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DENTAL PROBLEMS

Signs and Symptoms: Differential Diagnosis:
• Bleeding • Dental Caries
• Pain • Infection
• Fever • Fracture
• Swelling • Avulsion
• Missing/Fractured Tooth • Abscess/Cellulitis
• Gingivitis

Universal Patient Care Guideline
Continued from: O2 (if Hypoxemic)
Tactical Evacuation Guideline IV / IO Guideline (prn)
Cardiac Monitor (prn)
Control Bleeding
If less than 1hr – attempt to
PAIN MANAGEMENT Guideline NO Tooth Avulsion? YES replace tooth in socket
(*See Pearls)
Place tooth in NS
(milk if available)
When appropriate, return to:
Tactical Evacuation Guideline PAIN MANAGEMENT Guideline

Pearls:
• Significant soft tissue swelling to face / mouth can represent cellulitis or an abscess.
• Avulsion (Complete Avulsion Only)
o Gently rinse (do not scrub) tooth with NS and attempt to re-implant with firm
pressure into the socket. Never perform this in children with primary teeth.
o As able and without obstructing airway, place bulky dressing over tooth and use
as a soft bite block to stabilize tooth. Instruct to bite down gently, do not move
jaw.
• Subluxation (tooth displaced in socket)
o Treatment not always required.
o For obviously loose or displaced tooth consider placing bulky dressing over tooth
and use as a soft bite block to stabilize tooth. Instruct to bite down gently, do not
move jaw.
• Occasionally, cardiac chest pain can radiate to the jaw.
• Patient with dental abscess may experience significant pain at altitude due to gas volume
expansion at lower atmospheric pressure. Consider flying at lower altitude and refer to
pain management guideline.

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