Dental Emergencies
The most common dental emergencies result from inflammation, infection, or trauma.
Toothache (Pulpitis)
Treatment
1. If the offending carious lesion can be localized, first apply a piece of cotton soaked with eugenol (oil of cloves).
2. Place a temporary filling material, such as Cavit or zinc oxide-eugenol (ZOE) cement (intermediate restorative material [IRM]), into the lesion to protect the nerve. Softened candle wax can be used if necessary as a temporary filling material.
3. Administer a nonsteroidal antiinflammatory drug (NSAID) (e.g., ibuprofen 400 to 800 mg PO q6h prn).
4. If the episode of pain lasts longer, indicating a moderate pulpitis, fill the lesion as described earlier and give the patient a non-narcotic analgesic.
5. For severe pulpitis with continuous and severe pain, administer a local anesthetic and then evacuate the patient. You can achieve a nerve block with bupivacaine 2% with 1 : 200,000 epinephrine (Marcaine) that lasts for about 8 hours and does not produce central nervous system depression. Large doses of narcotics may not provide pain relief and might compromise the patient’s ability to participate in evacuation.
6. In extraordinary circumstances, locate the offending tooth, expose the pulp, remove the inflamed tissue with a barbed hook, and cover the lesion with temporary filling material.
Periapical Osteitis
Inflammation of the supporting structures at the root of a tooth.
Temporomandibular Disorders
Myofascial Pain and Dysfunction
Signs and Symptoms
Mandibular Dislocation
Treatment
1. Place the rescuer’s thumbs on the patient’s lower molars and move the mandible down, then posteriorly, and then up. The thumbs should be padded to prevent bites as the jaw pops back into its socket.
2. Alternatively, rest the rescuer’s palms on the mandible and wrap the fingers along the occlusal surface of the mandibular teeth. Rock the hands posteriorly and down, sliding the mandibular condyle back into the TMJ.
3. If muscle spasm is severe, sedation might be necessary.
4. After reduction of the mandible, the patient must avoid wide mouth opening.
Infections
Treatment
1. Apply a topical steroid (fluocinonide 0.05%) mixed with oral benzocaine 20% over each ulcer six to eight times per day. Do not mix the medications until you are ready to apply them, and do not rub the mixture into the lesions.
2. Other options include premixed preparations, such as triamcinolone (Kenalog) in oral benzocaine 20%.
3. Tincture of benzoin or a topical anesthetic (viscous lidocaine 2%) can be applied to the dried surface of the ulcer before meals and at bedtime.
