Dental Emergency Management Techniques in Medical Practice

Total Page:16

File Type:pdf, Size:1020Kb

Dental Emergency Management Techniques in Medical Practice Dental Emergency Management Techniques in Medical Practice during the COVID 19 Pandemic Dr Jacqueline Stuart BDSc, PhD Adjunct Lecturer JCU James Cook University, College of Medicine and Dentistry T: 0419112769 E: [email protected] Presentation Outline 1. Dental Practice limitations imposed during Co-Vid 19 2. Prevalence of Dental Presentations to the Medical Practitioners. 3. The Importance of Improving Interprofessional communications. 4. Dental Anaesthetic Techniques. 5. Antibiotic Use in Dental Emergency Management. 6. Common Emergency Dental Presentations and their Treatment Options. Dental professionals are reported to be at very high risk of COVID-19 infection due to the close face-to-face patient contact required during patient care (Peng et al., 2020). Studies suggest that COVID-19 may be airborne through aerosols formed during dental and medical procedures or indirectly through saliva (Wax et al., 2020., Tsang et al., 2020) ADA Dental Service Restrictions in COVID 19 Five restriction levels for dental practice during the pandemic exist. These are based on published triaging systems in Australia for Dentistry and take into consideration the following key objectives: 1. A proportionate, pre-planned response to the possible escalation of COVID-19 based on the evolving community context. 2. Staged restrictions of dental services to reduce transmission risks for COVID-19 3. Avoidance of likely burden on medical primary care and emergency services should access to urgent dental care cease. Australian Dental Association, Managing COVID-19 Guidelines 25-03-2020 https://www.ada.org.au/Campaign/COVID-19/Managing-COVID-19/Practice-Resources/Dental- restriction-Levels/ADA-dental-restriction-levels-in-COVID-19-Publishe.aspx Management of Patients Confirmed with COVID-19 who Require Urgent Dental Care • Patients confirmed with COVID-19 may either be a hospital in-patient or being managed by ‘hospital in the home’. • Dental treatment will be provided with transmission based, contact and airborne precautions. Airborne precautions include the need for the patient to be treated in a negative pressure room, with dental staff wearing P2/N95 respirators which have been previously fit-tested, and then fit checked at time of use. • All confirmed coronavirus cases will only have dental treatment as an in-patient or within a hospital setting by appropriately trained and credentialled dental personnel. Australian Dental Association, Managing COVID-19 Guidelines 25-03-2020 https://www.ada.org.au/Managing-Covid-19-Guide A patient with a significant dental emergency who is at risk of COVID-19 infection or with a confirmed diagnosis, will most often be able to be managed with analgesics until the patient has reached the end of any mandatory quarantine period, or is no longer at risk of being infectious. Australian Dental Association, Managing COVID-19 Guidelines 25-03-2020 https://www.ada.org.au/Managing-Covid-19-Guide Services that can be performed Restricted services, defer treatment No All dental services No restrictions apply restrictions Level 1 All dental treatments using Defer non-urgent treatment for Restrictions standard precautions for people people who DO meet who do not meet epidemiological epidemiological or clinical or clinical risk factors for COVID-19 symptom criteria for COVID-19 infection transmission risk. Australian Dental Association, Managing COVID-19 Guidelines 25-03-2020 https://www.ada.org.au/Campaign/COVID-19/Managing-COVID-19/Practice- Resources/Dental-restriction-Levels/ADA-dental-restriction-levels-in-COVID-19-Publishe.aspx Services that can be performed Restricted services, defer treatment Level 2 Provision of dental treatments Defer all treatments that are Restrictions that are unlikely to generate likely to generate aerosols aerosols or where aerosols generated have the presence of minimal saliva/blood due to the use of rubber dam. • Examinations and hand scaling • Restorative procedures using high speed handpieces only provided with the use of rubber dam • Non-surgical extractions • Denture procedures • Orthodontic treatment Services that can be performed Restricted services, defer treatment Level 3 Only urgent dental treatments that do Defer all routine recall Restrictions not generate aerosols, or where examinations and non-urgent treatments generating aerosols is