Editors

Ky�stiOikarinen

First Aid for Severe Dental Pain

A GP can give first aid independent of the cause of the dental pain. Treatment possibilities include systemic analgesics and antimicrobials, local treatments, local anaesthetics, or combinations of these.
A GP can treat pain and inflammation after dental extraction or operation when consultation with a dentist is not possible. All other cases should be referred to a dentist after treatment of the acute phase.

Pain is provoked by a mechanical (current of air), by thermal (cold) or physical (sweet) irritation.
Caries is the most typical cause of dental pain. Other common causes include tooth chipping and exposure of dentinal tubules in the root surface due to apical recession of the gingiva caused, for example, by heavy tooth brushing or a gingival operation.
One of the first oral symptoms of gastro-oesophageal reflux disease Gastro-Oesophageal Reflux Disease may be shooting dental pain.
After filling the tooth can be painful, with the pain resembling that caused by caries or exposure of dentinal tubules.

Patient counselling. Tooth pastes relieve the symptoms after exposure of dentinal tubules and that can be applied to sensitive root surfaces are available in pharmacies. Potassium Nitrate Toothpaste for Dentine Hypersensitivity
A dentist can varnish exposed dentinal tubules with fluoride or calcium hydroxide paste. The treatment of carious or advanced abrasions in the root are treated with conventional fillings.
The shooting pains that may occur after filling a tooth subside in a few days. During that time the tooth is sensitive, and the patient should avoid irritating foods and drinks (sweet, cold or hot).

Pulpitis is mostly caused by caries that has advanced to the dental pulp but can also be caused by, for example, dental trauma.
Pulpitis causes acute, severe and pulsating dental pain that is provoked by hot and relieved by cold irritation. Initially the pain localizes to one tooth, but may later become more diffuse.

Non-steroidal analgesics are often ineffective. Centrally acting analgesics are usually the drugs of choice. Sometimes a combination of peripherally and centrally acting analgesics is most effective.
Local anaesthesia relieves the pain immediately.
- Infiltrative local anaesthesia is sufficient in all upper teeth and anterior lower jaw.
- 1 ml of anaesthetic solution is injected submucosally on the bone and periosteum.
- Lower jaw molar teeth require block anaesthesia, which is usually given by a dentist.
- The anaesthetics most commonly used by dentists contain either prilocaine, articaine or lidocaine, combined with a vasoconstrictive agent (adrenaline or felypressin).
Pulpectomy and root canal treatment are performed by a dentist. The first aid treatment in the dental chair is opening of the pulpal cavum through the crown. Sometimes grinding of the occlusal contact relieves the symptoms.

Caused by an untreated pulpitis that develops into perapical osteitis. Pus moves into the buccal soft tissues through the periosteum. This causes palpable and tender swelling in the vestibulum.
Severe pain is caused by distraction of the periosteum. The pain may be unbearable.

Incision and drainage of the abscess, usually in the sulcus, can be performed with a sharp knife.
Systemic antibiotics, primarily penicillin (macrolide in case of penicillin allergy)
A widespread dental abscess often needs hospitalization, especially if the patient has fever, and/or if the abscess spreads wider impairing e.g. opening of the mouth or even breathing.

Pericoronitis is caused by bacterial inflammation in the soft tissue around the crown of an unerupted tooth, usually the lower third molar.
The symptoms are swelling, pain, odour, limitation of mouth opening and general symptoms of infection.

Pericoronitis is always treated with antibiotics in the initial phase (primarily penicillin; a macrolide in case of penicillin allergy).
An unerupted third molar tooth should be extracted if it causes pain or recurrent infections.
In some cases, the first aid may consist of extracting the antagonist third molar if it causes problems by mechanically irritating the soft tissues of the opposite jaw.

Bruxism can cause dental pain resembling that caused by pulpitis.
The symptoms can involve one or several teeth simultaneously and are a result from unsually strong masticatory stress.

An occlusal splint made by a dentists is worn at nights on the teeth to prevent unphysiological night-time grinding of the teeth
Occlusal adjustment by selective grinding of the teeth performed by a dentist.

Pain is most common after extraction of lower molar teeth, especially wisdom teeth and results from a disturbance in the clotting of the extraction socket.
This dry alveolitis is characterized by pain that intensifies markedly on the third or fourth postextraction day and by lack of response to peripherally acting analgesics.

A symptomatic extraction socket should be rinsed with ample amounts of saline solution. Tamponation of the socket with different disinfectant and anaesthetic agents is, however, not anymore recommended. The rinsing may be repeated daily until symptoms subside.
- In some cases, removal of the necrotic bone layer and revitalization of the socket is required. For this procedure the patient should be referred to a dentist.
A systemic antimicrobial is needed if the patient has symptoms of infection.
Normal post extraction pain can usually be managed with peripherally acting anti-inflammatory drugs. Centrally acting analgesics can be used when necessary either alone or combined with peripherally acting drugs.