Emergency Dental Care
Dental Pain Management
Most people will suffer the unpleasant effects of dental pain or toothache during their lifetime. Every year nearly half of the population will experience some form of dental pain or discomfort and 25 percent will eventually be driven to seek emergency treatment. Severe dental pain can be totally incapacitating. Low grade, chronic dental pain is debilitating and in both cases the first priority must be to make an urgent dental appointment for diagnosis and treatment by a dentist. The early warning signs should never be ignored.
It is easy to understand the reason for such unpleasant symptoms. The nature of the teeth and their association with the jaws are part of a complex sensory mechanism with short nerve pathways to the brain. Pain tells the brain that all is not well.
The teeth and the tooth attachments may give rise to painful symptoms as a result of decay, abscess, gum (periodontal) disease or eruption problems. The pain may vary from an intermittent or fleeting sensitivity; sensitivity to hot and cold that may indicate the early onset of decay; to the most dreadful acute throbbing pain caused by advanced decay and a dental abscess. In this latter case it may be impossible even to touch the teeth together and eating may be difficult.
Pain may occur following dental treatment. It is not uncommon after a very large and deep filling has been placed or a dental extraction carried out. The degree of pain is related to the damaged dental tissues (eg the surgical removal of an impacted wisdom tooth can be associated with several days of pain or discomfort). Patients must therefore expect to take suitable medication and will be advised to follow procedures aimed at promoting rapid healing whilst reducing the discomfort to a minimum. It is most unusual for post-operative pain to last for more than 10 days. In the vast majority of cases medication will not be required for more than three days.
There are other causes of dental pain that simulate toothache in people who otherwise may have good oral hygiene and excellent teeth (eg sinusitis can cause pain on one or both sides of the face). Trigeminal (facial) neuralgia can bring stabbing pains that will cause serious incapacity. Deep-seated aches in the jaws may also indicate the presence of disease. Diagnosis may not be easy or certain. It is imperative to see a dentist who may have to refer to a consultant for further tests.
Accidents (trauma) that involve injury to the teeth, mouth and face are particularly common in childhood. Just over one third of all five-year-olds will have suffered an injury to their first (primary) teeth. By 12 years old, 20-30 percent of children will have suffered injuries to their teeth. Boys are one third more likely to be affected.
Rapid action by parents, carers and teachers can save a child’s teeth, so it is important to know what to do if an accident should happen. With some injuries there is a much better chance of good recovery if treatment is given immediately, rather than waiting for professional assistance (see below). Any trauma or injury to first teeth (baby teeth) can affect the developing second teeth. Children who have had injuries to first teeth need to be monitored regularly by their dentist.
Urgent action that should be taken after injury to baby teeth (primary teeth):
Calm the child down. Children will usually be very distressed.
Wash the blood away with plenty of cold water.
Use damp gauze, cotton, clean cloth or tissue to stop the bleeding by pressing on any wound including gums, tongue, lips and cheeks.
Try to locate any lost teeth or tooth fragments. It is important to show these to dental/medical staff to eliminate the risk that they have been inhaled.
Do not replace primary (first) teeth in the mouth. Infections that may occur after replacement of a primary or baby tooth could affect the development of second teeth.
Urgent action after injury to permanent teeth (second teeth):
Remain calm and reassure the victim.
Wash the areas of injury with plenty of water.
Apply a cold compress of damp cotton, gauze, clean cloth or tissue, with pressure, for five minutes to stop the bleeding.
Locate any pieces of broken tooth and put the fragments in water. These may be able to be used to repair the broken tooth with special dental adhesive and filling material.
If a whole tooth has been knocked out (avulsed) pick up the tooth by the crown (top). Do not touch or scrub the root. If it has been soiled, it can be gently washed for about 10 seconds under a cool tap. Hold the tooth by the crown and gently insert it into its socket then ask the casualty to bite on a damp cloth while they are taken to a dentist.
If it is not possible to insert the tooth, put it in some milk, or ask the victim to place the tooth in their mouth between their teeth and cheek. Seek immediate dental assistance.
Sport results in many injuries to the teeth. A thorough check-up at the beginning of each season to identify teeth at risk and the provision of a mouthguard, fitted by a dentist, provide the best protection possible. Anyone involved in contact sports (eg football, rugby, hockey, boxing and wrestling) should have mouthguard protection. Even non-contact sports (eg basketball, squash, skateboarding, and cycling) can cause damage to the teeth and participants would benefit from the use of mouthguards.
Prominent front teeth (anterior), especially if not covered by the lips, are much more likely to be fractured. Orthodontic treatment (aligning the teeth with braces) reduces this risk.
Seat belts, appropriate child restraints, and car seats all prevent trauma to teeth, mouth and face, as well as the rest of the body in the event of a car accident or sudden stop.