Intended for healthcare professionals

Practice 10-Minute Consultation

Dental pain

BMJ 2013; 347 doi: (Published 05 November 2013) Cite this as: BMJ 2013;347:f6539

This article has a correction. Please see:

  1. Yvonne MacAuley, senior house officer, executive registrar1,
  2. Patrick O’Donnell, general practitioner2,
  3. Henry F Duncan, consultant in endodontics3
  1. 1Dublin Dental University Hospital, Lincoln Place, Dublin 2, Ireland
  2. 2Graduate Entry Medical School, University of Limerick, Limerick, Ireland
  3. 3Division of Restorative Dentistry and Periodontology, Dublin Dental University Hospital, Trinity College Dublin, Ireland
  1. Correspondence to: Y MacAuley yvonne.macauley{at}
  • Accepted 15 August 2013

A 40 year old woman presents complaining of severe dental pain and swelling, and is unable to contact her dentist. She reports that the pain started three days ago and has increased in intensity since, with her face becoming swollen in the last 24 hours.

What you should cover

Nature and severity of the pain

Dental pain occurs as a result of inflammation of the pulp (pulpitis) (see figure). This is generally caused by bacteria from decayed teeth or defective dental fillings. Dental pain can be practically grouped into five progressive pain categories. A short pain history and examination is required to categorise this pain.

Dental anatomy, decay, and pain. The crown of a tooth is made up of three basic layers; enamel (A), dentine (B), and pulp (C). The dental pulp is essentially a connective tissue containing nerves, blood vessels, and lymphatics. It is continuous with the supporting tissues around the tooth. Pain results when the pulp is inflamed, which is generally caused by bacteria from decay (D), or a leaking dental restoration or “filling”.

  • 1. A short, sharp pain lasting only a few seconds and occurring in response to a cold or “sweet” stimulus is likely to be reversible pulpitis. This is generally not a severe problem, and the pulp of the tooth can be saved. Antibiotics and analgesics are not required, but the patient should be advised to attend a dentist.

  • 2. A dull, aching, “pulsing” pain that occurs spontaneously and in response to thermal stimuli is likely to be irreversible pulpitis. There is no swelling, but pain is debilitating, often disturbs sleep, and may last for hours. Irreversible pulpitis requires expedient dental intervention. Antibiotics and analgesics are ineffective.

  • 3. Untreated pulpitis leads to pulp necrosis and death, and the …

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