Management of Acute Dental Problems

Brief description of condition

Inflamed dental pulp with signs and symptoms that vary depending on whether reversible or irreversible pulpitis.

Key signs and symptoms

• Tooth pain - may either be intermittent and associated with stimuli or is longer lasting (up to several hours) and may keep the patient awake at night.

Initial management

Recommend optimal analgesia.

Do not prescribe antibiotics.

Advise the patient to seek non-urgent dental care or if analgesia is ineffective, to seek urgent dental care.

Subsequent Care

Determine if reversible or irreversible pulpitis.

• Reversible: Gives a positive or exaggerated response to sensibility test; tooth is not tender to percussion.
• Irreversible: Pain may be difficult to localise to a single tooth, may last for several hours, may be dull and throbbing, may be worsened by heat, but may also be alleviated by cold. The pain can occur spontaneously, typically keeping the patient awake.

If reversible pulpitis

Consider:

• Providing a temporary dressing.
• Restoring the affected tooth.

If irreversible pulpitis

Consider:

• Providing first stage endodontic therapy (pulpotomy for children's teeth and pulpectomy for adult's teeth). Note that in some cases, achieving anaesthesia is difficult and a corticosteroid-antibiotic paste (e.g. Ledermix®) may be used to reduce inflammation for extirpation at a later date.
• Extracting the tooth.

References

1. Fedorowicz Z, Keenan JV, Farman AG, Newton T. Antibiotic use for irreversible pulpitis. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD004969. DOI: 10.1002/14651858.
2. Levin LG, Law AS, Holland GR, Abbott PV, Roda RS. Identify and define all diagnostic terms for pulpal health and disease states. Journal of Endodontics 2009; 35(12): 1645-57.