Management of Acute Dental Problems

Brief description of condition

Infection under the operculum i.e. the gingival (gum) tissue covering a partially erupted tooth. Pain associated with erupting teeth in children (both primary and permanent teeth).

Key signs and symptoms

• Pain (usually well-localised around a partially erupted tooth)
• Swelling (swelling of gingival (gum) around a partially erupted tooth; can extend to facial swelling, especially with mandibular molar tooth)
• Discomfort with swallowing
• Limited mouth opening
• Unpleasant taste or odour from the affected area
• Fever
• Nausea
• Fatigue

Initial management

Determine if the airway is compromised: the patient is unable to swallow their own saliva or they are unable to push their tongue forward out of their mouth.

If the airway is compromised:

Send the patient immediately to emergency medical care via NHS 24.

If the airway is not compromised:

For adults:

• Recommend optimal analgesia
• Do not prescribe antibiotics unless there are signs of spreading infection (e.g. limited mouth opening, facial swelling), systemic infection, or for an immunocompromised patient
• Advise the patient to rinse their mouth with 0.2% chlorhexidine mouthwash
• Advise the patient to seek urgent dental care.

For children:

• Advise optimal analgesia, soft tooth brushing around affected area and rinsing the mouth after food.

Subsequent care

For adults, consider:

• Ultrasonic scaling and/or debridement to remove any foreign body lodged around the partially erupted tooth, under local anaesthesia, where possible.
• Irrigating under damaged tissue with 0.2% chlorhexidine.
• Extracting the tooth, if there are repeated episodes of pericoronitis associated with the same tooth.
• Extracting or adjusting an opposing tooth, where there is trauma to the inflamed operculum, if the position of the tooth suggests that it is unlikely to achieve function in future.

References

1. American Academy of Periodontology. Parameter on acute periodontal diseases, Journal of Periodontology 2000; 71 (5 Suppl): 863–6.
2. SDCEP. Drug prescribing for dentistry: dental clinical guidance, 2nd edition. Dundee: Scottish Dental Clinical Effectiveness Programme; 2011.
3. NICE. Guidance on the extraction of wisdom teeth, 2000.