Clinical Review ABC of oral health

Dental emergencies

BMJ 2000; 321 doi: http://dx.doi.org/10.1136/bmj.321.7260.559 (Published 02 September 2000) Cite this as: BMJ 2000;321:559
  1. Graham Roberts,
  2. Crispian Scully,
  3. Rosemary Shotts

    Most oral emergencies relate to pain, bleeding, or orofacial trauma and should be attended by a dental practitioner. However, in the absence of access to dental care, a medical practitioner may be called on to help. Jaw fractures require the attention of oral or maxillofacial surgeons.

    Orofacial swelling in a patient with an acute dental abscess

    Dental pain

    Pulpal pain is spontaneous, strong, often throbbing, and exacerbated by temperature and outlasts the evoking stimulus. Localisation is poor, and pain tends to radiate to the ipsilateral ear, temple, or cheek. The pain may abate spontaneously, but the patient should still be referred for dental advice, as the pulp has probably necrosed, and acute periapical periodontitis (dental abscess) will probably follow in due course. Endodontics (root canal treatment) or tooth extraction are required.

    Chronic dental abscess (gumboil) at a typical site, in this case related to the broken molar

    Periapical periodontitis pain is spontaneous and severe, persists for hours, is well localised, and is exacerbated by biting. The adjacent gum is often tender to palpation. An abscess may form (“gumboil”), sometimes with facial swelling, fever, and illness. Fascial space infections are fortunately rare since they threaten the airway: patients should be referred to a specialist. In the absence of immediate dental attention it is best to incise a fluctuant abscess and give antimicrobials (amoxicillin) and analgesics. The acute situation usually then resolves, but the abscess will recur, since the necrotic pulp will become re-infected unless the tooth is endodontically treated or extracted, though a chronic abscess may be asymptomatic apart from a discharging sinus. Rarely, this may open on to the skin.

    • Emergency treatment of dental abscess is antimicrobials, analgesics, and drainage of a fluctuant swelling by a dentist

    • Dental treatment should then be arranged, or the abscess will recur

    Bleeding

    Most oral bleeding results …

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