Table of Contents

List of Contributors ix

Preface xi

Acknowledgements xiii

1 Introduction, Infection Control and Prescribing 1
M. Greenwood

Introduction to the dental emergency clinic 1

Infection and infection control 2

Prescribing 8

Conclusions 12

Further reading 12

2 History Taking and Clinical Examination of Patients on a Dental Emergency Clinic 13
I.P. Corbett, C.B. Hayward and M. Greenwood

Introduction 13

History taking 13

Patient examination 18

Special tests 24

Record keeping 25

Consent 25

Conclusions 28

Further reading 28

3 Radiology and the Dental Emergency Clinic 29
R.I. Macleod

Introduction 29

Patients in pain 33

Trauma radiology 35

Looking at radiographs 36

Conclusions 38

Further reading 38

4 Acute Oral Medical and Surgical Conditions 39
P.J. Thomson

Introduction 39

Oro-facial swelling 39

Blistering disorders of the oral mucosa 45

Oral ulceration 47

Disturbed oro-facial sensory or motor function 49

Haemorrhage 50

Other acute conditions 51

Bony pathology 52

Summary 55

Further reading 55

5 Restorative Dental Emergencies 57
A. Moufti and C.B. Hayward

Introduction 57

General principles 59

Pain management 59

Infections and soft tissue problems 65

Crack, fracture and mobility of teeth and dental restorations 71

Fractured and loose implants 81

Fractures and swallowing of removable prostheses 82

Conclusions 83

Further reading 83

6 Acute Presentations of Chronic Oro-Facial Pain Conditions 85
J. Durham

Introduction 85

Oro-facial pain history 86

Examination of patients with oro-facial pain 89

Special investigations for oro-facial pain 90

Presentation, investigations and initial management of acute non-odontogenic oro-facial pain 92

Further reading 102

7 Traumatic Injuries to the Teeth and Oral Soft Tissues 103
U. Chaudhry and I.C. Mackie

Assessment of the traumatised patient 103

Management of traumatic dental injuries 105

Injuries to the hard dental tissues and the pulp 105

Injuries to the hard dental tissues, the pulp and the alveolar process 112

Injuries to the periodontal tissues 116

Dento-alveolar fractures 127

Conclusions 127

Further reading 128

8 Pain Relief in the Dental Emergency Clinic 129
U.J. Moore

Introduction 129

General mechanism of pain 129

Distribution of pain fibres in the mouth and jaws 134

Sources of pain in the mouth and jaws 135

Control of pain 136

Psychology of pain 137

Medication 139

The ladder of analgesia 144

Avoiding problems in prescribing analgesics 144

Further reading 147

9 Management of the Special Needs Patient 149
T. Nugent

Introduction 149

Commonly seen conditions 151

Assessment 152

Medical history in the patient with special needs 153

Informed consent 154

Examination 155

Factors to consider in treatment 155

Conclusion 158

10 Making a Referral 159
I.P. Corbett and J. Greenley

Introduction 159

When to refer 159

How to refer 160

Where to refer 161

The referral letter 161

Urgency 164

Cancer referrals 165

Copies of the referral letter 167

Summary 169

Further reading 170

11 Medical Emergencies in the Dental Emergency Clinic – Principles of Management 171
M. Greenwood

Introduction 171

Contents of the emergency drug box 171

The ‘ABCDE’ approach to an emergency patient 174

Airway (A) 175

Use of defibrillation 180

Principles of management after the initial treatment of a medical emergency 181

Conclusions 182

Further reading 182

12 Examples of Specific Medical Emergency Situations 183
M. Greenwood

Introduction 183

Vasovagal syncope (simple faint) 184

Hyperventilation 184

Asthma 185

Cardiac chest pain 187

Epileptic seizures 188

Diabetic emergencies 190

Allergies/hypersensitivity reactions 192

Adrenal insufficiency 196

Stroke 197

Local anaesthetic emergencies 197

Problems with haemostasis 200

Conclusions 203

Further reading 203

Appendix 1 Normal Reference Ranges 205

Appendix 2 Changes in Vital Signs in Patients with Infection 207

Appendix 3 Warfarin Protocol 209

Appendix 4 Aspects Relating to Local Anaesthetics 213

Appendix 5 NICE Guidelines for the Removal of Wisdom Teeth 215

Appendix 6 Protocol for Surgical Dental Treatment of Patients Taking Bisphosphonates 217

Appendix 7 Common ‘Recreational’ Drugs 221

Index 229

About the Author

Mark Greenwood is an NHS Consultant in Oral and Maxillofacial Surgery as well as Honorary Clinical Professor of Medical Education in Dentistry at at the School of Dental Sciences at Newcastle University. Qualified in both medicine and dentistry, he has been published in many peer reviewed journals and has co-authored two books on general medicine and surgery for dental practitioners. Ian Corbett is a Clinical Lecturer in Oral and Maxillofacial Sciences and Honorary Specialist Registrar in Oral Surgery at the School of Dental Sciences at Newcastle University.