Episode 8: Dental Emergencies Part 2

Author: Eoghan Colgan    @eoghan_colgan
Special Guest: Christine Goodall.  @MAVScotland



Dental Emergencies Part 2

Guest Bios

christine goodall  @MAVScotland

Christine Goodall Photo

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


  • 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)



  • 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



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



  • 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



  • 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



  • 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

useful Videos

Hannah BellComment