428 Maxillofacial and Dental Emergencies
TRAUMATIC CONDITIONS OF THE FACE AND MOUTH
Lacerations
MANAGEMENT
1 Face
(i) Meticulously debride facial cuts under local anaesthesia, and
suture using fine 5/0 non-absorbable monofilament nylon or
polypropylene sutures, removed by 4 days.
2 Lips
(i) Use 3/0 or 4/0 absorbable sutures such as polydioxanone
or polyglactin for intraoral lesions, and 5/0 non-absorbable
monofilament nylon or polypropylene sutures for external
lacerations.
(ii) Refer the patient to the oral surgery team if the full thickness of
the lip is lacerated vertically, breaching the vermilion border, to
avoid cosmetic deformity from inexperienced repair.
3 Tongue
(i) Leave most lacerations unless they are >1 cm or through the edge,
or bleeding profusely. In those cases repair with an absorbable
suture such as 3/0 polydioxanone or polyglactin.
(ii) Advise regular mouthwash of warm saline.Tooth injuries
MANAGEMENT
1 Chipped tooth
(i) Enamel or dentine damage: the tooth will be sensitive but viable.
Advise the patient to avoid hot and cold drinks and refer to the
patient’s own dentist within 24 hours.
(ii) Pulp space exposed: the tooth may be bleeding from the pulp,
and sensitive to temperature and or touch. Refer the patient
immediately to the oral surgery team, as there is a risk of pulp
infection or necrosis.
2 Displaced tooth
(i) Do not manipulate unless the tooth is about to fall out, in which
case it should be firmly replaced in its socket.
(ii) Refer the patient to a dental surgeon as soon as possible for
immobilization of the tooth.