Daly B, Sharif MO, Newton T, Jones K, Worthington HV Local interventions for the management of alveolar osteitis (dry socket). Cochrane Database Syst Rev. 2012; 12 https://doi.org/10.1002/14651858.CD006968.pub2
When providing an ‘on call’ service for oral and maxillofacial surgery, which can be very busy, one may rely heavily on kit provided on the ward, from theatre and/or in the emergency department, which is not readily to hand. However, when faced with a multi-user environment, presentation of cases out of hours and sometimes in an emergency situation, it is useful to have ready and rapid access to a toolbox with many of the available and necessary equipment and items one may need in general oral and maxillofacial surgery, restorative dentistry and urgent orthodontic situations, such as:
Pain and situations requiring local anaesthetic: single use dental syringe plus needles and cartridges with different types of LA solution.
Bleeding socket/wound: haemostatic material and sutures; bleeding wound: mosquito forceps, plus silver nitrate sticks, as required.
Dry socket: Alvogyl and chlorhexidine mouthwash (for mouthrinse only and not socket irrigation, owing to the potential for serious adverse side-effects1,2).
Laceration(s): a variety of sutures, needle holders, tissue forceps and scissors.
Avulsed or displaced tooth/teeth: impression trays, fixative and material (with mixing bowl and spatula), temporary splinting devices, such as self-cure composite, and orthodontic archwire (there is no need for an expensive and bulky light source) and plastic storage bags.
Dento-alveolar fractures or cases for/with wire intermaxillary fixation: Erich archbar roll plus 0.5 mm Stainless Steel wire and wire cutters.
For teeth that have been fractured in trauma with missing restorations, loose and lost crowns: temporary filling material and glass ionomer cement and/or those that have exposed pulps: calcium hydroxide paste.
Facial fractures with deranged occlusions: intermaxillary elastics, IMF screws and screwdriver.
Infections: alginate type dressing material and strips of corrugated plastic drain material, plus microbiology culture swabs.
Trismus and retraction: wooden spatulas, acrylic trismus screws.
Loose orthodontic wires: wax to cover, spare elastic modules and power chain with wire pusher instrument.
Multi-use: ethyl chloride spray (vitality testing, local numbing, adjunct to injections with LA topical cream), disposable scalpels, sterile gloves, masks, several disposable lights, swabs, chlorhexidine wipes, non-alcoholic iodine solution and scrubbing brushes are also stored.
The basic toolbox can be obtained from a hardware store. There is better utility if there are multiple drawers, which should be clear to transparent, to see what is in each, of large and small size or with compartmentalization for different components and made of durable and waterproof easy to clean plastic, that can withstand the rigours of transport between different locations on a frequent basis. It should also have a strong handle which is comfortable to the hand grip (Figure 1).
Figure 1. Maxillofacial toolbox with contents.
We have found that the use of the maxillofacial toolbox has enabled easier, safer and more efficient handling of patients in urgent situations, however, regular stock maintenance is required. This toolbox is an extension of a previous idea of a maxillofacial toolkit.3
We would recommend this as an essential item on any maxillofacial surgery ward; it should be available to all maxillofacial ‘on call’ staff, kept well stocked in a secure location, but readily available and easily accessed, both in an out of usual working hours. We would also welcome any other suggestions for this toolbox from your readers.
