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Dental Problems History Signs and Symptoms Differential · · · · · · · · · · · · · · · · · · · · · Age Past medical history Medications Onset of pain / injury Trauma with "knocked out" tooth Location of tooth Whole vs. partial tooth injury Dental or Jaw Pain Suspicious for Cardiac YES Bleeding Pain Fever Swelling Tooth missing or fractured B 12 Lead ECG Procedure P Cardiac Monitor Decay Infection Fracture Avulsion Abscess Facial cellulitis Impacted tooth (wisdom) TMJ syndrome Myocardial infarction Exit to Appropriate Cardiac Protocol NO Control Bleeding with Direct Pressure YES Exit to Appropriate Trauma Protocol Treat Dental Avulsion: See below NO Bleeding YES Control Bleeding with Direct Pressure Small gauze rolled into a square and placed into socket with patient closing teeth to exert pressure YES Place tooth in Milk / Normal Saline / Commercial Preparation May rinse gross contamination Do not rub or scrub tooth NO Dental Avulsion NO Transport YES Appropriate Pain Protocol if indicated Adult / Pediatric General Section Protocols Significant or MultiSystem Trauma NO Monitor and Reassess Exit to Appropriate Protocol Notify Destination or Contact Medical Control Pearls · · · · · Recommended Exam: Mental Status, HEENT, Neck, Chest, Lungs, Neuro Significant soft tissue swelling to the face or oral cavity can represent a cellulitis or abscess. Scene and transport times should be minimized in complete tooth avulsions. Reimplantation is possible within 4 hours if the tooth is properly cared for. Occasionally cardiac chest pain can radiate to the jaw. All pain associated with teeth should be associated with a tooth which is tender to tapping or touch (or sensitivity to cold or hot). Protocol 70 Any local EMS System changes to this document must follow the NC OEMS Protocol Change Policy and be approved by OEMS