Ep 185 Atraumatic Dental Emergencies

Here’s the problem: About 1% of all visits to the ED are for dental complaints, yet most of us have little training on how to recognize and manage dental emergencies. There are a multitude of reasons to explain the hoards of dental patients showing up in our EDs, not to mention the cost of seeing a dentist. Regardless, we need to know how to recognize and manage dental emergencies to best take care of our patients. After some suggestions from listeners and various colleagues to do an episode on dental emergencies, and learning more about dental emergencies myself, I realized, that the simple algorithm I apply to most patients I see in the ED with atraumatic dental pain  - doesn’t look like deep space infection or something I can drain -> analgesics + antibiotics -> send to dentist, was inadequate. In this Part 1 of our 2-part podcast series on dental emergencies, with the help of Dr. Chris Nash and Dr. Richard Ngo, we tackle these atraumatic dental emergencies: infections ranging from dental caries to pulpitis and gingivitis to dental abscess, cellulitis and deep space infection, as well as acute necrotizing gingivitis, pericoronitis and dry socket. These all have specific clinical characteristics and require specific management...

Podcast production, sound design & editing by Anton Helman; voice editing by Braedon Paul.

Background research by Ronak Saluja & Ryan O'Reilly

Written Summary and blog post by Anton Helman August, 2023

Cite this podcast as: Helman, A. Ngo, R. Nash, R. Atraumatic Dental Emergencies. Emergency Medicine Cases. August, 2023. https://emergencymedicinecases.com/atraumatic-dental-emergencies. Accessed May 30, 2024

Résumés EM CasesDental infections

Progression of dental infections in dental emergencies

It is important to understand the usual progression of dental infections as the management changes as the infection progresses. Simple dental anatomy helps to understand this progression.

Dental anatomy

Dental cary: a bacterial disease of teeth that demineralizes tooth enamel and dentine by acid produced during the fermentation of dietary carbohydrates by oral bacteria. It is characterized by loss of enamel and discoloration of the tooth.

Simple dental cary characterized by loss of enamel and discoloration

Pulpitis: inflammation of the tooth pulp caused by a cary encroaching the pulp.

Gingivitis: inflammation of the gingiva (gum adjacent to the tooth) caused by plaque on tooth surface

Dental condition

Clinical characteristics

Management

Simple dental cary

Toothache, spontaneous pain or pain that occurs without any apparent cause

Tooth sensitivity on biting and tenderness to palpation

Mild to sharp pain when eating or drinking something sweet, hot or cold.

Visible holes or pits in your teeth

Brown, black or white staining on any surface of a tooth

Dental hygiene (brushing with flouride, flossing etc)

*no antibiotics required

Pulpitis

* Pain triggered by hot, cold and sweet stimuli, lasts for a few seconds, and resolves spontaneously

* Physical exam unremarkable aside from tap tenderness to tooth

Analgesics, if severe, urgent referral to dentist removal of the cary, dental restoration or filling

*no antibiotics required

Gingivitis

* Red, swollen, tender gingiva

* Bleeding after brushing

* halitosis

Dental hygiene