Dental Emergencies

Decision

Is the airway at risk?

(Check for drooling, stridor, change in voice, foreign body in airway, etc)

Yes → Activate EMS and begin preoxygenation

Background

In general, ED transfer should be considered for dentoalveolar trauma if the patient has multisystem trauma necessitating further workup, difficulty handling secretions, trismus severe enough to preclude oral intake, or uncontrolled pain. Patients with simple dentoalveolar trauma can be discharged with appropriate follow-up. Those with signs of systemic illness or immunocompromise who present with more severe odontogenic infections, necrotizing periodontal disease, deep neck infection, facial cellulitis, or threatened airway compromise should be transferred for IV antibiotics and more extensive evaluation of their underlying disease. Any concern for impending airway compromise due to a deep neck infection such as Ludwig angina requires immediate emergency medical service transport to the ED.

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References

Evidence-based medicine requires a critical appraisal of the literature based upon study methodology and number of subjects. Not all references are equally robust. The findings of a large, prospective, randomized, and blinded trial should carry more weight than a case report.

To help the reader judge the strength of each reference, pertinent information about the study is included in bold type following the reference, where available. In addition, the most informative references cited in this paper, as determined by the authors, are noted by an asterisk (*) next to the number of the reference.

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