Dental First Aid

DENTAL FIRST AID SUPPLY KIT

• Gloves (should be worn during any oral exam)
• Mask (if blood splatter possible)
• Eyewear (if blood splatter possible)
• Sterile gauze 2" x 2"s
• Flashlight
• Tongue Blade
• Ice Pack
• Saline Solution
• Orthodontic Wax
• Tea Bags

REMEMBER; ALWAYS wash your hands BEFORE and AFTER WEARING gloves. Wear gloves when examining the mouth and surrounding structures.

Toothbrushes are a good addition to your kit, and dental floss can be used to dislodge objects wedged between teeth.

Medications cannot be used in most schools without written consent by a parent or guardian and often signed by a physician or dentist.

EMERGENCY TELEPHONE NUMBERS NEEDED ON FILE

• DENTIST
• DOCTOR
• EMERGENCY CONTACT for the child
• EMERGENCY TEAM

ORAL TRAUMA

Serious head injury should be ruled out.

Signs and symptoms of concussion may include:

• Nausea/vomiting
• Dilated pupils
• Dizziness
• Cold/clammy
• Headache

Check for tooth fragments or knocked out teeth in the mouth, lip and cheek areas.

If swelling or bruising is present, apply cold compress alternating 10 minutes on and 5 minutes off the site of the injury.

Try to calm the injured person.

Determine the type of injury

• If bleeding profusely:
  contact parent and arrange for emergency services
• If minor bleeding:
  apply pressure (approx. ten to fifteen minutes)
• If bleeding continues past ten to fifteen minutes, contact parent and arrange for EMTs or transport to emergency room.

INJURED TEETH

(Pushed into gums/loose/chipped)

• DO NOT attempt to move the tooth into correct position
• Gently cleanse with warm water
• Contact parent and arrange to take to dentist immediately

TOOTHACHE

• DO NOT place aspirin on tooth or gum tissue (it will cause a chemical burn)
• Check child's temperature and observe for respiratory distress
• Contact parent and arrange to take child to the dentist immediately

Follow-up 24 hours after first contact to be sure the child was actually seen by a dentist.

Aspirin works systemically, NOT topically! (Aspirin will macerate the gum tissue.)

If the child is old enough- have them rinse vigorously with warm salt water or try using dental floss to clean out any debris.

SOFT TISSUE INJURY

• Gently clean area
• Apply cold compress to minimize swelling
• Assess for referral to dentist or emergency room

Apply a cold compress to minimize swelling, 10 minutes on and 5 minutes off the injury site.

BROKEN OR DISLOCATED JAW

THIS MAY BE A POTENTIALLY LIFE THREATENING SITUATION

• Immobilize jaw (wrap towel, scarf or tie around head)
• Contact parent and EMTs to take child to emergency room immediately
• Note time of injury and any other injuries present
• Keep head elevated
• Apply cold compress
• Monitor vital signs and consciousness
• Record all observations

Immobilize jaw by placing a scarf, necktie, handkerchief or towel under chin, tying the ends on top of the head.

ORTHODONTIC APPLIANCES (BRACES)

• Take out the loose or broken appliance/wire if it can be easily removed. If unable to remove easily, contact parent to arrange take the child to the orthodontist.
• Protruding wires may be covered by orthodontic wax, sugarless gum, gauze, or cotton ball, so it is no longer irritating to the tissue. A tongue blade or pencil eraser may also gently bend it, or snip it with heavy-duty nail clippers.

Loose bands, appliances, or wires do not require emergency attention if it is not bothering the child, but the parent should be notified to contact the orthodontist.

KNOCKED OUT TOOTH (AVULSED)

• Handle by the crown of the tooth (NOT the root!)
• Rinse gently, if needed. (NEVER scrub)
• Replant into socket, hold in place
• Transport tooth (if unable to replant) in cold, saline solution, or saliva. Only use water as a last resort
• DO NOT LET DRY OUT!
• Contact parent. Contact dentist. Take child and tooth to dentist within 30 minutes if possible
• If wound is contaminated by soil-a tetanus booster injection may be needed

This information applies to a knocked out permanent (adult) tooth. Primary (baby) teeth are not replanted.

