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Medical Education Division |
Operational Medicine 2001
Field Medical Service School
Student Handbook
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DENTAL
EMERGENCIES FMST 0418 16 DEC 99
TERMINAL
LEARNING OBJECTIVE(S): 1.
Given a dental emergency casualty in a combat environment and the
standard Field Medical Service Technician supplies and equipment, manage dental
emergencies, per the references. (FMST.04.19)
ENABLING
LEARNING OBJECTIVE(S): 1.
Without the aid of reference materials and given a list of teeth, select
the appropriate terminology for each
tooth, per the student handbook. (FMST.04.19a) 2.
Without the aid of reference materials and given a list of the parts of a
tooth, select the appropriate terminology
for each part, per the student handbook. (FMST.04.19b) 3.
Without the aid of reference materials and given a list of dental
emergencies, select the appropriate treatment for each emergency, per the
student handbook. (FMST.04.19.c) 4.
Without the aid of reference materials and given a list of dental
classifications, select the appropriate
definition for each classification, per the student handbook. (FMST.04.19.d) 5.
Without the aid of reference materials and given the FMST MOLLE Medic bag
and a simulated dental casualty, identify, treat and monitor the casualty, per
the student handbook. (FMST.04.19e) OUTLINE: A. BASIC ANATOMY AND TERMINOLOGY OF THE TEETH
a. Twelve total b. Six in Upper Set (Maxillary) c. Six in Lower Set (Mandibular) d. Located farthest back in mouth
a. Eight total b. Four in Upper Set c. Four in Lower Set d. Located in front of the molars
a. Four total b. Two in Upper Set c. Two in Lower Set d. Located in front of the bicuspids
a. Eight total b. Four in Upper Set c. Four in Lower Set d. Located in front of the cuspids 6. STRUCTURE OF A TOOTH a.
1) Hardest substance in the body 2) Covers the entire crown 3) Provides protection to exposed tooth b. Dentin 1) Light yellow substance 2) Bulk of the tooth 3) Second hardest substance 4) Found inside the crown, under enamel and inside root c. Pulp 1) Provides sensation and blood supply to the tooth d. Gingiva (Gums) 1) Soft tissue covers and surrounds neck of the tooth 2) Healthy gingiva is pink, firm and resilient e. Cementum 1) Bonelike substance 2) Covers roots of the teeth 3) Ligament attaches to bone to anchor teeth f. Root Canal 1) Extension of the pulp chamber 2) Houses nerves, veins and artery of the tooth g. Apical Foramen 1) Opening at apex of the tooth 2) Permits passage of nerve and blood vessels B. DENTAL EMERGENCIES
a. Definition - Lost filling or loose crown b. Causes 1) Trauma 2) Untreated dental carries (cavities) c. Signs / Symptoms 1) Chalky white spot on enamel 2) Dark stained cavity 3) Cavity filled with food or spongy mass of decaying dentin 4) Sensitive tooth to hot, cold and / or air d. Treatment 1) Gently remove debris with an excavator 2) Replace lost restoration with IRM (Zinc Oxide) 3) Replace loose crown with mix of IRM as cement 4) Patient bites down to set proper occlusion
a. Definition - Severe, spontaneous tooth pain b. Causes 1) Pulp reacts to injury or extensive tooth decay c. Signs / Symptoms 1) Large carious lesion 2) Possible pulpal exposure 3) Blood and / or pus 4) Fracture or lost restoration 5) Spontaneous, continuous or intermediate pain 6) Pain increases on lying down 7) Piercing and / or pulsating pain d. Treatment 1) Gently remove loose debris 2) Pack cavity with cotton pellets or IRM 3) Give analgesics 4) CASEVAC severe cases
a. Definition - Infected tooth pulp and surrounding apex b. Causes 1) Infection from trauma and / or decay c. Signs / Symptoms 1) Gumboil or parulis 2) Severe pain from light pressure to affected tooth 3) Tooth mobility 4) Facial swelling 5) Elevated temperature 6) Increased pain with chewing 7) Bad taste in mouth 8) Malaise d. Treatment 1) Temperature > 100 degrees F - CASEVAC 2) Facial swelling (cellulitis) - CASEVAC 3) Pharyngeal swelling - CASEVAC 4) If no pharyngeal swelling and temperature < 100 F (a) Incise and Drain (I & D) the swelling (b) Irrigate with normal saline (c) Antibiotics (d) Follow-up daily (e) CASEVAC if no improvement
a. Definition - Infected gum tissue around crown of tooth b. Causes 1) Impacted food 2) Impacted foreign matter 3) Advanced peridontal disease c. Signs / Symptoms 1) Similar to Periapical Abcess d. Treatment 1) Remove debris and / or foreign object 2) Probe area to promote drainage 3) Irrigate with sterile saline 4) CASEVAC if temperature > 100 F
a. Definition - Inflammation of gum around a partially erupted tooth. Most common in newly erupting 3rd molars (Wisdom Teeth). b. Causes 1) Food 2)
c. Signs / Symptoms 1) Heavy plaque and calculus deposits 2) Gingival inflammation 3) Bleeding 4) Tooth mobility 5) Swelling 6) Possible lymph nodes swelling 7) Pain at tooth 8) Food sticking between the teeth d. Treatment 1) Clean around tooth with dental instrument or toothbrush 2) Irrigate with normal saline 3) Instruct patient on keeping area clean and rinsed 4) CASEVAC if swollen lymph nodes, pharyngeal compromise and / or temperature > 100 F
a. Definition - Inflammation of the gum tissues caused by poor oral hygiene. Especially common in a field environment. b. Causes 1) Poor hygiene 2) Poor brushing technique c. Signs / Symptoms 1) Red gums 2) Gums easily bleed 3) Bad breath d. Treatment 1) Instruct on proper oral hygiene
a. Definition - Severe, destructive gum infection b. Causes 1) Poor oral hygiene 2) Stress 3) Poor diet 4) Lack of sleep c. Signs / Symptoms 1) Heavy plaque and calculus 2) Foul breath 3) Pus oozing from gingiva 4) Elevated temperature 5) Gingival recession 6) Gray / white covering of gingiva 7) Pain with chewing or brushing 8) Excessive gum bleeding 9) Possible lymph node swelling d. Treatment 1) Scale and debride teeth if instruments available 2) Scrub teeth and gums with Chlorhexidine 3) Irrigate vigorously 4) Instruct patient on proper hygiene, diet and brushing technique 5) Antibiotics if necessary 6) CASEVAC if elevated temperature > 100 degrees F
a. Definition - Inflammation of bone and tissues following extraction or lost tooth b. Causes 1) Blood clot dislodged and lost c.
