Emergency NHS dental treatment and advice for patients who do not have a regular dentist for urgent dental symptoms. Unscheduled dental care can be provided also as out-of-hours evening sessions and bank holiday sessions for the patient who cannot access the general dental practice (non-registered patients).
The service provides the following service:
- Urgent dental care for the relief of pain
- Treatment of facial swelling and trauma
- Treatment for haemorrhaging
The Emergency service and Out of Hours service aims to:
- Increase access to NHS services for emergency treatment
- Prevent A&E attendance
- See patients on the same day as appointments are made
- Relieve dental pain
- Refer patients on for specialist treatment if required
- Meet patient demand
- Empower people to make informed choices about their well-being
Patients with special dental needs may require additional measures in order to provide an efficient urgent care, including inhalation sedation, intravenous sedation or general anaesthesia. Occasionally, some form of physical restrain may be also necessary.
Dental emergencies do not always involve pain, although this is a common signal that something needs to be looked at. Pain can originate from the tooth, surrounding tissues or can have the sensation of originating in the teeth but be caused by an independent source.
1. Odontogenic pain (toothache) associated with the teeth, originating in the dental pulp and/or the peri-radicular tissues – stimulated by hot, cold, sweet, touch, biting, slight, mild, moderate, severe pain, sharp, dull, throbbing pain of short/long duration, “sharp” “shooting” pain, well-localised, spontaneous or no spontaneous, day pain, nocturnal pain, constant, intermittent pain
- dentin hypersensitivity
- reversible or irreversible pulpitis
- pulp necrosis
- apical periodontitis, periapical abscess, apical abscess
- acute periodontal disease, periodontal abscess
Treatment depends on diagnosis – sedative dressing to ease the pain, pulp extirpation, root canal treatment, antibiotic provision, analgesic (NSAID) prescription, abscess drainage, treatment of periodontal disease, application of highly-concentrated fluoride varnish (dentin hypersensitivity)
2. Non-odontogenic pain (atypical facial pain) – not associated with the teeth but involves other orofacial tissues. The following conditions can mimic pain from a toothache and may be the reason a patient presents to a dental clinic with pain:
- Temporomandibular joint dysfunction syndrome (TMD)
- Neuromuscular origin; examples include muscle tension headache, neck pain
- Neurovascular pain
- Neuropathic pain caused by trauma, inflammation or tumors in the oro-facial region
- Trigeminal neuralgia
Treatment depends on proper diagnosis, in cooperation with other specialists: TMJ therapy, myotherapy, migraine relief, surgery (oncology), carbamazepine prescription (trigeminal neuralgia), psychological advice.
3. Acute dental trauma: enamel infraction, crown fracture (non-complicated, complicated with pulp involvement), concussion, subluxation, extrusion, intrusion, avulsion.
Treatment depends on diagnosis: ‘wait and see’ approach, endodontic treatment, direct restoration, reimplantation, reposition, splinting, prophylactic antibiotic therapy
4. Lost or broken filling, crack, defected filling, leaking restoration, loose restoration, crown fracture, mobile restoration, detached restoration, decemented bridg.
Treatment depends on diagnosis: filling replacement, margins sealing, new crown/bridge provision, recementation, temporary filling
5. Broken denture
Treatment: denture repair
6. Orofacial swelling, celullitis due to infection
Treatment: broad-spectrum antibiotic prescription, often polipharmacy (combination of two antibacterial agents), oral surgery or Maxillo-Facial surgery referral, extraction of symptomatic tooth, drainage, monitoring
Treatment: antiseptic and antibacterial rinse with chlorhexidine (precautiions re: possible allergic reaction), application of antiinflammatory medication (Alvogyl) under local or topical anaesthesia, surgical incision of covering soft tissues (rarely), antibiotic provision Metrinidazole 200mg, tds/5 days, review.
8. Post-operative hemorrhage (following extraction)
Treatment requires mainly local measures to arrest bleeding: alveolar socket revision under LA, hemostatic agents use (Haemocollagene/Surgicell), sutures placement, press-pack
9. Post-operative pain, infection, post-operative swelling
Treatment: wound/socket revision, antiseptic and antibacterial rinse with chlorhexidine, application of anti-inflammatory medication under topical anaesthesia, antibiotic provision
10. Oral mucosa lesion (laceration, ulceration, stomatitis)
Treatment depends on provisional diagnosis: topical antiseptic and antibacterial swabs with chlorhexidine, application of antiinflammatory medication (adhesive film), denture adjustment, denture reline, topical gel, spray prescription (chlorhexidine, benzydamine, antifungal medication) antibiotic provision, oral medicine referral, urgent referral for head&neck cancer consultation.
Severe learning disability, non -verbal patient, indicates some acute dental problems by banging his face on one side. Full dental assessment not possible due to lack of cooperation. No obvious external swelling o facial asymmetry.
Potential diagnostic measures:
- temperature measurement,
- tenderness to cheeks/lips/chin palpation,
- bimolar radiographs,
- thermal scan of facial area (thermal camera),
- CRP blood test?