5-12
a. DENTAL CARIES (“cavities”)
Subjective: Symptoms
Intermittent or continuous pain, usually intense. Heat, cold, sweet, acid, or salty substances may worsen
the pain.
Objective: Signs
Finding the offending tooth may be difficult, but it will usually be grossly decayed, with the carious enamel
and dentin area discolored. Tooth will be tender and sensitive to heat and cold. Tapping the tooth with
an instrument will usually elicit pain. When conducting a thermal test, use a normal tooth as a basis for
comparison. (see Thermal Test in Dental Procedures section). Check vitality: pain upon touching dentin
indicates vitality. A vital tooth will give a painful response to cold.
Assessment:
Differential Diagnosis - caries in vital tooth versus dead tooth.
Plan:
Primary: Remove caries and place a temporary restoration. Local anesthetic may be necessary before
applying a temporary restoration. (See Procedures for Dental Anesthesia and for Temporary Restorations.)
Alternate: For teeth that are still vital: Eugenol (IRM liquid) is an agent that will temporarily soothe
hyperemic pulp tissue if treated indirectly (if not in direct contact with the pulp). If a mix of zinc oxide
and eugenol is applied directly to vital pulp, it will kill the pulp. A dental officer must give definitive care
in the near future.
Patient Education: Do not chew on the treated tooth.
b. TOOTH/CROWN FRACTURES - anterior (front) teeth are particularly susceptible to injuries that result
in fracture of the crown.
Subjective: Symptoms
History of trauma or biting hard object; feels jagged tooth edge; finds tooth fragment; sensitivity to heat/cold.
Objective: Signs
Visibly broken or cracked tooth.
Assessment:
Look for other injury if related to trauma.
Plan:
Simple fractures of the crown involving little or no dentin, smooth the rough edges of the tooth with an
emery board or small flat file.
Extensive fractures of the crown involving considerable dentin but not the pulp:
- Wash the tooth with warm saline,
- Isolate and dry the tooth with cotton gauze or rolls.
- Then cover the exposed dentin using one of several methods:
a. Cover the exposed dentin with (IRM) zinc oxide-eugenol paste (it is difficult to achieve retention on
anterior fractures). An aluminum crown, trimmed and contoured to avoid lacerating the gingiva, can be
filled with this paste and placed over the tooth.
b. Incorporate cotton fibers into a mix of zinc oxide and eugenol (the fibers give additional strength) and
place this over the involved tooth, using the adjacent teeth and the spaces between them for retention.
Have the patient bite to be sure neither the bands or the “splint” interferes with bringing the teeth
together.
c. Glass ionomer cement can be used as a substitute for IRM. It has the advantage of readily bonding
to teeth.