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Common dental emergency treatment methods

2020-12-18

Newstar Dental Laboratory tells you  Common dental emergency treatment methods

1. Oral bleeding 


Oral bleeding is most common with gum bleeding, postoperative bleeding and traumatic bleeding. In addition to local factors, systemic diseases such as blood disease, diabetes, liver and kidney disease, hypertension and arteriosclerosis, as well as hemangioma, malignant tumors, and vitamin C Deficiency, menstruation, pregnancy or long-term use of anticoagulants, etc., can cause or aggravate the above bleeding

1. Bleeding gums

Gingivitis, periodontitis or other odontogenic inflammation caused by soft scales, stones, food impaction or poor restorations, etc., can easily cause gum bleeding when local irritation is received. Especially those with systemic diseases are more likely to cause local bleeding.

(1) Local factors The general oral hygiene of patients is poor, with local calculi deposits, red and swollen gums, sometimes accompanied by loose teeth and deep periodontal pockets, and there may be obvious bleeding in the gingival margin or interdental space.

(2) Systemic factors The local bleeding caused by the system usually has a history of repeated bleeding. Therefore, it is not difficult to make a diagnosis based on the medical history and oral examination. However, for those with good oral hygiene and obvious local bleeding, they should pay attention to checking blood pressure and related blood items, blood life, etc., to identify whether it is due to hypertension, arteriosclerosis, liver and kidney disease, diabetes, and blood diseases such as Bleeding caused by primary thrombocytopenic purpura, leukemia, hemophilia, and aplastic anemia.

(1) Local symptomatic treatment

① Take effective hemostasis measures immediately. After removing the blood clot and finding the bleeding point, first use a cotton ball to compress the gums for a few minutes. When the local bleeding is relieved, use a small cotton ball dipped in 1:1000 epinephrine, 1% ephedrine or other hemostatic agents, directly To compress the bleeding gum margin or insert it into the interdental space, hemostatic powder, hemostatic paper, gelatin sponge, hemostatic sponge, and traditional Chinese medicine preparations such as Yunnan Baiyao, Panax notoginseng powder, puffball powder, etc. can also be used to suppress bleeding for at least 30 minutes. If necessary, it can be combined with periodontal therapy to stop bleeding.

② Local use of lotion, mouthwash and lozenge.

③For bleeding caused by local irritants such as subgingival stones, food impaction, etc., the local area can be simply scraped, and washed with 3% hydrogen peroxide solution, physiological saline, and coated with 1% iodine glycerin or iodine mixture, combined with the local Compression can stop bleeding.

(2) Systemic drug therapy

According to the cause of bleeding, use hemostatic drugs such as Anluoxue, hemostatic allergy, coagulation drug vitamin K, and antifibrinolytic drug 6-aminocaproic acid as appropriate. Give oral antibiotics and vitamins and other drugs.

2. Postoperative bleeding

(1) Local factors: bleeding after tooth extraction or other oral surgery and treatment, mostly caused by local injury and infection factors, such as gum tear, alveolar bone fracture, small blood vessel rupture, and residual inflammation of the alveolar fossa, granulation tissue and foreign bodies Wait.

(2) Systemic factors: systemic diseases, especially those with bleeding tendency, can cause bleeding after various surgical treatments.

(1) Bleeding site: According to the history of tooth extraction or surgical treatment, combined with clinical research, the bleeding site can be clarified.
(2) The amount of bleeding: the amount of bleeding after surgery should be correctly estimated, and the presence of hemorrhagic shock should be judged according to clinical symptoms and examination.
(3) Bleeding time: judge whether it is primary or secondary bleeding according to the bleeding time. If bleeding occurs within 24 hours after surgery or tooth extraction, it is mostly caused by local trauma, inflammation, foreign body, incomplete hemostasis, or unprotected blood clots. Such bleeding is primary bleeding. However, secondary bleeding occurs after 24 hours and is mostly caused by infection. For those who have no obvious local cause of bleeding, but suffer from hemostasis, pay attention to whether there are systemic diseases such as coagulopathy.

For local treatment of bleeding after surgery, local compression is generally performed first, but it is not effective for compression to stop bleeding, or if there is continuous bleeding in the wound after surgery, and rapid postoperative swelling, the wound should be opened in time to find the bleeding point, ligated or sutured to stop the bleeding. For local treatment of bleeding after tooth extraction, the surface blood clots are generally removed first, and then treated according to different causes of bleeding:

(1) Gingival tear: suturing under local anesthesia to stop the bleeding. For those who cannot be sutured, local hemostatic agents and compression can be used to stop bleeding.

