CHAPTER 6 - EMERGENCY TREATMENT FOR ORAL DISEASES AND INJURIES

The dentist is responsible for all patient diagnosis and treatment. Certain circumstances may warrant that you, the Dental Technician, provide emergency dental treatment to a patient. An example might be when one of the following circumstances occur:

You are standing duty Dental Technician watch\There is no dental officer aboard the dental clinic, the hospital, the ship, or the Fleet Marine Force where you are stationed.

A mass casualty situation has occurred

\The dental officer may be involved with the treatment of more serious medical injuries.

Always contact a dental officer if an emergency occurs. The dentist will indicate the treatment plan and authorize you to perform treatment. You may provide temporary treatment that provides relief from pain, combats infection, or prevents further damage to the oral structures. Always instruct your patient to come to dental sick call the next day, or make an appointment in the dental specialty for which you have treated him or her. Advise your patient to keep the appointment even if the symptoms of the condition disappear. Follow any command or department instructions on patient care.

Oral conditions are discussed in terms of _{symptoms and signs.} A symptom is what a patient tells you about his or her disease or injury (for example, this person tells you of a toothache or sore gums). A sign is what you observe when you examine the oral structures (for example, bleeding gums, carious lesion, or heavy deposits of plaque or calculus).

EMERGENCY TREATMENT GUIDELINES

Certain emergency guidelines have been established to assist you in providing emergency treatment to your patients. In all these conditions, you should follow the emergency guidelines listed below:

Check the patient's general physical condition.

Question the patient and record any symptoms.

Review patient's health history.

Examine the patient and record signs, including the vital signs. Also check for other injuries if trauma has been found.

Consult with the dentist and report the patient's condition.

Request instructions from the dentist.

Follow the treatment plan exactly.

Record the emergency treatment provided on the Health Record, Dental, SF 603. Use the standard operating procedures (SOP) format discussed in Dental Technician, Volume 2, NAVEDTRA 12573, chapter 2, "Oral Examination."

Advise the patient the treatment provided is temporary and to return for definitive treatment.

DISEASES OF THE TISSUES OF THE TEETH

An important part of your job as a Dental Technician is the ability to recognize diseases of the tissues of the teeth. We will discuss some of these diseases in the paragraphs that follow as well as give symptoms that will help you recognize these diseases.

DENTAL CARIES

Dental caries still occur in the majority of the adult population. The most common cause of dental caries is bacterial plaque, which we discussed in chapter 5.

Caries begin in the enamel, appearing as a chalky white spot. If the lesion progresses, it will continue into the dentin and eventually involve the pulp.

Symptoms

The patient may complain that the affected tooth is sensitive to hot and cold (usually cold), sweets, and _{pressure to biting.} Sometimes the pain from an affected tooth can manifest in a healthy, noninvolved tooth; this is called referred pain.

Signs

Upon examination you may find the following signs of an infection:

A chalky white spot on the enamel

Roughness on the surface of the tooth

A dark, stained cavity

A cavity filled with food or a spongy mass of decaying dentin

Treatment

As a part of the emergency treatment plan, you may perform the following duties:

Perform emergency treatment guidelines.

Gently remove all debris from the cavity with a spoon excavator as illustrated in figure 6-1.

Flush the cavity with warm water.

Isolate the tooth with cotton rolls or gauze.

Carefully dry the cavity with cotton pellets as illustrated in figure 6-2.

Mix a temporary filling (zinc oxide eugenol, IRM, etc.).

Gently fill the cavity with the temporary filling material as illustrated in figure 6-3.

Check the occlusion. Make sure the temporary restoration does not touch the opposing tooth.

Instruct the patient to return for definitive treatment on the next work day.

Figure 6-1.\Removing debris from the cavity.

Figure 6-2.\Preparing to dry the cavity.

Figure 6-3.\Placing the temporary filling.