PEM Source

Your source for all things Pediatric Emergency Medicine

All posts with tag: "dental"

PEM Questions

(Click the link to comment and to vote - voting not working through email, sorry!) A 7 year old boy presents to the ED after falling off his bike and impacting his mouth against the handlebar and the ground. Bystanders reported to the parent that there was a tooth on the ground, and per paramedics the parent is on the way in and may or may not have the tooth. Exam reveals a grossly luxated tooth that is very loose, and two sockets of apparently missing teeth. [yop_poll id="84"]
(Click the link to comment and to vote - voting not working through email, sorry!) A 10-year old child is brought in for swelling that developed 2 hours ago around the mouth as well as a sensation of difficulty swallowing and breathing. Vital signs are normal and she is not hypoxic nor stridorous, but she does have right sided perioral swelling as well as mucous membrane swelling. There is no discoloration. She has no urticaria, pruritis, nor hypotension. She had dental work on her right lower teeth the day prior, and had local anesthetic injection for that. She took one dose of acetaminophen the day prior and one dose 6 hours ago. Her stepfather gave her diphenhydramine 1 hour ago, but it hasn’t helped. The child denies trauma and says that she felt tingling in the area for 1 hour prior to the onset of swelling. [yop_poll id="81"]
(Click the link to comment and to vote - voting not working through email, sorry!) A 19 year old man presents 4 hours after leaving his dentist office from wisdom tooth extraction. He has been having bleeding from the socket that will not stop for the last 2 hours. His dentist office is now closed and no one is answering the phone. He has no prior history of excessive bleeding and is not taking any medications. He is hemodynamically stable, and on exam you see a clot in the socket surrounded by a steady ooze of blood, which the patient spits out onto a napkin every minute or so. [yop_poll id="73"]
(Click the link to comment and to vote - voting not working through email, sorry!) A 4 year old child comes in 20 minutes after falling with avulsion of her left upper lateral incisor. The parents have brought the tooth in a tissue. The entire crown and root are present. There is no active bleeding from the socket. The remainder of her exam is normal; she is able to open her mouth widely without pain and has no bony tenderness over her facial bones or jaw. [yop_poll id="57"]

Tips and Tricks

Your local hospital cafeteria can be a useful resource in managing your PED patients:
  1. Sugar liberally applied to the edema of a paraphimosis or rectal prolapse may help decrease swelling and improve reduction efforts
  2. A mayonnaise packet provides useful lubricant for removing a tight ring
  3. Tannins from a tea bag (particularly black tea) can help clotting with post dental extraction bleeding (place a moistened tea bag in the socket and have the patient apply pressure by biting down)
  4. A packet of sugar + 10 mL sterile water = make your own sucrose solution for treatment of pain associated with procedures in infants
Know of any more? Comment below!
What do you do if you have a patient with a tooth avulsion and no commercial periodontal dressing? You can use the flexible thin metal nasal bridge on an N95 mask and glue the reimplanted avulsed tooth to an adjacent tooth using 2-octocyanoacrylate skin adhesive (made for laceration repair). N95 maskN95 mask, Amazon.com See this discussed in an Aliem.com trick of the trade See more on tooth avulsion management from NCEMI Common Simple Emergencies

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