(2) Gingival bleeding: first use cotton roll and local hemostatic agent. If it is ineffective, suture should be used to stop bleeding. Under local anesthesia, use horizontal mattress suture on both sides of the gums, add hemostatic agent locally, and use cotton roll to bite and compress Hemostasis 30min

(3) Alveolar socket bleeding: Fill the alveolar socket with absorbable gelatin sponge, and then use cotton rolls to compress the bleeding. If the amount of bleeding is heavy and the above-mentioned methods still cannot stop the bleeding, use suture hemostasis or add iodoform gauze to stop the bleeding, and take out the gauze within 48 to 72 hours after hemostasis. If there is a foreign body or inflammatory granulation tissue in the alveolar socket, the bleeding should be recompressed after curettage under local anesthesia.

In the case of systemic drug therapy, oral antibiotics should be routinely used for 3-7 days, and analgesics and hemostatic agents should be used appropriately. For patients with obvious symptoms such as local swelling, intramuscular injection or intravenous drip of antibiotics and dexamethasone and other systemic adjuvant drugs should be given. Patients with systemic diseases such as blood coagulation dysfunction should take symptomatic drugs.

3. Traumatic bleeding

After being hit by an external force, it causes local injuries and bleeding, such as bruises and lacerations.

(1) The location of bleeding can be clarified according to trauma history and clinical examination.

(2) The nature of bleeding. If the bleeding is jet-like and bright red, it is arterial bleeding if there is pulsation at the bleeding end; if the blood flow is slow or bleeding is oozing, and the color is dark red, it is venous bleeding or capillary bleeding.

(3) Bleeding volume The maxillofacial blood supply is abundant, and the bleeding volume after injury is large. The bleeding volume can be judged by asking the medical history and clinical examination. But for oral bleeding, especially those with a history of coma, the amount of bleeding should be fully estimated to determine whether there is hemorrhagic shock.

(4) Damage characteristics:

① Bleeding after contusion is mainly manifested as subcutaneous or submucosal hemorrhage, with purple-red congestion changes. In severe cases, larger blood vessels can be damaged and hematomas can be formed. If the local swelling area continues to increase, it indicates that there is still active bleeding. If the hematoma loves to live on the bottom of the mouth, side of the pharynx or neck, breathing difficulties may occur, and even the room will cause the room.

②Other traumas, such as laceration wounds with neat edges, irregular edges of explosive wounds, soft tissue defects in many cases, tooth marks in bites, and irregular wounds in traffic injuries, combined with carbon facial cream, etc. These injuries can cause different Degree of local bleeding.

(1) Local treatment

①For subcutaneous or submucosal hematoma caused by contusion, cold compress and appropriate pressure can be applied. If the swelling area continues to increase, it indicates that there is still active bleeding. It is necessary to promptly perform surgical exploration, ligate the bleeding blood vessel, and keep the airway open.

②For the treatment of bleeding wounds such as lacerations, sutures and compression bandaging methods can generally be used, but attention must be paid to reliable ligation of bleeding blood vessels. If the wound cannot be closed and sutured, and the wound is deep, the bleeding is large, and it is difficult to control the bleeding for a while, iodoform gauze can be used to compress and stop the bleeding, and the bleeding can be stopped in time after the conditions are created.

Systemic treatment should be treated with antibiotics for 5 to 7 days, analgesics and hemostatic agents for 2 to 3 days. Pay attention to nutritional supplements, and timely supplement blood volume and anti-shock treatments.

2. Acute pulpitis

Acute pulpitis usually develops from an acute attack of chronic pulpitis or pulp congestion. When inflammation occurs, pulp congestion, exudation and pressure increase in the pulp cavity, so the clinical features include acute onset and severe pain.

Bacterial factors Bacteria is the most important pathogenic factor of pulpitis, and its infection route is:

① Infection by the tooth. For example, bacteria and their toxins in dental caries enter the pulp through the dentin tubules, traumatic tooth fracture, accidental pulp penetration, severe abrasion affecting the pulp cavity, and occlusal surface gaps or damage caused by tooth development deformities can cause bacteria to enter the pulp cavity and cause the tooth Medullitis.

