Episode 8: Dental Emergencies Part 2
Author: Eoghan Colgan @eoghan_colgan
Special Guest: Christine Goodall. @MAVScotland
7/3/2018
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Guest Bios
christine goodall @MAVScotland
Christine is an Honorary Consultant and Senior Clinical Lecturer in Oral Surgery and Sedation at the University of Glasgow/NHSGGC and has been there for the past 14 years. Most of her training is in OMFS and she worked in various hospitals around Glasgow during her SHO years including the old Victoria Infirmary and Monklands moving on to do StR training in Academic OMFS in Glasgow and Aberdeen. She now works at Glasgow Dental Hospital and School where she divides her time between clinical work, research (she is leading on the evaluation of Navigator), teaching and running Medics against Violence a charity she set up in 2008. She is the Lead Clinician for her specialty, TPD for the West of Scotland and the Chair of the SAC in Oral Surgery (there aren’t that many oral surgeons!!). Years of nights spent running between EDs in Glasgow and Lanarkshire on a very old and now defunct SHO on call rota have given her invaluable experience in the management of dental and OMFS emergencies. These are some of the things she finds useful.
If you are in Glasgow and not sure of what to do please phone us. During the day you can get our triage nurse on 0141 211 9660 and quick access to a specialty grade oral surgeon for advice and help, from 5-9 you can call the GEDS (Glasgow Emergency Dental Service) service on 0141 232 6323 to access an experienced GDP and after 9pm you can call OMFS via the QEUH switchboard on 0141 201 1000.
Show Notes
Eoghan and Dr Goodall continue their conversation on dental emergencies. Dr Goodall offers more tips and pearls to help manage dental trauma, tooth avulsions, facial fractures, jaw dislocations and face/tongue wounds. A huge thank you to Dr Goodall for her time and to the Royal College of Physicians and Surgeons of Glasgow for the recording space..
Take Home Points
BROKEN TOOTH
The type/depth of break has limited clinical significance
Give paracetamol and ibupfoen for pain
Could consider local anaesthetic infiltration if severe pain
Cover with zinc oxide-eugenol paste if available
Disposition: see dentist within 24 hours (either own dentist or emergency OOH dentist)
AVULSED TOOTH
Can transport in milk, salty water or patients gum
All isotonic which protects the cells on the root
Resite them ideally within 45 minutes
Better chance of reimplantation
Could consider after longer periods of time but chance of successfull reimplantation reduces
Hold the tooth by the crown (visible part of tooth)
Rinse with saline, don’t scrape it or remove tissue
Push back into socket
More easily sited after .local anaesthetic
Make sure it is the right orientation and the right depth into the socket
Should look the same as the opposite side
Then bite on some gauze to hold in place and see dentist/max-fax at earliest opportunity
FACIAL FRACTURES
Mandibular fractures:
Signs:
Painful
May have numbness of mental nerve (classic)
Deranged occlusion or difficulty bringing teeth together
Moving mandible is very uncomfortable
Most are compound fractures and prone to infection
Should be referred emergently (likely operated on the next day)
Zygomatico-maxillary complex fractures:
Most not fixed immediately and can be put on next trauma list unless:
Eye signs:
Entrapment (decreased upward gaze and diplopia)
Retrobulbar haemorrhage (loss of movement, visual impairment etc
JAW DISLOCATION
Signs:
Unable to close mouth
If they can close their mouth they do not have a dislocation
Conventional reduction generally successful but aided by:
Sedation to overcome masseter muscle spasm
Have patient sit on a seat and stand over/above patient as you reduce
FACIAL WOUNDS
Tongue wounds can bleed a lot
Use local anaesthetic with adrenaline (and dental syringe) and inject around the wound
Can use pressure with dry gauze and constant pressure
Place stitches knowing that does not require perfect closing (will heal up well)
Could consider diathermy if available for deep, difficult bleeding points
Lip wounds:
Take care opposing the edges around the vermillion border
Less care required for internal lip wounds but probably best to close unless very superficial
Facial Wounds
Able to close in A&E unless other structure involved (can refer these to plastics or max-fax):
Facial nerve
Parotid gland and parotid duct
AUDIENCE QUESTIONS
When you receive an OBE you find out a month in advance but are sworn to secrecy (though no one is very sure what would happen if you don’t keep the secret)
A dental drill is so noisy because it is an air turbine rotating at 200,000rpm’s (pretty fast!)
Biggest change in dental surgery in recent years – introduction of plating systems that come from orthopaedics
Remember – you are part of a team and never be fearful of waking someone up for help!!
And consider phoning your local dental hospital for advice during office hours
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