| Popis: |
Patients with dental complaints commonly present to the emergency department for initial management. Immediate airway assessment and stabilization as needed are imperative. Based on clinical signs and symptoms, providers may assess the degree of dental decay and make an appropriate referral. Nonsteroidal antiinflammatory drugs are effective for most dental pain, and antibiotics are not indicated in the absence of overt infection. Emergency providers may drain simple odontogenic abscesses, but referral for definitive endodontic therapy is still required. Abscesses may extend into the deep fascial spaces of the face and neck. When “red flag” findings are seen, it is critical to protect the airway and obtain early consultation with specialists, along with advanced imaging and likely admission for drainage and intravenous antibiotics. Complications such as Ludwig angina, vascular erosion, and necrotizing fasciitis may lead to significant morbidity and mortality in otherwise healthy patients. Gingivitis and periodontitis are typically chronic, slowly progressing diseases but also have acute necrotizing variants that require antibiotics and prompt dental follow-up. Dentoalveolar fractures may be temporized by an emergency provider with commercial splints and coverings. Tooth avulsion is a dental emergency that requires proper handling and prompt replantation within 60 minutes. Mandibular fractures should be suspected with malocclusion and a positive tongue blade test. After diagnosis, however, these may be managed on an outpatient, nonemergent basis. Given the significant force required to produce a mandible fracture, patients should be assessed for other acute traumatic injuries. This review contains 11 figures, 5 tables, and 45 references. Key words: antibiotic, dental infection, dentoalveolar trauma, gingivitis, mandible fracture, odontogenic abscess |