1) Absence of blood clot in socket 2) Food visible in socket 3) Foul odor in mouth 4) Elevated temperature 5) Throbbing pain 6) Headache 7) Irrigation increases pain d. Treatment 1) Irrigate with sterile saline 2) Place Eugenol in socket 3) Cover / pack with sterile gauze 4) Remove gauze in 24 - 48 hours 5) Use Gel-Foam with Eugenol if possible (no removal necessary) 6) Analgesics 7) CASEVAC if temperature > 100 degrees F
a. Definition - Oral hemorrhage b. Causes 1) Oral trauma 2) Tooth extraction c. Signs / Symptoms 1) Oozing or flowing blood 2) Blood clots in mouth 3) Blood on pillow d. Treatment 1) Patient bites down on rolled up 4 X 4 2) Maintain for at least one hour 3) Reevaluate 4) IV fluids if hypovolemic 5) CASEVAC if bleeding uncontrolled 6) Replace dressings as they become saturated
a. Definition - Traumatically extracted tooth b. Causes 1) Trauma 2) Sports injuries c. Signs / Symptoms 1) Facial swelling 2) Abnormal occlusion 3) Missing tooth or teeth 4) Difficulty in eating , chewing or swallowing 5) Difficulty in moving mandible 6) Pain in mandibular movement d. Treatment 1) Carefully replace intact tooth if found (a) Handle tooth by crown / avoid root (b) Rinse tooth (c) Place in socket (d) Patient holds in place with fingers 2) CASEVAC as practical 3) Transport tooth with patient (a) Immerse in patient's saliva, milk, Ringer's Lactate or Saline 4) Pack area with gauze if bleeding
a. Definition - Break in the tissues of a tooth. Includes small chips to breaks extending through the root. b. Causes 1) Trauma c. Signs / Symptoms 1) TYPE I (a) Slight chip (b) Sensitive to hot and / or cold 2) TYPE II (a) Dentin is exposed (b) Sever pain (c) Hypersensitivity to heat and cold 3) TYPE III (a) Large fracture with exposed pulp (b) Entire crown broken away (c) Chewing or occlusion impossible due to pain 4) TYPE IV (a) Fracture of the root (b) Crown does not have to be involved (c) Extreme pain d. Treatment 1) TYPE I (a) Smooth area with fine sandpaper or file (b) Apply dental varnish and / or temporary restorative material such as Dycal or Calcium Hydroxide if available 2) TYPE II (a) Use plastic crown if available (1) Trim to fit (2) Fill with thin mix of Calcium Hydroxide (3) Place three holes in incisal edge (b) CASEVAC if practical 3) TYPE III (a) Same as treatment for TYPE II Fracture 4) TYPE IV (a) Apply splint to affected tooth and adjacent teeth (1) Mix cotton fibers and Zinc Oxide with Eugenol (2) Pack around tooth and adjacent teeth Note:
Caution patients with fractures to avoid hot or cold liquids as they may
damage the pulp and lead to tooth loss. C. PREVENTIVE DENTISTRY
a. All service members required to undergo an annual dental examination b. Exam includes periodontal and oral cancer screening
a. Service members placed into four classification numbers for status of dental readiness b. Ensure dental readiness of unit is completed prior to deployment 1) CLASS I (WHITE) (a) No pathological oral conditions (b) No treatment other than routine 2) CLASS II (GREEN) (a) Minor pathological conditions (b) Treatment is routine or elective (c) Treatment can be delayed for up to six months 3) CLASS III (YELLOW) (a) Pathological conditions requiring early treatment (b) Considered urgent for immediate treatment 4) CLASS IV (RED) (a) No record of dental exam in last 12 months (b) Missing dental records automatically CLASS IV
a. Field environments and deployments stress dental readiness b. Medical/Dental personnel stress proper hygiene, nutrition and oral care c. Schedule examinations and ensure all personnel are obtaining care REFERENCE(S): 1. Hospital Corpsman 1 & C, Rate Training Manual and Nonresident Career Course Field Medical Service School
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There
are thirty-two teeth in the normal mouth
Enamel
Debris
Signs /
Symptoms