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High-Yield Facts

  • Avulsed primary teeth should not be replaced. Avulsed permanent teeth should be reimplanted as soon as possible. Always consider aspiration when a tooth/tooth fragment cannot be located.

  • Maintain a high index of suspicion for carotid injury in a patient with trauma to the oropharynx.

  • Uncomplicated dental infections are treated on an outpatient basis. Deep fascial space infections often require hospitalization, IV antibiotics, and surgical drainage.

  • Suppurative complications of pharyngitis include peritonsillar abscess (PTA), Lemmiere postanginal sepsis, and Ludwig angina.

  • Needle aspiration can aid in differentiating between peritonsillar cellulitis and PTA. Aspiration, incision and drainage, or tonsillectomy may provide definitive treatment.

  • Airway assessment is important in suspected cases of PTA, retropharyngeal abscess (RPA), and Ludwig angina. Definitive management of unstable airways is best achieved in the operating room with the assistance of an anesthesiologist or an ENT specialist.

Emergencies pertaining to the oral cavity and neck can be broadly divided into four categories: dental trauma, oropharyngeal trauma, dentoalveolar infections, and soft-tissue infections. Traumatic injuries are described in Section V.

Oral and Dental Anatomy

Eruption of the 20 primary teeth begins with the lower central incisors between 6 and 10 months of age and is typically complete by 33 months. Eruption of the 32 secondary (permanent) teeth begins with the lower central incisors at approximately 6 years of age and is usually completed by 21 years of age. A tooth is composed of a neurovascular center, or pulp, which is surrounded by dentin (Fig. 96-1). The exterior surface of the tooth, or crown, is covered by enamel. The root of the tooth is protected by cementum and is attached to alveolar bone by the periodontal ligament (PDL). The oral cavity is bordered by the hard and soft palate superiorly, the tongue and its supporting structures inferiorly, and the cheeks which are supported by buccinator muscles. The vestibule is the space between the cheeks/lips and teeth. Gingiva covers the alveolar surfaces of the maxilla and mandible.

Dentoalveolar Trauma

Falls are the most common cause of injury in the preschool and school-age group. Among older children and teenagers, males are twice as likely to suffer dental trauma commonly resulting from motor vehicle collisions, sports-related injuries, and altercations.1 The most commonly injured dental structure is the maxillary central incisor.2 Dental trauma may be a marker for child abuse.

Diagnostic Findings

Luxations are injuries resulting from damage to the supporting structures of the teeth (PDL and alveolar bone) and are defined in terms of the lie of the tooth (see Table 96-1 for distinct types). Dental fractures may involve the tooth and/or supporting structures. Classification of dental fractures, adopted from the World Health Organization's Application of the International ...

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