Dental disorders

Question 1

Features

Answer 1

• Dental caries
• impacted teeth
• infected tooth sockets and dental roots

can cause pain in the maxillary and mandibular regions.

Impacted third molars (wisdom teeth) may be associated with surrounding soft tissue inflammation

• causing pain which may be localised to the mandible
• or radiate via the auriculotemporal nerve to the ear.

Question 2

Features of dental caries

Answer 2

Pain is usually confined to the affected tooth but may be diffuse.

Pain is almost always aggravated by thermal changes in the mouth:

• cold—if dental pulp vital
• hot—if dental pulp is necrotic

Pain may be felt in more than one tooth.

Dental pain will not cross the midline

Question 3

Treatment of dental pain

Answer 3

Arrange urgent dental consultation.

Pain relief aspirin 600 mg (o) 4–6 hrly or paracetamol 0.5–1 g (o) 4–6 hrly.

If pain severe, add ibuprofen 400 mg (o) 4–6 hrly to paracetamol.

Question 4

Dental infection (e.g. tooth abscess)

Answer 4

Dental treatment may relieve but if moderate to severe:

• amoxycillin 500 mg (o) tds for 5 d

If unresponsive:

• amoxycillin/clavulanate 875/125 mg (o) bd

Add:

• metronidazole 400 mg (o) 12 hrly for 5 d

If widespread (e.g. adjacent fascial infection):

• use parenteral antibiotics e.g.
• procaine penicillin 1 g (IM) daily for 5 d

Question 5

Alveolar osteitis (dry tooth socket)

Answer 5

Refer urgently for specialised toileting and insertion of dressing.

Usually heals naturally in 14 days.

Antibiotics of no proven use.