Dental Pain in the ED
- Inflammation of the nerve of the tooth.
- Different pain history to periodontitis.
- Pain may be spontaneous, or aggravated by hot or cold stimuli.
- Initially it may be difficult to localise which tooth the
pain is coming from
- DDx may include acute sinusitis and shingles.
- Painkillers may be helpful in the short term.
- Antibiotics are not indicated.
- Tooth needs to be opened or removed by a dentist, during working
hours.
- Inflammation of the supporting tissues of the tooth
- Pain is usually well localised and aggravated by pressure
such as biting.
- Antibiotics will be useful: use amoxycillin (erythromycin
if allergic). [Beware erythromycin if on warfarin]
- Antibiotics take 24-36 hours to be effective.
- Prescribe analgesia.
- Definitive treatment will require removal of the tooth or
the nerve by a dentist, during working hours.
- Inflammation of the soft tissue (gum) covering an erupting tooth (usually a wisdom tooth).
- If associated with swelling, pyrexia, trismus or cervical lymphadenopathy antibiotics will be required.
- Use amoxycillin or metronidazole.
- Advise patient to be reviewed by their dentist, particularly if there is associated facial swelling or if it fails to resolve.
