WK2 - Lecture 8 - Broken Instrument Tip.pdf

DH 410 EMERGENCIES IN DENTAL PRACTICE Lecture 8: Broken Instrument Tip (not in Malamed textbook)  Broken Instrument Tip  Fairly common  Etiologies  Excessively thin due to sharpening  Excessive force during instrumentation  Ten...

DH 410 EMERGENCIES IN DENTAL PRACTICE Lecture 8: Broken Instrument Tip (not in Malamed textbook)  Broken Instrument Tip  Fairly common  Etiologies  Excessively thin due to sharpening  Excessive force during instrumentation  Tenacious calculus  Defective instrument  Uncommon due to quality control during production Figure 22.1 Thin instrument on right needing replacement due to high risk of breakage  Signs and Symptoms of Broken Instrument Tip  Tip missing from end of instrument  Patient may state they feel something lodged between teeth Figure 22.2 Broken instrument tip interproximally between #27 and #28  Treatment of Broken Instrument Tip  REMAIN CALM – Inform patient in a clam manner  Terminate procedure  Slowly sit patient in upright position  Isolate area where you were last working with gauze or cotton rolls  Maintain cheek/lip retraction (if possible)  Ask patient NOT to swallow or move head  If they need to spit, they should spit into a cup  Try not to alarm patient  Do NOT suction, rinse, or use air  Examine immediate area to locate tip  Treatment of Broken Instrument Tip  If tip not visible, blot gingival area dry and examine closely  Probe/explore sulcus  Do not push tip further into sulcus  Treatment of Broken Instrument Tip TIP LOCATED:  Remove with curette  Can use perioretriever – autoclavable, magnetized instrument designed to remove broken instrument tips  Explain and show removed tip to patient  Match with broken instrument (all pieces present)  Document thoroughly in chart  May consider having patient sign that tip was removed  Treatment of Broken Instrument Tip TIP NOT LOCATED:  Take radiograph to locate and then remove  Explain and show removed tip to patient  Good idea to have patient sign that they saw tip was removed  Thoroughly document in patient record  If tip found on radiograph, but cannot be removed refer to oral surgeon Figure 22.3 Removal of broken instrument tip with perioretriever Radiograph of broken tip  Treatment of Broken Instrument Tip  If the tip is not located, by clinician or x-ray, the patient MUST be referred for a chest x-ray  This is done to be sure the tip hasn’t been swallowed or aspirated  If the tip is found in the chest x-ray, it must be surgically removed  Prevention of Broken Instrument Tip  Maintain instrument integrity  Replace thin instruments  Use proper instrument for area being treated  Use instrument correctly  Use ultrasonic scaler on patients with heavy deposits  Additional Items  Perioretriever  Reference Little, J. W., Miller, C., & Rhodus, N. L. (2017). Little and Falace’s dental management of the medically compromised patient. Mosby. Grimes, E. B. (2014). Medical emergencies: Essentials for the Dental Professional. Prentice Hall