② Periodontal infection. Bacteria in the periodontal pockets reach the root tip through the periodontal, collateral root canals or lymphatic vessels, causing retrograde pulpitis.

③ Blood-borne infection. Mainly occurs when there is sepsis throughout the body, bacteria in the blood enter the pulp and cause pulpitis.

Physical factors are various traumas, excessive temperature, electric current and other stimuli.
Chemical factors irritation from cavity disinfectants, cushion substrates or fillings.

(1) Spontaneous and paroxysmal pain In acute pulpitis, severe spontaneous pain can occur without any stimulation. The nature of the pain is sharp pain, and there are paroxysmal attacks and nighttime aggravation Features.

(2) Temperature stimulation makes the pain worse. In the early period of pulpitis, cold and heat stimulation can aggravate the pain or induce pain. After the funeral, the pain of heat stimulation is obvious, but the pain is relieved by cold stimulation.

(3) Pain often cannot be located. The pain radiates along the trigeminal nerve distribution area to the upper and lower teeth, adjacent teeth and head and face on the same side.

(1) The purpose of medullary drainage is to drain the inflammatory exudate and the resulting high pressure in the medullary cavity to relieve pain. The method is to quickly penetrate the medullary cavity with a sharp drill under local anesthesia.

(2) Soothing and analgesic removal of caries, softening the dentin or opening the pulp, use a small cotton ball impregnated with analgesic to place it on the bottom of the hole or open the pulp. Place it lightly and do not apply pressure.

(3) Pharmaceutical analgesia Oral analgesics have a certain analgesic effect.

Three, acute periodontal abscess

Acute periodontal abscess is a localized purulent inflammation in the periodontal tissue, which develops from periodontitis. In clinical practice, attention should be paid to distinguish it from alveolar abscess.

(1) Poor drainage The purulent inflammation of the inner wall of the deep periodontal pocket spreads to the deep connective tissue, and the pus cannot be drained out or the drainage is not smooth, and the periodontal abscess accumulates in the periodontal tissue.
(2) Occlusal trauma Patients with occlusal trauma can cause deep periodontal pockets, which can prevent smooth drainage of purulent exudates, especially when the root bifurcation is involved.
(3) Rough actions during improper teeth cleaning or scraping, pushing tartar fragments into the deep tissue of the periodontal pocket or damaging the gum tissue. The treatment of deep periodontal pockets is incomplete. Although the mouth of the pocket is tightened, the inflammation at the bottom of the pocket still exists and no drainage can be obtained.
(4) Systemic factors reduce the systemic resistance. For example, patients with diabetes and other patients with periodontal funeral swelling can have regurgitation.

(1) Medical history features: a history of periodontitis and repeated swelling and pain. The early pain is severe, and there may be throbbing pain. The tooth has a "floating feeling" and bite pain.

(2) Local manifestations: teeth percussion pain and looseness are obvious, and oval or hemispherical swelling protrusions are formed on the cheek or lingual gums of the tooth. In the late stage of the funeral swelling, the pus is limited, the surface of the funeral swelling is soft, and there may be fluctuations in the diagnosis. The funeral swelling eventually penetrates the gingival surface or gingival sulcus to be drained, and the symptoms are relieved. X-ray film shows that the alveolar bone on the side of the tooth root has absorption shadows, and there may be sub-bone pockets.

(3) Systemic manifestations: Patients with acute periodontal funeral swelling generally have no obvious systemic symptoms, and may have regional lymphadenopathy. If multiple periodontal funeral swelling occurs, it is often accompanied by obvious symptoms of general discomfort.

(1) Local treatment can remove large tartar and tartar before the abscess is formed, rinse the periodontal pocket alternately with 3% hydrogen peroxide solution and normal saline, and apply anti-inflammatory and astringent drugs such as iodine and glycerin.

(2) Incision and drainage When the abscess is formed and there is a sense of undulation, incision and drainage from the periodontal pocket or gingival surface under local anesthesia, and keep the drainage smooth.

(3) Rinse the mouth with 0.2% chlorhexidine solution, and apply antibiotics and analgesics throughout the body.

(4) After the inflammation is relieved or subsided, it is expected that the wear and tear should be adjusted in time and further periodontal treatment should be done.
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