List of Contributors ix
Preface xi
Acknowledgements xiii
1 Introduction, Infection Control and Prescribing 1
M. Greenwood
Introduction to the dental emergency clinic 1
Infection and infection control 2
Prescribing 8
Conclusions 12
Further reading 12
2 History Taking and Clinical Examination of Patients on a Dental Emergency Clinic 13
I.P. Corbett, C.B. Hayward and M. Greenwood
Introduction 13
History taking 13
Patient examination 18
Special tests 24
Record keeping 25
Consent 25
Conclusions 28
Further reading 28
3 Radiology and the Dental Emergency Clinic 29
R.I. Macleod
Introduction 29
Patients in pain 33
Trauma radiology 35
Looking at radiographs 36
Conclusions 38
Further reading 38
4 Acute Oral Medical and Surgical Conditions 39
P.J. Thomson
Introduction 39
Oro-facial swelling 39
Blistering disorders of the oral mucosa 45
Oral ulceration 47
Disturbed oro-facial sensory or motor function 49
Haemorrhage 50
Other acute conditions 51
Bony pathology 52
Summary 55
Further reading 55
5 Restorative Dental Emergencies 57
A. Moufti and C.B. Hayward
Introduction 57
General principles 59
Pain management 59
Infections and soft tissue problems 65
Crack, fracture and mobility of teeth and dental restorations 71
Fractured and loose implants 81
Fractures and swallowing of removable prostheses 82
Conclusions 83
Further reading 83
6 Acute Presentations of Chronic Oro-Facial Pain Conditions 85
J. Durham
Introduction 85
Oro-facial pain history 86
Examination of patients with oro-facial pain 89
Special investigations for oro-facial pain 90
Presentation, investigations and initial management of acute non-odontogenic oro-facial pain 92
Further reading 102
7 Traumatic Injuries to the Teeth and Oral Soft Tissues 103
U. Chaudhry and I.C. Mackie
Assessment of the traumatised patient 103
Management of traumatic dental injuries 105
Injuries to the hard dental tissues and the pulp 105
Injuries to the hard dental tissues, the pulp and the alveolar process 112
Injuries to the periodontal tissues 116
Dento-alveolar fractures 127
Conclusions 127
Further reading 128
8 Pain Relief in the Dental Emergency Clinic 129
U.J. Moore
Introduction 129
General mechanism of pain 129
Distribution of pain fibres in the mouth and jaws 134
Sources of pain in the mouth and jaws 135
Control of pain 136
Psychology of pain 137
Medication 139
The ladder of analgesia 144
Avoiding problems in prescribing analgesics 144
Further reading 147
9 Management of the Special Needs Patient 149
T. Nugent
Introduction 149
Commonly seen conditions 151
Assessment 152
Medical history in the patient with special needs 153
Informed consent 154
Examination 155
Factors to consider in treatment 155
Conclusion 158
10 Making a Referral 159
I.P. Corbett and J. Greenley
Introduction 159
When to refer 159
How to refer 160
Where to refer 161
The referral letter 161
Urgency 164
Cancer referrals 165
Copies of the referral letter 167
Summary 169
Further reading 170
11 Medical Emergencies in the Dental Emergency Clinic – Principles of Management 171
M. Greenwood
Introduction 171
Contents of the emergency drug box 171
The ‘ABCDE’ approach to an emergency patient 174
Airway (A) 175
Use of defibrillation 180
Principles of management after the initial treatment of a medical emergency 181
Conclusions 182
Further reading 182
12 Examples of Specific Medical Emergency Situations 183
M. Greenwood
Introduction 183
Vasovagal syncope (simple faint) 184
Hyperventilation 184
Asthma 185
Cardiac chest pain 187
Epileptic seizures 188
Diabetic emergencies 190
Allergies/hypersensitivity reactions 192
Adrenal insufficiency 196
Stroke 197
Local anaesthetic emergencies 197
Problems with haemostasis 200
Conclusions 203
Further reading 203
Appendix 1 Normal Reference Ranges 205
Appendix 2 Changes in Vital Signs in Patients with Infection 207
Appendix 3 Warfarin Protocol 209
Appendix 4 Aspects Relating to Local Anaesthetics 213
Appendix 5 NICE Guidelines for the Removal of Wisdom Teeth 215
Appendix 6 Protocol for Surgical Dental Treatment of Patients Taking Bisphosphonates 217
Appendix 7 Common ‘Recreational’ Drugs 221
Index 229
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