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Management of defective dental restorations may seem initially like a daunting task to the Emergency Physician. The treatment of common dental emergencies is published in the Emergency Medicine Clinics of North America under the heading “Difficult and Advanced Procedures.”1 The urgent management of these conditions can be relatively simple for the clinician armed with a modicum of knowledge of dental anatomy, pathophysiology, and various treatment modalities.1,2 The astute clinician must also recognize the inherent limitations of treating these problems in the Emergency Department.

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Patients frequently present to the Emergency Department with some sort of dental complaint.1–4 They typically complain of discomfort.1,2 They may or may not be aware of the etiology of the discomfort. The patient’s chief complaint may be directed at a particular tooth. Be diligent in searching the entire mouth for alternative primary, comorbid, or secondary problems. The recognition of frequently encountered comorbid problems such as root fractures, periapical abscesses, and dentofacial trauma are beyond the scope of this chapter.

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The perioral tissues are exceptionally sensitive to noxious stimuli. This is particularly true for the oral mucosa, the periodontal ligament, and the dentin. This concept is paramount to the effective management of any dental-related complaint. The management of defective dental restorations is essentially as simple as relieving the patient’s discomfort and employing temporizing measures until they can be followed-up by the appropriate specialist.

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A meaningful discussion of the management of defective dental restorations requires a brief outline of the available types of dental appliances. In general, dental appliances are either fixed or removable. Fixed dental appliances are considered permanently attached to the teeth. They include crowns, bridges, implants, some forms of dentures, orthodontic bands and brackets, interdental wiring, and any type of filling (silver amalgam, gold, porcelain, or tooth-colored composite material). Removable dental appliances are those that are not permanently attached to the teeth and include partial dentures, complete dentures, space-maintenance devices, and other orthodontic devices.

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A few basic principles will help guide the nondental practitioner in treating patients with a defective dental restoration. Know your limitations. A defective dental restoration is rarely, if ever, a true emergency.2 Refer the patient to a Dentist if you are unfamiliar with an appliance or a presentation, or if there is any hesitancy to treat. Always consider a secondary or comorbid process. Obtain dental radiographs when in doubt. Treat the tooth for dental trauma if a restoration is determined to be defective secondary to trauma. Never remove a fixed appliance without first discussing it with a specialist, preferably the one who placed it. Always treat pain, inflammation, and evidence of infection. Always consider ingestion or aspiration when dealing with a multiply fragmented appliance. Obtain neck, chest, and abdominal radiographs if all appliance fragments cannot be accounted for. It is probably best to do as little as possible if a patient is actively involved in an ongoing treatment ...

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