dental treatments. limited to management of; • Acute dental pain e.g. endodontic treatment under rubber dam • Non-Surgical Extractions • Dental tooth trauma performed under rubber dam Services that can be performed Restricted services, defer treatment Level 4 Very limited urgent dental Defer all dental treatments for Restrictions treatments which include patients not fitting the risk management of the following : categories identified on the left. • Swelling of the face, neck or mouth • Dental trauma causing change in the position of teeth, soft tissue damage and/or significant pain • Significant bleeding Level 5 No routine dental treatment Any dental treatment without Restrictions provided. All patients with acute expressed permission from the dental concerns to be directed to public health authorities. emergency care centres. People who have difficulty in accessing dental services frequently present to: • Hospital Emergency Departments (Cohen, Bonito, Akin, Manski, & Macek, 2008; Cohen et al., 2011) • Private Medical Practices (Britt et al., 2000) • Pharmacists (Cohen, Bonito, et al., 2009) • Aboriginal Health Centres (Tennant et al.,2014:Walker et al., 2013) When restrictions are placed on accessing routine oral health care, a significant concern exists for overall patient dental/medical care. During this Pandemic, more patients than usual may access Accident and Emergency Hospital Departments. These patients may potentially need hospital admission for the management of acute dental infections that may threaten the airway and require intensive care (Manus et al., 2020). • From 2016-2017 there were 70,200 avoidable hospital admissions for dental conditions (Australian Institute of Health and Welfare, 2019) • It is estimated that there were 750,000 consultations with medical practitioners in 2011 for dental-related issues in Australia (National Advisory Council on Dental Health, 2012). Medical practitioners generally lack substantive training in dentistry (Cohen, Harris, et al., 2009; Skapetis, Gerzina, & Hu, 2011) Very few doctors at the Emergency Hospital Departments have been trained in the management of dental problems (Skapetis, Gerzina, & Hu, 2011) Potentially Preventable Hospitalisations in Regional Queensland 2012-2014 UTI Convulsions ENT Infections DentalDental Conditions Conditions Cellulitis Gangrene Pelvic Inflammatory Disease Perforated or Bleeding Ulcer Pneumonia Number of Indigenous and Non-Indigenous Hospitalisations Harriss et al, (2019). Preventable hospitalisations in regional Queensland; potential for primary health? Australian Health Review, 43, 371-381. Dental Conditions Number of Potentially Preventable Hospitalizations due to Dental Conditions 2016-2017 One in 10 potentially preventable hospitalisations in Australia from 2015-2016 were for conditions of dental origin (Australian Institute of Health and Welfare, 2019) (AIHW,2017) Patients with substantial facial swellings may progress to life-threatening emergencies. For such patients, extractions of the causative pathogenic teeth should be prioritised over restorative rescue, and input from dedicated oral surgery and maxillofacial services and close follow-up is indicated (Manus et al., 2020). Improving interprofessional communications will ensure better patient outcomes • OPG Interpretation • Basic Dental Anatomy • Australian Tooth Numbering System Orthopantomogram.......OPG The image provides an overview of the state of the dentition as well as information regarding the mandible, maxilla, sinuses and the temporomandibular joints. Dental Pathology on OPG Dental Abscess Odontogenic Ameloblastoma Dentigenous Cyst OPG of a 7 year old with a mixed dentition Anatomy of the Normal Healthy Tooth Enamel Crown Dentine Pulp Periodontal Root ligament Alveolar bone Tooth apices (Douglass & Douglass, 2003) Australian tooth numbering system: Permanent Dentition 13 12 25 22 23 11 21 24 46 37 45 36 44 35 43 42 33 34 41 31 32 Australian tooth numbering system: Deciduous Dentition 54 53 62 63 52 51 61 85 84 74 83 73 82 81 71 72 Eruption Times for Deciduous and Permanent Teeth 16 mo 29 mo 8 mo 7-8 yr 17-21 yr Dental Anaesthesia Although the efficacy of using a mouth rinse before commencing dental procedural treatments cannot be guaranteed to have a significant effect on viral load in a patient with COVID-19, it is recommended by the ADA that all patients should be asked to undertake a 20-30 second pre-procedural mouthrinse with either: 0.2% povidone iodine, 1% hydrogen peroxide