Management of Acute Dental Problems

Brief description of condition

Severe facial pain in the distribution of the trigeminal nerve, usually unilateral (i.e. only one side of the face). The duration of acute episodes is short lived.

Key signs and symptoms

• Pain (severe, stabbing, lancinating and shooting pain, often triggered by touching certain areas of the face)
• Brief facial spasm or tic

Initial management

Prescribe carbamazepine (see SDCEP Drug Prescribing for Dentistry guidance for dose) without delay.

Recommend optimal analgesia.

Consider use of a long-acting local anaesthetic block in the affected area.

Advise the patient to seek emergency medical care.

Subsequent Care

Monitor symptoms and response to medication at follow-up appointments and titrate the dose.

Monitor for adverse effects by ordering a full blood count and liver function tests.

If unresponsive or intolerant of drug therapy, refer to a specialist for further assessment.

References

1. NHS Inform 2012b. Trigeminal neuralgia. February 2012.
2. SDCEP. Drug prescribing for dentistry: dental clinical guidance, 2nd edition. Dundee: Scottish Dental Clinical Effectiveness Programme, 2011.
3. Yang M, Zhou M, He L, Chen N, Zakrzewska JM. Non-antiepileptic drugs for trigeminal neuralgia. Cochrane Database of Systematic Reviews 2011, Issue 1. Art. No.: CD004029. DOI: 10.1002/14651858.CD004029.pub3.
4. Zakrzewska JM, Akram H. Neurosurgical interventions for the treatment of classical trigeminal neuralgia. Cochrane Database of Systematic Reviews 2011, Issue 9. Art. No.: CD007312. DOI: 10.1002/14651858.CD007312.pub2.