Dental Emergencies Case Study

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Chapter 6
Dental Emergencies

Dental problems demanding immediate intervention are termed as dental emergencies. Situations which can wait for normal dental appointments are not emergencies.
Conditions demanding an emergency call are classified as:
I. Oro – facial pain
1. Cuts or wounds to oral tissue
2. Prolonged tooth ache
3. Pain in wisdom tooth
4. Dry socket
5. Ludwig’s angina
6. ANUG –Acute Necrotizing Ulcerative Gingivitis
II. Restorative emergencies
1. Lost filling
2. Lost crown or cap
3. Objects wedged between teeth
4. Lost tooth
5. Orthodontic emergencies
III. Inflammatory emergencies
1. Mouth sores
2. Periodontal abscess or infection
3. Periapical abscess
IV. Traumatic emergencies
1. Knocked out tooth or Avulsion
2. Fractured tooth
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Develops within 24 to 48 hours. This presents as acute pain in the site as the alveolar bone and nerve endings are exposed to air.
Treatment: Thorough debridement of the area and eugenol packing.

Tooth fracture:
Cause: Ellis Class III and IV fractures demand immediate care. Class III fracture is fracture involving the pulp and Class IV is fractures of the root.
Treatment: In Ellis Class III, the tooth is covered with calcium hydroxide cement as an emergent treatment. Endodontic treatment is the final call. In Class IV, the tooth is extracted. If lesser than one third of the root is affected, then it may be salvaged.

Knocked out tooth/Avulsion:
Cause: It is a true dental emergency. It involves the complete displacement of the tooth from its socket and is mostly traumatic.
Treatment: the tooth can be reimplanted based on the condition of the periodontal ligament fibers and subsequently splinted with suture or splint material. The tooth is pre-soaked in doxycycline to slow inflammation for 5 minutes before
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It is the moral, social and legal obligation of the dentist to treat a patient at risk. The dental office team also bears a moral obligation to the same.
A Standard of care should be employed while treating patients. The standard of care is defined as “What the reasonable, prudent person with the same level of training and experience would have done in the same or similar circumstances”. It encompasses four components.
1) The duty to act – the patient comes to the dentist with an implied understanding that the dental professional is competent in providing care and in the process, can also attend to any unforeseen circumstances. This demands that a dentist be trained for attending medical emergencies. The moral obligation of the dentist also dictates that if need demands, not only his patients, but any member in an emergency state be attended. This could be a family member, friend or an acquaintance.
2) An act of omission or commission –
Act of omission – means not performing tasks that a reasonable, prudent person would have done in such
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