or 0.2% chlorhexidine rinse (alcohol free). Australian Dental Association, Managing COVID-19 Guidelines 25-03-2020 https://www.ada.org.au/Managing-Covid-19-Guide Provide Dental Anaesthetic pain relief and refer. The Trigeminal Nerve Different Dental Anaesthesia Techniques Submucosal injection of local Infiltration anaesthetic directly into an area of terminal nerve endings. This typically provides pulpal anaesthesia for 1-2 teeth. Injection of the local anaesthetic Peripheral Nerve solution into the vicinity of a peripheral nerve to anaesthetize that nerve’s Block entire area of innervation. Maxillary Infiltration Injection This involves the extravascular placement of the local anaesthetic in the region to
Recommended publications
  • Initial Observation of Factors Interfering with the Treatment of Alveolar Osteitis Using Hyaluronic Acid with Octenidine—A Series of Case Reports
    biomolecules Case Report Initial Observation of Factors Interfering with the Treatment of Alveolar Osteitis Using Hyaluronic Acid with Octenidine—A Series of Case Reports Martin Kapitán , Jan Schmidt * , Radovan Mottl and Nela Pilbauerová Department of Dentistry, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Sokolská 581, 50005 Hradec Králové, Czech Republic; [email protected] (M.K.); [email protected] (R.M.); [email protected] (N.P.) * Correspondence: [email protected] Abstract: Alveolar osteitis (AO) is a common complication following the extraction of the teeth, particularly the lower third molars. It starts within a few days after the extraction and manifests mainly as pain in the extraction site. Several strategies of treatment are available in order to relieve pain and heal the extraction wound. Recently, a novel medical device combining hyaluronic acid (HA) and octenidine (OCT) was introduced for the treatment of AO. This series of case reports aims to summarize the initial clinical experiences with this new device and to highlight factors possibly interfering with this treatment. The medical documentation of five patients with similar initial situations treated for AO with HA + OCT device was analyzed in detail. Smoking and previous treatment with Alveogyl (Septodont, Saint-Maur-des-Fossés, France) were identified as factors interfering with the AO treatment with the HA + OCT device. In three patients without these Citation: Kapitán, M.; Schmidt, J.; risk factors, the treatment led to recovery within two or three days. The patient pretreated with Mottl, R.; Pilbauerová, N. Initial Alveogyl and the smoker required six and seven applications of the HA + OCT device, respectively.
    [Show full text]
  • Parul Bansal1,*, Vineeta Nikhil2, Sana Ali3, Preeti Mishra4, Rajendra Bharatiya5
    Parul Bansal1,*, Vineeta Nikhil2, Sana Ali3, Preeti Mishra4, Rajendra Bharatiya5 1Reader, 2HOD & Professor, 3-5Senior Lecturer, Dept. of Conservative & Endodontics, 1-4Subharti Dental College, Meerut, Uttar Pradesh, 5AMC Dental College & Hospital, Ahmedabad, Gujarat, India *Corresponding Author: Email: [email protected] Human beings are not just limited to moon today but are trying their level best to reach Mars and even beyond. Microgravity conditions can have various physiological implications on the astronaut’s general as well as dental health. Aeronautical dentistry is a newly recognized dental specialty concerning the application of dentistry to aeronautical environment. This article highlights the physiological changes in human body exposed to microgravity and radiation as well as prevention, diagnosis and management of dental emergencies which can arise during space mission. Keywords: Aeronautical, Barodontalgia, Dentistry, Microgravity. Bells. Another source of radiation is solar energetic Human physiological adaptation to the conditions particles known as solar flares. Radiation levels depend of space is a challenge faced in the development of on perimeters like altitude, geographical latitude and human space flight.1 A round trip to Mars with current the activity of the sun. The most important variable that technology is estimated to involve at least 18 months in determines the average dose rate in flight is altitude. transit alone, thus there will be a greater time laps since the crew members last terrestrial dental examination, Radiation level in space which routinely occurs every year. Moreover exposure The average total dose of radiation of a person on to microgravity and radiation environment during short Earth is less than .005 sievert (sv) per year.
