If the patient’s oral mucosa is torn, suture it with fine 4/0 waxed silk or chromic catgut.
If the crown of a patient’s tooth is missing, its exposed pulp will be visible as a pink spot on the root surface. It will be acutely painful, so touch it with phenol on a small piece of cotton wool. This will kill and anaesthetize the nerve. Take a chest X–ray in case he has inhaled the missing fragment. It will have to be removed by bronchoscopy.
If a tooth is only mildly subluxed, leave it in place; it will probably tighten up and live. Meanwhile splint it with a piece of lead foil or the top of a milk bottle moulded to the tooth and gum.
If a tooth is so loose that you can lift it up and down in its socket, remove it. A dentist may be able to splint it and re–implant it, if he sees it soon enough, so don’t delay.
If there is an opening between a patient’s antrum and his mouth, try to close it. If his antrum is already infected, leave it open and irrigate it daily. Don’t pack it.
COMMINUTED FRACTURES OF THE ALVEOLUS If the bony fragment with its teeth is still attached to periosteum, leave it, and splint the patient’s teeth as best as you can with an arch bar. If the fragment of alveolus is completely detached from the periosteum, dissect it out and remove it.
GAPS IN THE MAXILLARY SINUS Close these temporarily by packing them with gauze impregnated with bismuth, iodoform, and paraffin paste (BIPP), or with vaseline gauze. As soon as the patient’s general condition is stabilized, close the gap with a flap of mucosa from his adjacent cheek. Suture it carefully, preferably with 3/0 black waxed silk sutures. Tell him not to blow his nose and to sneeze with his mouth open.
MISSING DENTURES A piece of denture can also be inhaled. It is unlikely to be radio–opaque, so a normal chest X–ray does not exclude inhalation.
