material: the
enamel, dentin, pulp, and cementum.
• The enamel covers the crown of the tooth and is the hardest
substance in the body.
• The cementum is the substance that covers the root of the
tooth.
• The dentin is underneath the enamel and dentin and is much
softer.
• When a cavity forms in the enamel and continues into the
dentin, it progresses very rapidly to the pulp, since the dentin
is very soft.
• The pulp is in the center of the tooth (root canal) and contains
the nerves and blood vessels that supply the tooth with
sensations of tooth sensitivity or pain.
Dental emergencies can be generally divided into three categories
I. Pain
II. Infection
III. Haemorrhage
IV. Traumatic injuries
I. Pain

1. Pulpitis
2. Acute Apical Periodontitis
3. Pericoronitis
4. Alveolar Osteitis(Dry Socket)
5. Trigeminal Neuralgia
1.Pulpitis
• Pulpitis is an inflammation of the pulp. It usually happens
when there’s an irritation inside a tooth due to things such as
grinding or a cavity.
• In reversible pulpitis, pain occurs when a stimulus (usually
cold or sweet) is applied to the tooth. When the stimulus is
removed, the pain ceases within 1 to 2 seconds.
• In irreversible pulpitis, pain occurs spontaneously or lingers
minutes after the stimulus (usually heat, less frequently cold)
is removed.
Management
2.Acute Apical Periodontitis
• Apical periodontitis is the local inflammation of the periapical
tissues that originate from pulp disease.
• It may occur due to the advancement of dental caries, trauma,
or operative dental procedures.
• The infected pulp is the main cause of apical periodontitis.
• The dental pulp may remain vital or have lost vitality and
become necrotic.
• The tooth will be tender and painful on percussion.
Treatment
• Root canal treatment
• Extraction of the involved tooth, remove the source of
infection, drains the exudates
3.Pericoronitis
• It is an inflammatory condition of the gingiva and other
supporting tissues that surround the crown of a completely or
incompletely erupted tooth (or) an inflammatory condition of
operculum.
• Most commonly occurs in-
- Permanent mandibular third molar
- Deciduous molar
Treatment
• Gentle debridement between operculum and occlusal surface
• Irrigation with antiseptic solution
• Antibiotic cover (Amoxicillin,Metronidazole)
• Analgesis and aniinfiammatory
• Depend upon the condition, operculectomy or extraction is
done
4.Alveolar Osteitis(Dry socket)
• Dry socket, also called alveolar osteitis, is a painful
complication of a tooth extraction.
• If the blood clot is dislodged or does not form well, the bone
and nerve are left exposed. This causes extreme pain and can
lead to infection.
• Typically severely pain, foul odour, swelling and
lymphadenopathy

Treatment
• Irrigation with warm saline(continue up to 3 to 4 week)
• Socket is packed with antiseptic dressing, iodoform gauze
containing eugenol
• Dressing changed every 24 hours for 1st 3 day
5.Trigeminal Neuralgia
• Trigeminal neuralgia (TN), also known as tic douloureux, is a type
of chronic pain disorder that involves sudden, severe facial pain. It
affects the trigeminal nerve, or fifth cranial nerve.
• TN is a type of neuropathic pain, typically caused by a nerve injury
or nerve lesion.

Treatment
-Medications; 1st line of treatment
• Anticonvulsant such as carbamazepine, gabapentin, phenytoin
• Tricyclic antidepressants such as amitriptyline
-Surgery
• Several neurosurgical procedures are available to treat TN. The
choice of procedure depends on the nature of the pain, physical
health, blood pressure, and previous surgeries; and the distribution
of trigeminal nerve involvement
II. Infection

1. Acute Apical Abscess

2. Facial Cellulitis
3. Ludwig’ Angina
4. Cavernous Sinus Thrombosis
1.Acute Apical Abscess
• Acute Apical Abscess is an inflammatory reaction to pulpal
infection and necrosis characterized by rapid onset,
spontaneous pain, extreme tenderness of the tooth to pressure,
pus formation and swelling of associated tissues.
• There may be no radiographic signs of destruction and the
patient often experiences malaise, fever and lymphadenopathy.

Treatment
• Drainage must be done. Opening the pulp chamber or
extration of the tooth.
• Root canal therapy
• If not treated spread of infection Osteomyelitis,
Cellulitis, Cavernous Sinus Thrombosis
2.Facial Cellulitis
• Diffuse inflammation of soft tissue which is not circumscribed
or confined to one area.
• It is commonly result from dental infection; apical abscess,
Osteomyelitis, Periodontal infection.
• Painful swelling which is firm and brawny.
• Overlying skin may be inflammed and purplish

Treatment
• Administration of antibiotics and removal of the cause of
infection.
• Resolution is usually prompt with adequate treatment.
3.Ludwig’Angina
• An aggressive and rapidly cellulitis that involves the
submaxillary space, sublingual space, and submental spaces,
bilaterally.
• Patient suffered with massive , firm, brawny
cellulitis/induration, and acute toxic state.
• True LA- massive swelling involving the spaces bilaterally.
• Impending LA- only involving one side.
Treatment
• Maintenance of airway(Tracheostomy, Cricothyroidotomy)
• Incision and Drainage
• Antibiotic Therapy(High dose penicillin and Clindamycin or
Chloramphenicol is used in penicillin-resistance patient)
• Elimination of original focus of infection
4.Cavernous Sinus Thrombosis
• Cavernous sinus thrombosis is a blood clot in the cavernous
sinuses. It can be life-threatening.
• Cavernous sinus thrombosis is typically caused by an infection
that has spread beyond the face, sinuses or teeth.
• Headache, nausea, pain, chills Fever(+) with progression signs
of CNS.
Treatment
• Corticosteroid medications may also be used to reduce
swelling.
• High-dose antibiotics
• Surgery may be needed to drain the site of the initial infection.
Cavernous Sinus Thrombosis
III. Haemorrhage
Hemorrhage in dental surgery can be categorized as:
1.Primary hemorrhage
• Bleeding occurs during surgery. It is really normal and can be
controlled easily.
2.Reactionary hemorrhage
• Bleeding occurs 2–3 hours after surgery.
• Occurs as a result of failure of coagulation to occur(as in
patient with systemic bleeding problem or those on
anticoagulants)
3.Secondary hemorrhage
• Bleeding occurs until 14 days after surgery, probably due to an
infection.
Traumatic dental injuries
• Traumatic dental injuries often occur as a result of an
accident or sports injury.
Oral Cancer
• 90%of oral malignancies are squamous cell carcinoma.
• Extrinsic factors include tobacco smoking and chewing,
excessive alcohol consumption, sunlight exposure, eating
spicy foods, presence of sharp edges(dental restoration).
• Intrinsic factors include general malnutrition and chronic iron-
deficiency anemia.
• Early lesion are usually asymptomatic.
• Pain may be a feature of an advanced lesion.
Management
• Surgical Excision
• Radiation Therapy
• Chemotherapy
• Or combination of two or more of these.
Conclusion

• ALWAYS BE PREPARED.
• Prompt recognition and efficient
management of medical emergencies by a
well-prepared dental team can increase the
likelihood of a safe & satisfactory
outcome.
• Basic life support training-A MUST
• As always, prevention is better than cure.
References