The management of a dental fracture is a core skill of the emergency physician.1 When the enamel is violated and the underlying dentin is exposed (i.e. Ellis Class II or greater), the dental pulp becomes at risk.2 Protecting the exposed dentin in a timely manner, therefore, is paramount. This is best accomplished through the use of dental cements.
The application of dental cement to a fractured tooth, while a relatively rare procedure, is one often fraught with difficulties. With many of the formulations requiring the rapid application of a fast-drying cement, time for accurate and clean application is limited. This often clumsy, haphazard spackling of the patient’s tooth with cement rarely feels smooth or confidence-instilling. Isn’t there a better way?
Trick of the Trade:
Syringe and Angiocatheter Application of Dental Cement
Using materials easily found in the emergency department, this trick is an easy, slick way to apply dental cement where you need it… and only where you need it.
- 3 mL syringe
- 18 gauge angiocatheter
- Dental cement, paper, and stem for mixing
- Gather all of your materials before mixing your cement and familiarize yourself with the technique. This will prevent your cement from prematurely drying in your syringe before application.
- Remove the plastic 18 gauge catheter tip from the angiocatheter and screw it into your syringe.
- Mix your dental cement. For ease of getting it into your syringe, mix slightly more than you may typically.
- Remove the plunger from your syringe and scrape the cement into the back end. Re-insert the plunger and press until the cement engages the angiocatheter.
- Apply the dental cement to your patient via this clean and targeted method.
- Be sure to have all your materials gathered before you start mixing. The syringe method does not alter drying times.
- Mix slightly more cement than you anticipate using, as some volume is lost in transfer from paper to syringe.
- As with any dental cement application procedure, strategically insert gauze and dental pledgets in the patient’s mouth to create a dry environment before application.
(c) Can Stock Photo / focalpoint