Dental conditions
Questionnaire/history?
Pain?
- Severe pain in mouth and jaw?
- Pain localised or radiation (eg to the ear)?
- Stimulated by hot and cold (typical for pulpitis)?
- Tooth pain when biting (typical for pulpitis)?
Swelling?
Bleeding?
Ulceration?
Altered sensation or appearance?
Trauma?
Non-dental causes of toothache?
- TMJ pain?
- Headache?
- Sinusitis?
- Parotitis?
- Trigeminal neuralgia?
- Giant cell arteritis?
Past medical history?
Current medication?
Known drug allergies?
Examination:
Gingivitis?
Ulceration?
Necrotising ulcerative gingivitis or pericoronitis?
Bleeding?
Swelling?
Dental abscess?
Altered sensation or appearance?
Management:
Immediate hospital referral:
(Note: severe dental infection can spread into surrounding soft tissues and cause life-threatening complications)
- Signs of spreading infection
- Difficulty swallowing, breathing or speaking
- Difficulty opening the mouth (trismus) may be due to pain or collection
- Swelling in the floor of the mouth or drooling
- Peri-orbital cellulitis
- Signs of sepsis (check vital signs)
Simple gingivitis:
Saline mouthwash or antiseptic mouthwash (eg chlorhexidine)
Necrotising ulcerative gingivitis or pericoronitis:
Advised antiseptic mouthwash and to see a dentist
Pulpitis:
Most common cause of dental pain, inflammation of the pulp, the soft fibrous tissue within the tooth which contains the neurovascular structures
As no infection of the surrounding tissue or associated swelling, pulpitis does not respond to antibiotics, it requires analgesia, pending surgical management by a dentist
Dental abscess:
Regular analgesia until a dentist can be seen for urgent drainage
(Note: antibiotics are only recommended if
- signs of severe infection
- signs of local or systemic spread
- systemic symptoms
- high risk of complications (eg significant immune compromise)
Metronidazole 400mg TDS or amoxicillin 500mg TDS, both for 3 days (alternative to amoxicillin Clindamycin)
Resource(s):
NHS Scotland: Acute Dental Problems
PHE/NICE antimicrobial prescribing