Dental
                                ======

þ Replacing avulsed teeth
 - Avulsed primary anterior teeth (age 6 months to 5 years) should not be
   replaced as they ankylose or fuse to the bone itself resulting in facial
   deformity. Ref: Tintinalli 4th ed. p 1106-7.
 - Intruded teeth:  leave alone and refer to dentist. Primary teeth usually
   left there, secondary often need manipulation
 - A percentage point for successful replantation is lost each minute that the
   tooth is absent from the socket.  Unless the tooth has been out for more
   than 2-3 hours, it should be replaced within minutes whenever possible.
   Ref: Tintinalli 4th ed. p 1106-7.
 - Toothsaver kits with proper solution can lengthen the time the tooth can
   survive out of the socket, although claims of 12-24 hours are exaggerated.
 - Home treatment:
  + quickly rinse the tooth under running tap water while holding only the
    crown (enamelized portion).
  + place tooth in a cup of milk.
  + bring patient (and tooth) to the emergency department as soon as possible.
    Ref: Tintinalli 4th ed. p 1107.

þ Dry socket:
 - 2-3 days after extraction
 - severe pain
 - caused by loss of clot, usually from smoking or drinking via straw
 - pack with eugenol-soaked gauze daily, or, better, pack with dry socket
   paste and don't have to repack daily.

þ Tooth Fractures
 - Ellis I:
   Fractures involving only the enamel require non-emergent referral to
   a dentist.
 - Ellis II:
   Fractures involving exposure of the dentin, which has a pinkish tinge,
   requires placement of a calcium hydroxide dressing on the exposed dentin.
   The dental fracture should then be covered it with aluminum foil or dry
   gauze and instructions to follow up in 24 hours with the dentist.
 - Ellis III:
   Fractures through to the pulp requires immediate dental consultation as
   persistent pain or abscess formation is likely.
   Ref: Tintinalli 4th ed. p 1106.

þ Tongue Lacerations
 - Tongue lacerations of greater than 1 cm should be closed with either 4-0
   chromic or black silk suture.  Care must be taken to reapproximate the
   edges because otherwise the epithelium will marginate downward to the base
   of the wound on each side of the laceration causing a "bifid" tongue
   appearance which as both cosmetic and functional deformity. Ref: Tintinalli
   4th ed. p 1109.

þ Postoperative Dental Bleeding
 - A patient who just had wisdom teeth extracted presents with persistent
   bleeding from the extraction site unresponsive to direct pressure by biting
   gauze.  How should this be treated?
  + Suction all clots out of the sockets
  + infiltrate the sockets with 2% lidocaine with 1:100,000 epinephrine,
  + reapply gauze for 20 minutes.
  + If bleeding persists, place a small piece of hemostatic material into the
    area and suture it in place with 3-0 black silk sutures.
  + If bleeding continues, consider a coagulopathy, and treat if present.
    Ref: Tintinalli 4th ed. p 1109.