    [Show full text]
  • Treatment of Dental Pain in the HIV-Positive Patient
    Differential Diagnosis and Treatment of Dental Emergencies in the HIV-positive Patient JanetJanet E.E. Leigh,Leigh, BDS,BDS, DMDDMD Introduction • Dental disease is evident in all patient populations regardless of medical condition • Dental disease most commonly occurs because of dental neglect, however,however HIV has certain unique oral health issues • Dental care consistently ranks in the top five unmet needs in Statewide Statement of HIV/AIDS Needs Surveys Goal • Enable primary health care provider to identify emergency versus routine dental conditions • Identify when treatment can and should be initiated in the medical office • Recognize the appropriate time requirements for dental referrals Course overview • Differential diagnosis of oral/dental pain • Treatment options in the medical office • Appropriate use of analgesics • Appropriate use of antibiotics • Dental emergencies requiring rapid referral to an emergency room • Dental emergencies requiring referral to a dentist, and the appropriate time frame for that referral Diagnosis of dental emergencies in the medical office • What level of emergency? What is a true dental emergency? •• TheThe presencepresence ofof painpain doesdoes notnot necessarilynecessarily constituteconstitute aa dentaldental emergencyemergency An acute emergency requires the presence of: • Swelling • Fever • Pus • Bleeding What is a true dental emergency? •• TheThe presencepresence ofof painpain doesdoes notnot necessarilynecessarily constituteconstitute aa dentaldental emergencyemergency An acute emergency
    [Show full text]
  • Dental Emergencies
    Dental Emergencies ED visits for dental care are on the rise. Some dental conditions can progress to life-threatening complications; stabilizing patients in such cases is incumbent on the emergency physician, as is management of pain and, to some extent, of the dental condition or injury itself. This article reviews basic dental anatomy as well as nontraumatic and traumatic causes of dental pain. Sandra A. Deane, MD, and Reina Parker, MD he ED is increasingly utilized by pa- patients utilizing the ED for dental care were of a tients for dental care. In 2002, ap- lower income bracket.2 In California during the pe- proximately 2.7% of ED visits were riod from 2005 to 2007, more than 80,000 ED visits attributed to dental problems1; since per year were made for preventable dental prob- Tthen, the circumstances leading to this rate of usage lems, with a seven-times higher incidence of visits have persisted or worsened. Many patients lack den- for those without private insurance.3 To complicate tal insurance, and those who have it often have lim- matters, many physicians do not feel they have ad- ited benefits. Furthermore, Medicaid has decreased equate training with regard to dental care.4 In ad- its dental coverage. According to a recent survey of dition, many patients are not aware that physicians persons with dental problems, 7.1% visited the ED, typically have very limited training in the care of 14.3% visited primary care physicians, and 90.2% dental problems. This article reviews common dental visited a dental professional.2 The majority of those problems seen in the ED.
    [Show full text]
  • Dental Summary
    Dental Summary Sept 2014 Dental anaesthesia Maxillary - tooth and adjacent buccal mucosa Inferior alveolar nerve block - mandibular premolar/molar teeth to midline, lower lip/chin/tongue - mouth open wide, enter at opposite side of mouth, needle at apex of buccal fat pad in pterygotemporal depression, insert 20-25mm until contact ramus of mandible, aspirate, inject 2ml, wait 10mins for effect Alveolar Osteitis aka dry socket Incr risk: smokers, female, prev episodes, poor oral hygiene 2-3/7 post extraction, severe pain, foul odour, trismus, afebrile, white necrotic bone in socket Management: irrigate socket, regional anaesthesia, remove necrotic debris, zinc oxide/eugenol paste, analgesia, dental review Periapical Abscess 1. Abs: uncomplicated: Pen or Clindamycin; complicated: Pen/Metronidazole 2. Analgesia 3. I+D if abscess 4. Chlorhexidine 0.1% rinses q2-3h if I + D 5. Surgical referral, if complicated infxn (Ludwig’s, Lemierre’s Syndrome) 6. Dentist f/u 1-2/7, Complicated – Oral Surg ASAP Dental Trauma Avulsed tooth Dental emergency - call dentist “time is tooth”: if tooth reimplanted within 30mins has 90% chance survival Handle by crown only - rise w/ saline - Replace and ask patient to bite on gauze - Splint If unable place in transport medium: Saline, Milk Antibiotics Fractures Consider XR, Consider ADT Ellis Class I - Through enamel of crown Ellis Class II - Through enamel and dentin (yellow/pink appearance) Painful and temperature sensitive Tx: Cover tooth with CaOH; Soft food diet Ellis Class III - Through enamel, dentin and pulp (pink appearance, blood often visible) Pulp necrosis risk =10-30%. Severe pain, temperature sensitive Tx: Dental emergency - contact on call Dentist www.shakEM.co.nz 1 .
