Overview of Dental Emergencies
Emergency dental treatment by a physician is sometimes required when a dentist is unavailable to treat the following conditions:
Postextraction problems (eg, bleeding, swelling and pain, alveolitis and osteomyelitis, and osteonecrosis of the jaw [ONJ])
Oral analgesics effective for most dental problems include acetaminophen 650 to 1000 mg q 6 h and NSAIDs such as ibuprofen 400 to 800 mg q 6 h. Ibuprofen and acetaminophen also can be used together for a brief period, alternating the drugs every 3 h. For severe pain, these drugs may be combined with opioids such as codeine 60 mg; hydrocodone 5 mg, 7.5 mg, or 10 mg; or oxycodone 5 mg.
Antibiotics for dental infections include penicillin VK 500 mg po q 6 h and clindamycin 300 mg po q 6 h.
Current American Heart Association guidelines (2007) recommend prophylactic antibiotics for prevention of infective endocarditis in patients undergoing dental procedures only for patients with prosthetic cardiac valves, previous infective endocarditis, specific congenital heart diseases, and for cardiac transplant recipients with heart valve problems (valvulopathy). Dental procedures requiring prophylaxis are those that require manipulation or perforation of gingival or oral mucosa or that involve the root end area of the teeth (ie, those most likely to cause bacteremia). The preferred drug is amoxicillin 2 g po 30 to 60 min before the procedure. For those who cannot tolerate penicillins, alternatives include clindamycin 600 mg or cephalexin 2 g.