Management of Acute Dental Problems

Disclaimer

The use of this website is subject to the disclaimer and terms of use set out below. By using this website you agree to be bound by these terms.

The guidance presented in this website has resulted from a careful consideration of current legislation, professional regulations, the available evidence and expert opinion where evidence is lacking. The recommendations should be taken into account when managing patients with acute dental problems. As guidance, it does not override the individual responsibility of the healthcare professional to make decisions appropriate to the individual patient. However, it is advised that significant departures from this guidance are fully documented and that this documentation is included in the record of advice given to all patients who present with acute dental problems.

SDCEP makes every effort to ensure the accuracy of the information contained in ‘Management of Acute Dental Problems’. However, SDCEP cannot guarantee its correctness and completeness at all times. SDCEP will not be held liable for information that is inaccurate. SDCEP does not accept responsibility for any loss, damage or expense resulting from the use of this website.

All links from this website are provided for information and convenience only. SDCEP cannot accept responsibility for the sites linked to, or the information found there. SDCEP cannot guarantee uninterrupted access to the sites to which this website links.

Background

Patients who have an acute dental problem seek care in a variety of settings. To encourage the consistent provision of safe and effective care that is tailored to each patient’s needs, Scottish Dental Clinical Effectiveness Programme (SDCEP) has published new best practice clinical guidance entitled ‘Management of Acute Dental Problems’.

This guidance has been developed by this multidisciplinary group and builds on the ‘Emergency Dental Care’ guidance published by SDCEP in 2007, the experience of managing dental calls within NHS 24 and research evidence on treatment of the wide range of conditions that may present. Further details about the background and development of the guidance, overarching principles, the decision support flowcharts on which this website is based and guidance on the management of the range of conditions listed in the A-Z of Conditions is available in the full version, available from the SDCEP website.

Who the Guidance is for

Management of Acute Dental Problems is intended for use by staff in any healthcare setting who may be asked to advise or manage patients with acute dental problems. This includes non-dental professionals, such as general medical practice, emergency department and pharmacy staff, as well as members of the dental team. Based on the main presenting symptoms, the guidance can be used to identify any immediate attention or advice to give to the patient and to determine the appropriate provider of subsequent care.

Categories of Care

For each of the main presenting symptoms, a series of questions leads users to an endpoint indicating the level of urgency with which the patient needs to receive care. In many cases, advice that can be given to the patient is also provided, for example for relief of symptoms while waiting for subsequent care. Conditions that might be the cause of the presenting symptoms are listed with links to more detailed advice on Initial Management (immediate care that any care provider can follow) and Subsequent Care (follow up care provided by a dental or other healthcare professional).

Endpoints are defined as:

• Emergency Care – arrange for the patient to have contact with a clinical advisor within 60 minutes and subsequent treatment within a timescale that is appropriate to the severity of the condition
• Urgent Care – advise the patient to seek dental or medical as indicated within 24 hours, unless the condition worsens
• Non-urgent Care – advise the patient to see a dentist within 7 days if required, unless the condition worsens
• Self Care – the patient should be able to manage the problem without the need for further involvement of a healthcare professional. However, advise the patient that if the symptoms persist or worsen, they should contact a dentist or general medical practitioner.

These categories should apply at any time in the 24 hour period. When there is a preferred provider of care, this is also indicated.

During normal working hours, all dental practices have arrangements to provide emergency care for their registered patients. Health Boards also have local emergency dental arrangements in place for non-registered patients and NHS 24 can advise on how to contact these.

In the out-of-hours period (18.00 to 08.00 hours during the week and throughout the weekend), some dental practices have their own emergency arrangements. In addition, a full triage and patient booking service is available through NHS 24.

It should be noted that some allowance on treatment times may need to be made for remoteness, rurality, patient travel and degrees of urgency within each category. Similarly, providers of care may vary depending on location.

Spreading or Systemic Infection

Health care providers need to be alert to the characteristics of the occasional patient who presents with spreading or systemic infection. There is, for example, an association between cervicofacial infection and acute morbidity and mortality.

It is important that the cardinal signs and symptoms of spreading infection (cellulitis, lymph node involvement, swelling) and systemic infection (fever and malaise) are recognised for patients presenting with acute dental problems.

Antibiotics are only appropriate for oral infections where there is evidence of spreading or systemic infection or for a patient who is immunocompromised. It is suggested that the question ‘does the patient look or feel unwell?’ is an appropriate way to assess the likelihood of systemic infection.

Local measures are the recommended first option in cases of bacterial infection. Rarely, it might be necessary to prescribe an antibiotic, for example, when swelling is severe and drainage cannot be achieved.

Copyright

© Scottish Dental Clinical Effectiveness Programme (SDCEP) 2013. SDCEP operates within NHS Education for Scotland (NES) and retains copyright to the content and design of this website. You can copy or reproduce text content from this website for use within NHSScotland and for non-commercial educational purposes. Use of the content for commercial purposes is permitted only with prior written permission. No material may be modified, edited or taken out of context such that its use creates a false or misleading statement or impression as to the positions, statements or actions of SDCEP or NES.