DO NOT use antiseptic on the tooth. Do not handle the tooth unnecessarily. Inspect the tooth for fractures before replanting it. Place the tooth back in the socket before a blood clot forms if possible. After gently replanting the tooth, have the child hold it in place with a tissue or clean cloth. A glass of cold milk is best. If milk or saline solution is unavailable, the child may spit into a cup to cover the tooth to transport it. The tooth may also be held in the cheek area if the child is old enough not to swallow it. It can be wrapped in plastic or even a wet towel. There are even commercial emergency tooth preserving systems available for purchase. Time is critical! Replantation within 15 to 20 minutes is best.

ORAL ULCERS

Could be:

• Apthous ulcer
• Cold/canker sore
• Fever blister
• Traumatic lesion
• Herpes
• German measles
• Chickenpox
• Mumps
• Impetigo
• Streptococcal infection

WEAR GLOVES

• Record location, type, severity of lesions
• Check child's temperature
• Advise child to avoid salty or spicy foods
• Ice may be applied to provide temporary relief
• Contact parent if lesions spread or persist

Child can rinse with warm salt water if old enough to swish and expectorate. Administer acetaminophen if needed and possible. (Medications cannot be used in most schools without written consent by a parent or guardian and often signed by a physician or dentist.)

NORMAL TOOTH ERUPTION

• PRIMARY TEETH BEGIN TO FORM AT 7 WEEKS OF GESTATION IN UTERO
• ERUPTION BEGINS AT ABOUT 6 MONTHS OF AGE
• THERE ARE 20 PRIMARY TEETH PRESENT BY ABOUT AGE 3
• PERMANENT TEETH APPEAR AT ABOUT 6 YEARS OF AGE
• REMEMBER; TEETH MAY ERUPT UP TO A YEAR EARLIER OR LATER THAN THE AVERAGE ERUPTION DATES LISTED HERE.

• Primary Teeth Eruption Table (.gif image)
• Primary Tooth Eruption - Animated Demonstration

• Permanent Teeth Eruption Table (.gif image)
• Permanent Tooth Eruption - Animated Demonstration

"My Mouth Hurts"

A resource for School Nurses, when a student says "My Mouth Hurts".

This is a sequence of slides to enable school nurses to better assess and refer students when necessary.

Click here to begin

How To Be A Good Dental Patient

• KEEP THE DENTAL APPOINTMENT!
• GIVE 24 HOURS NOTICE IF UNABLE TO KEEP APPOINTMENT
• BRING ONLY THE CHILD WITH THE APPOINTMENT
• BRUSH AND FLOSS TEETH BEFORE THE APPOINTMENT
• NEVER USE THE DENTIST AS A THREAT
• LET THE DENTIST/HYGIENIST EXPLAIN WHAT WILL BE DONE

Talk about visits to the dentist as you would about any other routine experience.

Have a positive attitude and encourage others to be positive about the dental visit.

Positive attitudes and example can mold the child's feelings about dental care for years to come. Never let others try to scare the child about the dentist.

Answer the child's questions simply. If they ask," Why do I go to the dentist and what will the dentist do?" You can answer, "To see if your teeth are healthy, and to count your teeth. They may also want to clean your teeth." If the child asks, "Will it hurt?" You may tell them, "No, not usually. But just tell the dentist if it starts to hurt and they will take care of it so it won't."

Follow the dentist's guidelines if they prefer that you remain in the waiting/reception area.

Ask questions about terms or procedures you do not understand.

Prolonged Bleeding After A Tooth Extraction

• Fold a sterile 2"x2" gauze and place on the extraction site. Have the child bite continuously for 30 minutes, without disturbing it.
• If the bleeding is bright red (not just oozing), you may place a damp tea bag wrapped in sterile gauze and have the child bite continuously for 30 minutes, without disturbing it. This seems to help control the bleeding and helps with clot formation.
• If bleeding cannot be controlled within an hour, or is excessive, advise the parent to consult the attending dentist.

Instructions for 24 hours after an extraction

• DO NOT rinse, swish, or use mouth wash
• DO NOT use a straw
• DO NOT smoke
• DO NOT spit excessively
• DO NOT disturb the extraction site with the tongue
• DO NOT eat or drink extremely cold or hot foods

DRY SOCKET
Possible if there is severe pain several days after the extraction

• Advise the parent to consult the attending dentist
• Administer an aspirin substitute for pain, if permitted