    [Show full text]
  • Changes in the Spectrum of Dental Emergencies Under the in Uence Of
    Changes in the Spectrum of Dental Emergencies Under the Inuence of SARS-COV-2 Kan Wu Sichuan University West China College of Stomatology Chunjie Li Sichuan University West China College of Stomatology Zheng Yang Sichuan University West China College of Stomatology Shangchun Yang Sichuan University West China College of Stomatology Wenbin Yang Sichuan University West China College of Stomatology https://orcid.org/0000-0001-5348-7906 Chengge Hua ( [email protected] ) Research article Keywords: SARS-COV-2, Dental emergency, Epidemiological analysis, Dental disease spectrum, Treatment program, Drug use Posted Date: May 27th, 2020 DOI: https://doi.org/10.21203/rs.3.rs-28103/v1 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Version of Record: A version of this preprint was published at BMC Oral Health on April 3rd, 2021. See the published version at https://doi.org/10.1186/s12903-021-01499-y. Page 1/12 Abstract BackgroundTo master the distribution and changing characteristics of dental diseases is of great signicance for the dental emergency center in order to strengthen the treatment abilities of medical staff and the effective use of emergency resources in the face of public health emergencies of highly infectious respiratory diseases. MethodsThe medical records of 4260 cases of dental emergency patients from December 2019 to March 2020 were retrospectively analyzed, with patients being divided into the pre- Corona Virus Disease 2019 (SARS-COV-2) group and the during SARS-COV-2 group according to the date of their admittance to the dental emergency department. The patient demographics, occurrence of dental emergencies and treatment approaches were compared before and during the pandemic.
    [Show full text]
  • What Is a Dental Emergency?
    WHAT IS A DENTAL EMERGENCY? NOT URGENT (MAY NEED TO WAIT): ◆ Loose or lost crowns, bridges or veneers. ◆ Broken, rubbing or loose dentures. ◆ Bleeding gums. ◆ Broken, loose or lost fillings. ◆ Chipped teeth with no pain. URGENT DENTAL ◆ Loose orthodontic wires. APPOINTMENT: ◆ Facial swelling extending to eye or neck. ◆ Bleeding following an extraction that does not stop after 20 mins pressure with a gauze/clean hankie. A small amount of blood is normal, STRAIGHT TO A&E: just like if you had grazed your knee. ◆ Facial swelling affecting vision or breathing, ◆ Bleeding due to trauma. preventing mouth opening more than ◆ Tooth broken and causing pain, or tooth fallen out. 2 fingers width. ◆ Significant toothache preventing sleep, eating, ◆ Trauma causing loss of consciousness, associated with significant swelling, or fever that double vision or vomiting. cannot be managed with painkillers. ACCESSING CARE Following recent guidance from NHS England and the Department of Health, dental practices have been advised to stop aerosol sprays and prioritise urgent treatment. As well as reducing risk to staff and patients, this will also prevent unnecessary travel in an attempt to reduce virus transmission. This information aims to advise people in pain who still need to access care and also support people in managing minor symptoms at home. IF YOU NEED TO ACCESS EMERGENCY CARE: ◆ Have you or anyone in your house been self isolating? ◆ Do you have any symptoms? ◆ High temperature or continuous cough? If YES to any of the above, CALL 111. They will direct you to an emergency facility with appropriate protective equipment which will allow staff to treat you safely.
