ABC of oral health. Dental emergencies.

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. 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.