Management of Acute Dental Problems

Brief description of condition

Acute onset paralysis or weakness of muscles only in the face, often first noticed on waking. It is essential to exclude other more serious conditions that have similar symptoms. Most people recover function, but there are some who do not.

Key signs and symptoms

• Paralysis or weakness of muscles only in the face, usually on one side

Initial management

Determine if there are signs of stroke, e.g. facial weakness or distortion, arm weakness, speech problems; rapid onset of these symptoms (F.A.S.T).

If there are signs of stroke

Send the patient immediately to emergency medical care via NHS 24 or call 999.

If there are no signs of stroke

• Protect the eye with a patch, eye lubricants, and possibly tape eyelids closed at night.
• Advise the patient to seek urgent medical care.

Subsequent Care

For adult patients, prescribe prednisolone (25 mg two times per day for 10 days) if within the first 72 hours of onset.

Refer the patient to general medical practitioner for onward referral to a specialist, if required.

References

1. Chen N, Zhou M, He L, Zhou D, Li N. Acupuncture for Bell's palsy. Cochrane Database of Systematic Reviews 2010, Issue 8. Art. No.: CD002914.
2. Lockhart P, Daly F, Pikethly M, Comerford N, Sullivan F. Antiviral treatment for Bell's palsy (idiopathic facial paralysis). Cochrane Database of Systematic Reviews 2009, Issue 4. Art No.:CD001869.
3. McAllister K, Walker D, Donnan PT, Swan I. Surgical interventions for the early management of Bell's palsy. Cochrane Database of Systematic Reviews 2011, Issue 2. Art. No.: CD007468. DOI: 10.1002/14651858.CD007468.pub2.
4. Salinas RA, Alvarez G, Daly F, Ferreira J. Corticosteroids for Bell's palsy (idiopathic facial paralysis). Cochrane Database of Systematic Reviews 2010, Issue 3. Art. No.: CD001942. DOI: 10.1002/14651858.CD001942.pub4.