DENTISTRY Management of acute dental pain

General medical practitioners are often called upon to manage acute dental pain in emergency situations, for example, out of hours or in rural areas, where it may not be possible for a dentist to provide immediate treatment. Common acute oral problems are usually easy to diagnose. Simple management can alleviate pain and further discomfort until a dentist can be called upon.

Most problems can be identified by the history and examination. Several dental conditions have typical symptoms with different types of pain.

When investigating acute dental pain, the history should focus on the pain's: location, type, frequency and duration, onset, exacerbation and remission (for example the response to heat or cold), severity, area of radiation.
Associated pathology and referred pain should also be considered.
Common types of oro-facial pain likely to cause a patient to seek emergency care are categorised in the box below. The character of the pain can point to a diagnosis.

There are several simple tests that may assist in diagnosis of dental pain.
Some of the most commonly used tests are the following
-Pulp sensitivity test
Dry ice, or an ordinary ice stick (made in a plastic or glass tube), is placed on the cervical third (neck region) of the tooth crown. A response to the stimulus indicates that the pulpal tissue is capable of transmitting nerve impulses. No response may indicate pulp necrosis.

-Percussion test
Using an instrument handle, the tooth is tapped in the longitudinal axis. A painful response suggests possible periapical inflammation.

If it is possible to obtain a screening radiograph, such as an orthopantomograph (OPG), this may assist in the diagnosis and localization of the cause of the pain. The radiograph should show clearly the apical and periapical structures of teeth and associated tissues. The relationship of the maxillary molars and premolars to the floor of the maxillary sinus can be examined, and radiographs may reveal recurrent caries or periapical radiolucencies associated with an established infection.

While antibiotics are appropriate in the management of certain dental infections, they are not indicated if the pain results from inflammatory (non-infective) or neuropathic mechanisms. The degree of pain is not a reliable indicator of acute infection.