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When a patient presents with a chipped or fractured tooth,
the first step is to determine the extent of the damage.
A patient with a minor or
incomplete fracture will present complaining of tooth pain on chewing or sensitivity to
cold. Minor fractures are relatively easy to treat, but the proper diagnosis must be made and
other possible causes for tooth pain ruled out, including a fractured or lost restoration
("filling") and pulpitis (reversible and irreversible). The tooth may have a crack
without the loss of tooth structure and still be basically intact, like a greenstick
fracture.
Using a penlight (transillumination), check for a crack in the tooth. See
if the fracture extends below the tissue
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Your patient complains of sudden pain with chewing.
-
You examine his teeth
and discover what appears to be a minor fracture of a posterior tooth.
-
Either fill the tooth or apply stomahesive.
-
Either way, you are preventing
mechanical stimulation of the dentin, which is the source of pain.
Major Fractures
Like a minor fracture,
the goal in treatment is to alleviate the pain by preventing stimulation of the dentin.
If
the pulp has been exposed, you must NOT use IRM (Intermediate Restorative Material) or any
other substance with eugenol to seal the tooth. The eugenol will kill the pulp. Seal a
pulp-exposure with Dycal or another calcium hydroxide product first, then apply IRM.
If only the dentin has been exposed, seal the fracture with IRM made of zinc oxide and
eugenol.
Stomahesive Application
Cut the Stomahesive to the desired length.
Apply to the area needing support.
Inspect to assure proper splinting. From "Dental Emergencies" Volume 803673 DN
Naval School of Health Sciences, December, 1995
For additional information, read:
"Dental
Emergencies" in the General Medical Officer Manual.
"Oral
Diseases and Injuries" in the Hospital Corpsman 1 and C Manual.
Approved for public release; Distribution is unlimited.
The listing of any non-Federal product in this CD is not an
endorsement of the product itself, but simply an acknowledgement of the source.
Operational Medicine 2001
Health Care in Military Settings
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Operational
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Health Care in Military Settings
CAPT Michael John Hughey, MC, USNR
NAVMED P-5139
January 1, 2001 |
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