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Trauma to teeth (Displaced teeth / avulsed teeth / broken teeth) Recommend Use of ibuprofen or other NSAID is not recommended for dental pain relief in patients with kidney disease unless in consultation with the patients MO Background Analgesia NSAIDS are particularly effective for bone pain. The most commonly used NSAIDs for dental, oral and facial pain is ibuprofen Severe pain usually requires the additional use of another analgesic such as paracetamol [1] Registered nurses can administer and supply ibuprofen in 200mg strength. However a dose of 200400mg 3-4 times daily is required to reduce the inflammatory response [1] Related topics: Head injuries, page 107 Eye injuries, page 253 Fractured mandible/jaw, page 127 Traumatic rupture of the ear drum, page 562 Tetanus immunisation, page 129 1. May present with: Avulsed (torn away), displaced or broken tooth / teeth secondary to injury Bleeding in mouth 2. Immediate management: not applicable 3. Clinical assessment: Obtain patient history including past episodes or complications, circumstances of injury current medications Perform standard clinical observations Perform physical examination including: inspect oral cavity, teeth, soft tissues assess bite, suspect jaw or facial fracture if bite is abnormal assess bleeding, duration and amount 4. Management: Control bleeding, e.g. with ice or pressure Give analgesia: oral Paracetamol/Codeine. for children < 12 years of age give Paracetamol only for adults allergic to codeine give Paracetamol See Simple Analgesia Protocol (back cover) Displaced permanent tooth / teeth: Reposition incisors still in socket to original position with firm finger pressure Splint - temporary splinting can be achieved by fixing the tooth to the adjacent teeth either by folding aluminium foil over them or using beeswax. This is intended to be a temporary measure only. Patient will require evacuation for further treatment by dentist Have soft diet for 2 weeks and chlorhexidine (0.2%) mouthwash twice a day for 1 week Administer analgesia Avulsed permanent tooth / teeth (completely out of socket): A tooth reimplanted within 1 hour has a much better chance of survival therefore it should be a priority to reimplant teeth as soon as possible If tooth is dirty, wash briefly (10 seconds) with Normal Saline, avoid touching the root Replace tooth in the socket with firm finger pressure. It may be useful to encourage the patient to bite on piece of gauze to assist in positioning the tooth Splint as above. This is intended to be a temporary measure only. Patient will require evacuation for further treatment by dentist Check last tetanus vaccination. See Tetanus Immunisation If bleeding continues refer to post-extraction haemorrhage Have soft diet for 2 weeks and chlorhexidine (0.2%) mouthwash twice a day for 1 week Administer analgesia Administer oral amoxicillin if not allergic to Penicillin. If allergic to Penicillin for young child requiring suspension give Sulfamethoxazole, Trimethoprim (Bactrim) suspension on MO order DTP IHW / RIN / NP / IPAP Authorised Indigenous Health Workers and Isolated Practice Area Paramedic must consult MO Rural and Isolated Practice Endorsed Registered Nurses may proceed Nurse Practitioners may proceed Route of Form Strength Recommended Dosage Duration Administration Capsule 250 mgOral Adult 5 days 500 mg 250-500 mg tds administer one dose and supply one full course Suspension 125 mg/5 mL 5 days Child 5 days or 250 mg/5 10 mg/kg/dose tds administer one dose and supply mL Round dose to nearest one full course measurable quantity Provide Consumer Medicine Information: Management of Associated Emergency: Anaphylaxis Schedule 4 Amoxycillin [2] If allergic to Penicillin, give Clindamycin: DTP IHW / RIN / NP / IPAP Authorised Indigenous Health Workers and Isolated Practice Area Paramedics must consult MO Rural and Isolated Practice Endorsed Registered Nurses may proceed Nurse Practitioners may proceed Route of Form Strength Recommended Dosage Duration Administration Capsule 150mg Oral Adult 5 Days. Administer one dose 300mg tds and supply one full course Capsule 150mg Oral Child 5 Days. Administer one dose 7.5mg/kg/dose up to 300mg and supply one full course tds Schedule 4 Clindamycin Provide Consumer Medicine Information: NB advise patient the use of Clindamycin can lead to severe colitis (inflammation of the bowel). If they experience diarrhoea while taking the drug or up to several weeks after the treatment Contact their MO or return to the clinic and have a stool specimen taken for Cl. difficile.[3] Management of Associated Emergency: Consult MO [2] Avulsed and displaced primary tooth / teeth: Do not splint or reposition primary (first) teeth. There is a risk of damaging the permanent tooth underneath Administer analgesia as indicated 5. Follow up: Consult MO or Dentist Educate regarding oral hygiene – tooth brushing, reduce sugar intake through food and drinks See next Dentist clinic 6. Referral / Consultation: Consult Dentist or MO on all occasions Temporary splint / bridge is only intended for overnight stabilisation of the tooth. Evacuation for a patient will be required for further treatment