emergency pain management

Question 1

Pt comes with a lost filling or fractured tooth. Describe what you would do if caries was or wasn’t there.

Answer 1

If caries is present then it should be removed with slow speed or spoon excavator.

The next step would be the same for if the pt didn’t have caries: temporise with ZOE, GIC (or composite for an anterior tooth).

Question 2

Pt comes in with lost crown. What would you do if the core is sound?

Answer 2

Replace with non-eugenol temp bond and then definitive cementation.

sandblasting of fitting surface is needed

Question 3

What would you do if the core is NOT sound when a pt comes in with a lost crown?

Answer 3

1. Vitality Testing
2. Radiographs
3. Replacement with non-eugenol temp bond
4. Warn the pt this is a temporary measure so follow up is needed.

Question 4

What would you do if a pt came into an emergency appt with dentine hypersensitivity?

Answer 4

1. Seal and protect.
2. Recommend sensitive toothpaste.
3. TBI - don’t brush too hard, electric with sensor.

Question 5

How to manage an emergency pt with pericoronitis.

Answer 5

1. Irrigate the operculum with saline.
2. Scale with ultrasonic.
3. PRESCRIBE METRONIDAZOLE 400MG X 3 DAYS IF SYSTEMIC INVOLVEMENT IS SUSPECTED.

Question 6

How to manage an emergency pt with reversible pulpitis.

Answer 6

1. Remove any soft caries with slow speed/spoon.
2. Dress with sedative dressing (ZOE)
   OR
   Place temp (GIC)
3. Warn the pt they will need further tx.

Question 7

How to manage an emergency pt with irreversible pulpitis or periapical periodontitis.

Answer 7

1. Access and dress the tooth with elder mix or odontopaste.
2. Don’t instrument the cancel.
3. Place cotton wool pledges to allow easy re-access.
4. Warn the pt they will need RCT.

OR EXTRACT

Question 8

How to manage an emergency pt with an acute periodontal abscess.

Answer 8

1. Prescribe antibiotics if systemic involvement is evident.
2. Establish drainage via the pocket through instrumentation of root surface.
3. Irrigate the pocket with saline.
4. Incision of the abscess may be necessary?

XLA may be needed if tooth shows loss of attachment and poor prognosis

Question 9

What to do if pt attends with dry socket.

Answer 9

1. Irrigate with saline.
2. Dress with alvogyl (CHECK FOR IODINE ALLERGY)
3. OHI and potential smoking advice.

Question 10

Adult dose of Ibuprofen

Answer 10

1 x 400 mg every 4-6 hours

(no more than 3 every 24 hours)

Question 11

Recommended adult dose of paracetamol.

Answer 11

2 x 500 my every 4-6 hours

(no more than 4 doses over 24 hours)

Question 12

For moderate pain of dental origin, what would you recommend an adult takes to manage?

Answer 12

Paracetamol or Ibuprofen

Question 13

For several pain of dental origin in adults, what would you recommend?

Answer 13

Alternate ibuprofen and paracetamol -

400mg ibuprofen, wait 2 hours and then 2x paracetamol.

Don’t exceed recommended dose over 24 hours.