0071643192.pdf

HEAD, EYE, EAR, NOSE, AND THROAT

EMERGENCIES

SYMPTOMS/EXAM

■ Excruciating pain approximately 3–5 days post extraction (time of onset differ-

entiates this from post extraction pain, which occurs within the first 24 hours)

■ No signs of infection or bleeding

■ Fresh, clean extraction site

■ Risk factors for clot loss include smoking, trauma, spitting, s/p difficult extrac-

tion of mandibular molar, females on OCPs, and local infection.

TREATMENT

■ Consider a dental nerve block or other analgesia.

■ Gentle irrigation of socket

■ Pack socket with iodoform gauze and eugenol solution (an oil with anti-

septic and analgesic properties).

■ Oral antibiotics

■ Dental referral in 24 hours

Avulsed Teeth

SYMPTOMS/EXAM

■ Only permanent/secondary teeth need replantation.

■ 1% loss of tooth survival for every minute out

FIGURE 14.23. Periapical abscesses may erode through bone and lead to infections

of the maxillary sinus, palatal space, vestibular space, buccal space, sublingual space, or

submandibular space.

(Modified, with permission, from Cummings C, Schuller D. Otolaryngology Head and Neck

Surgery. Chicago: Mosby-Year Book, 1986:1546.)

A. Vestibular space

B. Buccal space

C. Palatal space

D. Sublingual space

E. Submandibular space

F. Maxillary sinus

Buccinator

muscle

Mylohyoid

muscle

Areas of

potential

infection