TOOTHACHE

see Dental assessment
see Dental infections
see Chronic Pain

Very common presentation to emergency

Other causes

ASSESSMENT AND MANAGEMENT

Principles:

N.B.

Cold sensitivity testing - test with ice chips/ethyl chloride wrapped in gauze (place on crown)
Hot sensitivity - test with warmed dental mirror handle
Percussion tenderness - gently tap with dental mirror handle

Diagnosis is based mainly on the history

CONDITION SYMPTOMS SIGNS TREATMENT
Reversible pulpitis Immediate, fleeting
Precipitated by cold, hot or sweet
Pain may be poorly localised
Cold sensitivity Avoid precipitants
Plug carious cavity with cavit or ZOE (zinc oxide eugenol)
Irreversible Pulpitis Spontaneous, persistent throbbing, noturnal pain
Hot and cold sensitivity (initially)
Heat senstivity and relieved with cold (later)
Poorly localised (initially)
Localised (later)
Heat sensitivity
Percussion tenderness (later)
Analgesia (consider opiates)
Pulpal Necrosis

 

Variable to Painless Percussion tenderness.
Dental follow-up for extraction or root canal treatment
Acute periapical abscess Severe nocturnal pain Exquisitely tender
Tooth extruded, mobile and tender to percussion
+/- localized or diffused swelling.

OPG - peridontal radiolucency

Incision and drainage
Dental follow-up for ?extraction

Dr George Chu BDSc MBBS
Ed: Dr. Derek Louey MBBS FACEM