Download Trauma to teeth

 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