    [Show full text]
  • Pain Relief Knowledge, History, and Expectations Among Emergency Dental Patients
    Graduate Theses, Dissertations, and Problem Reports 2019 Pain Relief Knowledge, History, and Expectations among Emergency Dental Patients Daniel C. Brawley West Virginia University, [email protected] Follow this and additional works at: https://researchrepository.wvu.edu/etd Part of the Endodontics and Endodontology Commons Recommended Citation Brawley, Daniel C., "Pain Relief Knowledge, History, and Expectations among Emergency Dental Patients" (2019). Graduate Theses, Dissertations, and Problem Reports. 7440. https://researchrepository.wvu.edu/etd/7440 This Thesis is protected by copyright and/or related rights. It has been brought to you by the The Research Repository @ WVU with permission from the rights-holder(s). You are free to use this Thesis in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you must obtain permission from the rights-holder(s) directly, unless additional rights are indicated by a Creative Commons license in the record and/ or on the work itself. This Thesis has been accepted for inclusion in WVU Graduate Theses, Dissertations, and Problem Reports collection by an authorized administrator of The Research Repository @ WVU. For more information, please contact [email protected]. Pain Relief Knowledge, History, and Expectations among Emergency Dental Patients D. Cade Brawley, D.D.S. Thesis submitted to the School of Dentistry at West Virginia University in partial fulfillment of the requirements for the degree of Master of Science in Endodontics Daniel W. McNeil, Ph.D., Chair Mark A. Byron, D.D.S., M.S. Bryan D. Weaver D.D.S., MD Department of Endodontics Morgantown, West Virginia 2019 Keywords: acute dental pain, expectations, medication knowledge, dental emergency.
    [Show full text]
  • Managing a Dental Emergency at Home
    Managing a dental emergency at home ADVICE UNTIL YOU CAN SEE A DENTIST DURING THE CORONAVIRUS PANDEMIC (01/04/20) 1 Cavendish Way, Bearsted, Maidstone Kent ME15 8PW DR KARTIK PATEL BDS 01622 736968 www.bearsteddental.com How does coronavirus affect dentistry? Dental appointments involve close contact between the dentist and patient and so government guidance has instructed dentists to STOP ALL FACE TO FACE contact. This is to prevent them from catching the virus from an infected patient and passing it on to other pateints. Bearsted Dental Studio 01622 736968 Why routine appointments are not available COVID-19 has a seven-day period before symptoms show. If an unsuspecting patient had treatment, the spray from doing that procedure would likely infect the dentist and the nurse. The personal protective equipment dentists wear is currently required by hospitals treating coronavirus patients. Without this equipment dental staff are not safe to treat patients as normal. Bearsted Dental Studio 01622 736968 What if I have a dental emergency? If you have a dental emergency, you should call us as usual on 01622 736968 where we will be able to offer telephone advice and triage your problem with painkillers or antibiotics as appropriate. If you have Covid-19 symptoms or an URGENT dental emergency, call NHS 111 who will refer those needing active treatment to urgent dental treatment centres. AVOID going to hospital A&E. Bearsted Dental Studio 01622 736968 What is an URGENT emergency presently? Facial swelling spreading to eye/neck resulting in impaired vision or breathing Difficulty swallowing/restricted opening Tooth trauma resulting in pain/unconsciousness/ lost tooth Trauma or tooth extraction resulting in uncontrolled bleeding not stopped with firm pressure Severe toothache disturbing sleep with swelling not controlled by painkillers.
    [Show full text]
  • What Counts As a Dental Emergency?
