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Overview of Dental Emergencies

By

Michael N. Wajdowicz

, DDS, USAF

Last full review/revision Nov 2020| Content last modified Nov 2020
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Emergency dental treatment by a physician is sometimes required when a dentist is unavailable to treat the following conditions:

Analgesia and treatment of infection

Oral analgesics effective for most dental problems include acetaminophen 650 to 1000 mg every 6 hours and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen 400 to 800 mg every 6 hours. Ibuprofen and acetaminophen also can be used together for a brief period, alternating the drugs every 3 hours. 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 orally every 6 hours for 3 to 7 days and, if the patient is sensitive or allergic to penicillin, clindamycin 300 mg orally every 6 hours for 3 to 7 days (1).

Prophylactic antibiotics

For prevention of infective endocarditis, 2019 American College of Cardiology/American Heart Association guidelines recommend prophylactic antibiotics in patients undergoing dental procedures only for patients with

  • Prosthetic cardiac valves, including transcatheter-implanted prostheses or with prosthetic material used for valve repair

  • Previous infective endocarditis

  • Specific congenital heart diseases

  • Cardiac transplant recipients with heart valve problems (valvulopathy)

For patients with prosthetic joint implants, American Dental Association 2015 guidelines (2) state that prophylactic antibiotics are not typically recommended but may be considered for patients with

  • Immunocompromised state

  • Uncontrolled diabetes

  • Past joint infection

  • Recent joint placement

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 orally 30 to 60 minutes before the procedure. For those who cannot tolerate penicillins, alternatives include clindamycin 600 mg or cephalexin 2 g.

General treatment references

  • 1. Lockhart PB, Tampi MP, Abt E, et al: Evidence-based clinical practice guideline on antibiotic use for the urgent management of pulpal- and periapical-related dental pain and intraoral swelling: A report from the American Dental Association. J Am Dent Assoc 150(11):906-921.e12, 2019. doi: 10.1016/j.adaj.2019.08.020

  • 2. Sollecito TP, Abt E, Lockhart PB, et al: The use of prophylactic antibiotics prior to dental procedures in patients with prosthetic joints: Evidence-based clinical practice guideline for dental practitioners—A report of the American Dental Association Council on Scientific Affairs. J Am Dent Assoc 146(1):11-16e8, 2015. doi: 10.1016/j.adaj.2014.11.012

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Tongue Discoloration and Other Changes
A 12-year-old girl is brought to the office by her grandmother because she has had pain in her mouth for the past week. The patient appears to be drooling. Physical examination shows a smooth red tongue. Tenderness is noted on palpation of the oral mucosa. Based on these findings, this patient most likely has a deficiency of which of the following? 
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