People often come for dental emergency visit because either they have a toothache or a broken tooth. I would like to show how I would go about greeting the patients and performing examination on patient who has a dental emergency.
With patient comfortably sitting in the dental chair, I would review patient’s medical history. From reviewing patient’s past medical problems (such as hypertension, surgery) and medical allergies, this allows me to take necessary precautions for treating the patient. For example, if patients have reaction to penicillin, I would know to prescribe to another type of antibiotics to patient. Or if patient has had knee replacement surgery, I would have to premedicate the patient with antibiotics prior to dental visit. And often patient’s existing medical problem may play a role in patient’s dental problem. For example, diabetes can exacerbate the patient’s periodontal condition and more frequent periodontal cleaning visits may needed.
Next, I would begin to gather necessary background information on patient’s dental problem. I would find out about patient’s chief complaint. Chief complaint is the patient’s most pressing issue at the time. It could be a toothache or broken tooth. For example, the problem could be toothache on upper right tooth. Also, I would map out the scope of the problems. It could be affecting one tooth, or multiple tooth or the gum tissue. Then I would ask a series of question relating to the onset time, duration, severity of the toothache and ask about what type of stimuli that can trigger the toothache.
After knowing scope of the patient’s dental problem, I would be able to have necessary xray image taken on the patient’s specified area of concern. If there is dental problem, it would show up in the dental xray images. If there is dental cavity, the outermost layer of the tooth structure would appear lesser in density on the dental xray image.
By reviewing patient’s symptoms, such as the onset time, duration and severity of the toothache, I can determine whether it is just a simple hypersensitivity reaction or the pulpal inflammation of the tooth that would require further treatment such as the root canal therapy and a crown.
Toothache can be categorized into two broad categories. One is called the reversible pulpitis and the other broad category is irreversible pulpitis. Reversible pulpitis means the tooth is having some transient reaction to the local stimulus and the response does not linger for more than 20 seconds. Irreversible pulpitis means the tooth is having more serious inflammation and the nerve tissue within the tooth is not likely to recover even when the stimulus is withdrawn. So if the tooth is painful to cold stimulus and the response lasts for more than 20 seconds, the tooth can be assumed to have irreversible pulpitis. The tooth is undergoing downhill path. The offense and the damage is so severe that the tooth cannot adequate fend off the attack. More serious pain, inflammation, infection and swelling may occur if the tooth is left untreated.
By determining if the tooth is having reversible or irreversible response, I would then know how to proceed the treatment. With the reversible pulpitis, if the tooth is damaged or decayed, I would remove the decay and repair the defect and this most likely would resolve the problem.
However, with irreversible pulpitis, the tooth may need to have root canal therapy treatment, followed by complete buildup of the tooth, and a crown is put on the tooth for full coverage protection. The crown is necessary after the root canal therapy for two purposes. One is to strengthen the tooth from whatever defect or crack it has. Second, the crown serves as protective barrier from any potential bacterial leakage into the interior of the tooth.
If you happen to have toothache, please feel free to call my office for evaluation and treatment.
Written by Daniel Tee, DDS, MS
Practicing Emergency Dentist Serving Tempe, Chandler, Phoenix, Mesa, and Gilbert Arizona