Pick, Lick and Stick - Management of Dental Emergencies in Children

If any of you watched the Truth about Teeth on BBC a few months ago, the phrase 'Pick, Lick and Stick' will be familiar. Management of emergencies in children can be overwhelming, especially in a primary care setting. Here I shall outline the simple management of two of the most common emergencies in children in dental practice.

Management of Avulsion

See my previous post about the general management of dental trauma for the gold standard of treatment - bit in general practice what are the practical steps of how to treat this condition?
  1. Irrigate the socket and administer LA
  2. Replace the tooth in the socket and ask the patient to bite down on some gauze
  3. Isolate as best you can - rubber dam may not be practical in a distressed child
  4. Etch the middle third of the tooth; wash, dry and bond
  5. Place the wire in place first with the tooth that you are splinting too. The last tooth you apply onto the splint is the avulsed one
  6. Push hard to get the tooth fully seated through the blood clot
  7. Ask your nurse to stabilise the wire when bonding
  8. Splint to one tooth either side. This means the splint is flexible
  9. If you do not have orthodontic wire in practice, unravel a sterile paperclip and use that
For management of trauma, the only time you should consider using a rigid splint i.e. splinting to 2 teeth either side, is for alveolar bone fractures. In other injuries, a rigid splint will prevent physiological movement and therefore promote ankylosis. 

Management of Irreversible Pulpitis in a Primary Tooth

A child attends your practice in pain from a tooth - this can be a nightmare situation with a tired and distressed patient and a parent who is worried and upset. 

It is likely that if the child is young and hasn't had that much of an experience with dentists, that their compliance will not be very good either so management can be difficult. A useful tip to assess whether a patient may be compliant for treatments is to try to take bitewing radiographs. If they will not let you place the holder in their mouth, or will not sit still to take the radiograph, the best thing to do is to refer on to either a hospital or a community dental setting.

Management of emergency irreversible pulpitis in a compliant patient:

Extractions in cases of irreversible pulpitis are not always possible in patients who are distressed, in these cases: Dress with Ledermix and Kalzinol. This kills off the nerve but in case the patient suffers an acute abscess, you can flick off the dressing to allow drainage. 

Medication tips:

  • Advise Calpol and ibruprofen for pain relief
  • Alternate with these medications every 2 hours so that they do not overdose if they suffer severe pain
  • For antibiotics, oral suspensions of both amoxicillin and metronidazole are available
  • Always look up doses in the BNF, but remember you can DOUBLE the doses in severe infections
  • If you are concerned of the risk of admission of the patient, make sure you give the parents the warning signs e.g. raised temperature, difficultly swallowing and breathing and give them details of their nearest Accident and Emergency with a Maxfax unit

I hope that this simplifies things! Please leave any comments or thoughts in the comments section below!

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