Emergencies, Urgent Care, and Appliance Repair
What this domain tests
Triage and first response for dental trauma, common orthodontic urgencies (poking wires, loose bands, broken appliances), pain management, allergic reactions, and eye injuries.
Dental trauma
- Avulsion: handle the tooth by the crown, do not scrub it, and replant immediately if possible or store it in Hanks' balanced salt solution, milk, or saline. Water is hypotonic and damages the root surface. Refer to a dentist or endodontist within about 30 minutes; check tetanus status and look for other injuries.
- Crown fracture: save the fragment in saline or milk and cover a sensitive dentin exposure with glass ionomer if needed.
- Luxation, intrusion, and alveolar fracture: do not attempt repositioning in the orthodontic chair - stabilize, control pain, and refer.
Orthodontic urgencies
- Poking wire: place wax, bend the end with a Howe plier or a pencil eraser, or cut it with a distal end cutter using gauze and suction; schedule a repair visit.
- Loose bracket or band: re-bond or re-cement if possible; if the patient could swallow it, remove it and place wax.
- Lost ligature, separator, or elastic: replace at the next visit; reassure if a separator was swallowed.
- Expected pain peaks 2–3 days after adjustment; recommend over-the-counter analgesics and a soft diet. Severe or unilateral pain needs evaluation.
- Allergic reaction to latex or nickel: remove the offending material, document, and refer.
Eye injury and headgear
Headgear and facebows can injure the eye. Never remove a penetrating object; stabilize and send the patient to ophthalmology immediately. Headgear is not worn during contact sports.
Emergency kit
Wire cutters (light and heavy), wax, ligatures, elastics, mirrors, hemostats, gauze, saline, gloves, topical anesthetic, and an avulsion storage medium.
Worked example
A parent calls at 8 p.m. because a lower archwire is poking. Reasoning: triage first - is the wire embedded in tissue, is there bleeding, is the patient able to place wax, do they have cutters at home? If the wire is merely long and wax controls it, schedule a next-day trim and document the advice and who gave it. If tissue is lacerated or the patient cannot manage it, arrange an after-hours visit.
Traps that cost marks
Cutting a wire without suction, gauze, and eye protection; telling a patient to remove a band at home; storing an avulsed tooth in water; and giving telephone advice without documenting it.