Displaced teeth / avulsed teeth / broken teeth



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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 200-400mg 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:



2. Immediate management: not applicable


  1. Clinical assessment:

  • Obtain patient history including

  • Perform standard clinical observations

  • Perform physical examination including:



4. Management:


  • Control bleeding, e.g. with ice or pressure

  • Give analgesia: oral Paracetamol/Codeine.


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


Schedule

4

Amoxycillin

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

Form

Strength

Route of Administration

Recommended Dosage

Duration

Capsule

250 mg-

500 mg


Oral

Adult

250-500 mg tds



5 days

administer one dose and supply one full course



Suspension

125 mg/5 mL or 250 mg/5 mL

5 days

Child

10 mg/kg/dose tds

Round dose to nearest measurable quantity


5 days

administer one dose and supply one full course



Provide Consumer Medicine Information:

Management of Associated Emergency: Anaphylaxis

[2]

If allergic to Penicillin, give Clindamycin:



Schedule

4

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

Form

Strength

Route of Administration

Recommended Dosage

Duration

Capsule

150mg

Oral

Adult

300mg tds



5 Days. Administer one dose and supply one full course

Capsule

150mg

Oral

Child

7.5mg/kg/dose up to 300mg



tds

5 Days. Administer one dose and supply one full course

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


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