Dental Pain

EM Clerkship - A podcast by Zack Olson, MD and Michael Estephan, MD

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Minor complaint. Huge SLOE points! Step 1: Identify Which Tooth is Causing Pain * Bonus points if you number teeth correctly!* Number 1-32* Tooth #1 is top right* Tooth #32 is bottom right* Refer to dental chart for reference Step 2: Correct Terminology When Making Diagnosis * Pulpitis* Pain in the tooth itself* Reversible* Triggered by hot/cold etc (then goes away)* Irreversible* Does not resolve* Gingivitis* Pain of the gingiva around the tooth* Periapical abscess* Pain with percussion of tooth Step 3: Give Pain Medicine * NSAIDS have been shown to work best* Naproxen* Ibuprofen* Opiates for breakthrough pain* Hydrocodone-acetaminophen (Norco)* Oxycodone-acetaminophen (Percocet) Step 4: Consider Antibiotics * Pulpitis does not require antibiotics* Gingivitis/Periapical abscess frequently improve on antibiotics* Penicillin VK Step 5: Inferior Alveolar Nerve Block * Watch HERE Additional Reading * Inferior Alveolar Nerve Block (YouTube)* Common Dental Emergencies (AFP)