Acute dental pain
Description of Pain and Associated Features
| Description of Pain | Likely Cause | Initial Management by Medical Practitioners | Dental Treatment |
|---|---|---|---|
| Intermittent dental pain experienced when exposed to stimuli (hot, cold, sweet), resolves when removed | Reversible pulpitis | – Advise avoiding provoking food/drink – Cover cavity with inert material (e.g., chewing gum, Blu Tack) – Advise seeing a dentist ASAP – Analgesics and antibiotics not indicated | – Simple restoration – Desensitisation treatment |
| Severe dental pain with stimulus, persists as dull, throbbing ache | Irreversible pulpitis | – Advise avoiding provoking food/drink – Offer NSAIDs if suitable – Cover cavity with inert material – Consider local anesthesia for severe symptoms – Advise seeing a dentist ASAP<br>- Antibiotics not indicated | – Endodontic treatment (root canal) – Extraction |
| Dull, throbbing ache not triggered by stimuli, tooth sore to bite on | Infected root canal with acute periapical inflammation (apical periodontitis) | – Offer NSAIDs if suitable – Advise urgent dental visit – Antibiotics not indicated for localized infection unless dental treatment is delayed over 24 hours | – Endodontic treatment (root canal) – Extraction |
| Tenderness to pressure and biting | Fractured/cracked tooth or localized odontogenic infection | – Urgent dental visit – Difficult to differentiate without visible abscess or pus – Offer NSAIDs if suitable – Antibiotics only if infection confirmed and dental treatment delayed over 24 hours | – Restoration – Endodontic treatment (root canal) – Extraction |
| Facial swelling and pain following toothache without severe symptoms | Spreading odontogenic infection without severe/systemic features | – Offer NSAIDs if suitable – Start antibiotics if dental treatment delayed over 24 hours – Advise urgent dental visit | – Endodontic treatment (root canal) – Extraction |
| Swelling and pain with severe/systemic features | Spreading odontogenic infection with severe/systemic features | – Support airway, breathing, and circulation – Urgent hospital transfer to oral/maxillofacial surgeon or expert | – Surgical intervention<br>- Intravenous antibiotic therapy |
| Dental pain worsening when head tilted forward | Maxillary sinusitis | – Symptomatic therapy recommended – Antibiotics rarely needed | – Dental treatment not required |
| Dental pain worsening 1-4 days after extraction | Alveolar osteitis (dry socket) | – Flush socket with warm sterile saline – Offer NSAIDs if suitable – Advise seeing practitioner who performed extraction urgently – Antibiotics not indicated | – Further socket irrigation and analgesia<br>- Obtundent dressing may relieve pain |
| Severe pain throughout the mouth with gingival bleeding, necrosis, or ulcers | Necrotising gingivitis | – Offer analgesics – Use chlorhexidine mouthwash or hydrogen peroxide solution if pain limits cleaning – Advise urgent dental visit – Refer to management guidelines for necrotising gingivitis | – Local debridement<br>- Local irrigation<br>- Antibiotic therapy |
| Acute pre-auricular pain, mouth opening restricted | Temporomandibular disorder | – Advise resting jaw (e.g., soft foods, avoid extreme movements) – Apply cold or warm compresses as indicated – Offer NSAIDs if suitable – Advise seeing a dentist ASAP – Refer to guidelines for temporomandibular disorders | – If conservative measures fail, referral to specialist required |