OUCH, that hurts! Dealing with a painful dental emergency

• August 8, 2011
• Dr. Catherine-Anne Walsh

If you were “good”, the last time you saw your dentist, you would have made your next dental appointment before leaving the practice and you would have made sure you showed up for all your treatment and your preventative care. However, you are an extreme optimist and you strongly believe that you ARE actually a SUPERHUMAN, with a magical ability to make teeth cavities and gum disease disappear by just THINKING about the dentist. 

Well, SUPERDENTOMAN, as you are reading this right now, with your one hand on your cheek squeezing the jaw so it doesn’t throb so much and your other on the keyboard about to type in “non-judgmental dentist Sydney CBD” in your browser, admit it first: there is no such thing as a superhuman and even you, the super healthy healer with magical abilities, even you can get a toothache! You have been very bad! 

So, just before you hit “ENTER” and look for that non-judgmental dentist, here are some points to consider as you are clearing up your schedule to make room for that emergency dental appointment today.

IS THIS A “REAL” DENTAL EMERGENCY OR WILL IT JUST GO AWAY?

Have you fractured a tooth in an accident and/or suffered a strong blow to your face? 

This warrants an immediate visit to the dentist. If your tooth has fallen out completely, either soak it in milk or if there is no milk around, put it into your mouth (like a lolly, but try not to agitate it or chew it and try not to swallow it) until you get to the dentist. A fractured portion of the tooth can also be of value if large enough, so take it to the dentist. Even if you did not fracture or lose a tooth in a blow to your face, you may have damaged your teeth internally. A dentist will take some images of your teeth and test them for vitality, then recommend that you have them reviewed regularly and repeat these tests, to compare to this baseline. Baseline findings are extremely valuable in these situations, so don’t hesitate, to stop reading this and run straight to the dentist! 

How strong and constant is the pain?  

If you are experiencing constant, strong, unprovoked throbbing, which may or may not be worse when exposed to cold, hot or pressure and may or may not get better with painkillers (comes back as soon as painkillers wear off), you have a dental emergency! It is likely that a tooth (or teeth) are infected and the nerve tissues in these teeth are dying off. The only way to feel better is to remove the source of infection, ie. the bacteria within the nerve tissue in the middle of the tooth. This is also known as a root canal treatment. Whatever you may have heard of root canal treatments, are the only efficient way to eliminate infections quickly and ensure relief of pain!

An alternative to root canal treatment is often an extraction. Once a tooth is removed, you may need to replace it to ensure the ongoing undisturbed function of your mouth. This can often be more complex, take longer to complete and be more expensive than root canal therapy. Avoid antibiotic therapy if you can help it. Oral antibiotics have very limited success in treating early dental infections and they are only a temporary solution as they do not eliminate the source of infection, they only limit the infection from spreading further. 

Overprescription of antibiotics creates worldwide health risks and promotes the mutation of stronger, deadly bacteria which cannot be treated with any available antibiotics. Advise the dentist you are about to contact if you suspect this treatment may be needed, as they may need to schedule extra time for this procedure. 

Do you have any swelling or altered sensation in the area where you feel the most pain?

Do you feel that your breathing or swallowing is affected by pain or swelling? If so, you may be suffering from a complication of a dental infection, which may require intravenous antibiotics and a hospital referral. Swelling in the mouth is treated very seriously by most dental practices and priority is given to people who report it. 
Please advise your dental practice that you are experiencing swelling, as they are likely to see you very quickly to assess the problem. 

Can you localise where the pain is coming from? 
Does it affect one side of your mouth or both? Does it affect your upper or lower teeth? Does it affect one tooth only? Can you tell me which one? 
Usually, pain which is poorly localised may also be “referred” from other sites in the mouth or from the facial structures (e.g sinuses, jaw joints and muscles). If the pain is “non-odontogenic” (non-dental) in origin, recovery is usually slower, but treatment rarely requires immediate intervention. Rest, wearing your nightguard (aka occlusal splint) at night to protect you from clenching and grinding and non-steroidal anti-inflammatory agents, such as Ibuprofen, or muscle relaxants (as prescribed by your medical practitioner), maybe all the treatment you need.  

Are you able to sleep without painkillers?

Any pain which interferes with your sleep or daily activity is significant enough to be reviewed by the dentist.

WHAT DOES THE DENTIST NEED TO KNOW?

 Before they see you, the dental team need to have as much information about:

• Your medical history – medical conditions including any medication you are on
• Your current painful condition – when did it start, has it been getting worse, how debilitating it is, is it localised, when did you last take painkillers and which ones
• Your arrangements for the rest of the day– are you able to undergo immediate treatment or only basic pain relief treatment, depending on the time available
• Do you have a regular dentist – if you are seeing a dental team for the first time as an emergency patient, they need to know who is your regular dentist, so they can provide them with detailed notes regarding your treatment. In this case, you will usually receive basic pain relief treatment and be referred back to your regular dentist for ongoing care.

Communicating all these facts with the practice’s spokesperson can actually speed up the process once you are in the practice so you spend more time having pain-relieving treatment rather than filling out paperwork.

WHAT SHOULD YOU ASK BEFORE YOU SEE THE DENTIST?

If you are not attending your regular dentist today, here are some useful questions you may wish to ask the new practice spokesperson:

• Do the dentists at your practice have any expertise in root canal treatment?  As it is likely that you will be needing this treatment, it is good to know this as some dentists do not feel comfortable performing root canal treatment. They can still complete the basic pain relief treatment, but it is always better to see someone who is well-placed to treat you from start to finish, rather than having to refer you after the treatment had been started.
• Do your dentists often refer root canal treatment to specialists? While you want the dentist to be able to complete the treatment, you want to know whether they also know when the degree of difficulty exceeds their expertise and are willing to refer more complex cases to specialists. You don’t want to see someone who refers all their root canal treatment, but you also don’t want to see someone who never refers. A good answer from the spokesperson would be: “it all depends on the degree of difficulty”.
• Do your dentists feel comfortable doing tooth extractions or are they more likely to refer these to a specialist?  
• Do you have all the necessary Xray imaging equipment or do I need to have some images done at a radiology lab before I arrive?– some practices like to see a panoramic radiograph (x-ray image) of their clients as well as intraoral images (xray images taken on a film inside the mouth)
• How much time will you be allowing for me to have this procedure?– you need to know whether a practice is “squeeze you in” or allow ample time. It is always reassuring to know ample time is being put aside for pain relief and a meaningful discussion of your options. You don’t want to be rushed out when you are distressed.
• Am I likely to have any discomfort after the procedure, do I need to clear up my schedule for the rest of the day?
• What is the maximum fee for this treatment? Ask now for the worst case scenario cost estimate for today’s visit so you are not surprised and embarrassed if your expectations of cost do not match. There is nothing worse than thanking the staff for a pain-free procedure or long awaited pain relief, only to be surprised with the fee and not be able to remit them for their work, which you greatly appreciated. 

That just about covers it, so good luck for your pain relieving treatment today and remember: SCHEDULE ALL YOUR TREATMENT AND YOUR PREVENTATIVE CARE BEFORE YOU LEAVE the practice AND PUT IT IN YOUR PHONE CALENDAR. Promise yourself you will never put yourself through this pain again!