Thursday, January 04, 2007

Not dead yet....

...so, you'll all be happy to know that I survived my as-yet-undiagnosed mouth weirdness.

after 4-5 days, it stopped throbbing and shrunk up, tho' 1 week after it appeared there's still a small bump.

In other news I treated a rather horrendous trauma case yesterday - 15 yo kid comes in w/ his mom off the street (that is to say, not patients) and he'd fallen on some icy and took it right in upper front tooth (#9 for you dental types).
My receptionist referred to him as coming in with "tooth in hand" tho' actually it was hanging out in a large plastic Dunkin' Donuts cup w/ some milk in it. "Can you put it back in?" mom asks.... well, sure.... but will it stay?

The problem with the human head is that it sure does like to bleed a lot. I was recounting this incident to some architect friends and Mr. English excused himself to "go out for a bit of air." Apparently not everyone is fascinated by situations involving terms like "laceration" and "hemorrage." "Avulsion" is another fun one...

Anyhoo, shot him up w/ a carp of Septocaine even tho' it didn't really hurt that much to touch that area. Noted aforementioned laceration from cervical gingiva all the way up the depth of the vestibule to the subnasal area. The maxillary bone comprising the facial aspect of the #9 socket was fractured medially and apically and did NOT want to be reapproximated w/ the adjoining bone, which I found irritating.

So, rinsed off the root (don't scrub!) popped it back in and repacked w/ a whole sleeve of gauze and cotton rolls. I will say this. The blood doesn't bother me, but there's something deeply disturbing about an otherwise intact tooth having bits of asphalt still embedded in the enamel....

Rang up an oral surgeon for a consult and finally got a hold of the fourth one I tried.... (Hey guys! What's up with the extreme bankers' hours on a Wednesday afternoon?? You know who you are! JK....luvya all...) He suggested a number of steps w/ bonding some wire and suturing the tissue etc etc. I said, "yeah...boy, this always happens when you're half-way through a crown prep (#4). Dr. R---- was kind enough to offer to take the case and I was happy to refer.

Disappointing not to be "the hero" in that situation, but even after farming him out, my poor crown prep lady ended up being in the other chair for nearly 3 hours! yow. She was sympathetic and understanding, but still a tough situation.

The young man's mom came back this morning to say that things went well, he feels ok and the oral surgeon feels the prognosis isn't too bad to save the tooth. Hooray. Be sure to nail down the inevitable root canal before he's off insurance tho', right.... ? one step at a time...

1 comment:

Ameloblast said...

How long was the tooth avulsed for? The prognosis ultimately depends upon extraoral time...