    What Counts as a Dental Emergency? Non-Urgent Urgent Straight to A&E Treat at home, or contact us Call us for advice first • Facial swelling aecting vision or for further advice • Facial swelling extending to eye or neck. breathing preventing mouth opening • Loose or lost crowns, bridges or veneers. • Bleeding following an extraction that does more than 2 fingers width. • Broken, rubbing or loose dentures not stop aer 20 mins solid pressure with • Trauma causing loss of consciousness, • Bleeding gums. gauze/clean hankie. A small amount of double vision or vomiting. • Broken, lose or lost fillings oozing is normal, just like if you had a • Chipped teeth with no pain grazed knee. • Loose orthodontic wires • Bleeding due to trauma. • Trauma resulting in a tooth being knocked out of the socket, or a large fracture resulting from trauma and causing severe pain. • Significant toothache preventing sleep or eating, associated with significant swelling, or fever that cannot be managed with painkillers. Mouth Pain Mouth Ulcers For pain relief we advise paracetamol in the first instance unless this is not a Although painful, most mouth ulcers will heal within 7-10 days. A dentist or suitable option for you. Anti-inflammatories like Ibuprofen, unless this is not doctor should assess non-healing ulcers/oral lesions present for more than 3 a suitable option for you, can help reduce sensitivity from teeth. Combining weeks. Please call the practice for guidance if required; otherwise follow the paracetamol and ibuprofen has also been shown to be eective. home measures described below: There is no strong evidence that drugs like ibuprofen can make COVID-19 • Warm salty mouth washes (coronavirus) worse.
    [Show full text]
  • Efficacy of Endodontic Debridement on Postoperative Pain in Symptomatic Teeth with Pulpal Necrosis
    EFFICACY OF ENDODONTIC DEBRIDEMENT ON POSTOPERATIVE PAIN IN SYMPTOMATIC TEETH WITH PULPAL NECROSIS A Thesis Presented in Partial Fulfillment of the Requirements for the Degree of Master of Science in the Graduate School of The Ohio State University By Raquel D. Sebastian, D.D.S. Graduate Program in Dentistry The Ohio State University 2014 Master’s Examination Committee: Melissa Drum, D.D.S., M.S., Advisor Al Reader, D.D.S., M.S. John Nusstein, D.D.S., M.S. Sara Fowler D.M.D., M.S. F. Michael Beck, D.D.S., M.A Copyright by Raquel D. Sebastian, D.D.S. 2014 ABSTRACT Patients without a general dentist or access to dental care often present to a hospital emergency department with painful teeth. These patients are typically prescribed pain medication and an antibiotic until they can be evaluated and treated by a dentist. There are currently no studies to demonstrate if initial root canal debridement is better than just placing the patient on medications for pain relief during this symptomatic period. The purpose of this study was to compare initial endodontic treatment versus no initial endodontic treatment for postoperative pain in patients with symptomatic teeth with a pulpal diagnosis of necrosis and associated periapical area. Ninety-five patients presenting for emergency endodontic treatment experiencing moderate to severe pain were analyzed in the study. The patients were randomly divided into two groups: an initial debridement group who received anesthetic and emergency endodontic treatment, and a second non-debridement group who received anesthetic, but no initial debridement. At the end of the appointment, patients were given ibuprofen (600mg q6h) and acetaminophen (500mg q6h) and a prescription for an antibiotic.
    [Show full text]
  • Drugs for Pain Management in Dentistry
    Drugs for pain management in dentistry K Hargreaves,* PV Abbott† Abstract Pain that leads a patient to seek dental advice or Pain is one of the most common reasons patients treatment may be a result of many different diseases or seek dental treatment. It may be due to many conditions of the dental, oral, facial or nearby different diseases/conditions or it may occur after structures. Dental-related pain may also occur after treatment. Dentists must be able to diagnose the treatment by a dentist. Hence, dentists must be able to source of pain and have strategies for its diagnose the source and nature of the pain and they management. The ‘3-D’s’ principle – diagnosis, must be familiar with strategies for the management of dental treatment and drugs – should be used to manage pain. The first, and most important, step is dental, oral, facial and post-operative pain. to diagnose the condition causing the pain and The ‘3-D’s’ principle should always be used to identify what caused that condition. Appropriate manage pain in dental practice.2 The ‘3-D’s’ should be dental treatment should then be undertaken to followed in the correct order: (1) diagnosis; (2) dental remove the cause of the condition as this usually treatment; and (3) drugs. provides rapid resolution of the symptoms. Drugs should only be used as an adjunct to the dental The first, and most important, step for managing treatment. Most painful problems that require pain is to diagnose the disease or condition causing the analgesics will be due to inflammation.
    [Show full text]