Toothache
Faced with the choice of enduring a bad toothache or going to the dentist, we generally tried to ride out the bad tooth - Joseph Barbera
image by: Lume Dental
HWN Suggests
Dental Infections: To Treat or Not to Treat?
Having a basic layout of tooth anatomy in your mind allows you to localize the site of the dental complaint without ever going to dental school. This is because while the pulp contains pain-sensitive fibers, only the periodontal ligament contains pain- and pressure-sensitive fibers. Asking patients about sensitivity to sweets versus pain with chewing may help you localize the issue even before asking the patient to say “ahh!”.
Resources
Odontogenic infections
Caries are seen at the crown or root of the tooth and develop slowly, not becoming painful until involvement of the pulp. Pain should be managed with Ibuprofen or acetaminophen, oral hygiene and follow up with a dentist. Antibiotics are not needed.
Paucis Verbis: Dental infections
This card summarizes common dental infection complaints... that we see in the Emergency Department.
Dental Infections: To Treat or Not to Treat?
Overall, amoxicillin should be considered your first choice in a patient with a dental infection that is concerning for spread. Since it has broader spectrum, is more readily absorbed in the GI tract, and is more readily available in plasma, it easily unseats the previously-beloved pen VK as the bug juice for teeth. Nonetheless, medicine is part art and part science, so nothing is ever written in stone. So, when a patient presents to the ED with a tooth infection that is not responding to your antibiotic of choice, or maybe even has an antibiotic allergy, alternative regimens abound including: Amoxicillin/Clavulanic Acid, Clindamycin, Metronidazole, or Doxycycline.
Emergency Medicine Cases
Differentiate pulpitis versus a periapical abscesses by considering the duration of the pain and secondary signs such as tooth elevation, swelling, adjacent cellulitis, lymphadenopathy and fever.
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