Caries/Toothache

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CLINICAL DESCRIPTION

Acute or chronic inflammation of the pulp. Can be suppurative and could lead to necrotic pulp.

CLINICAL FEATURES

SIGNS AND SYMPTOMS

  • Throbbing continuous or intermittent toothache which is worse at night. Sometimes the pain is aggravated by hot or cold drinks. It is usually due to dental caries or trauma.

INVESTIGATIONS

  • X−ray: Intraoral (PA, bite wing)
  • Pulp testing.

TREATMENT

Depends upon the extent of caries and clinical judgment:

  • If minimal and confined to the enamel, apply topical Fluoride
  • If in enamel and dentine but not involving the pulp, do a Filling
  • If involving the pulp and there is periapical infection and/ or pulp inflammation do Root Canal Therapy
  • If severe, do tooth extraction followed by
  • Analgesics e.g.,
    • Paracetamol 1 gm 8 hourly for 3 day or in severe cases give 
    • Ibuprofen 200 - 400 mg 8 hourly for 3 days or diclofenac 50 – 100 mg 8 hourly for 3 days
  • When associated with abscess give Amoxycillin 250 - 500 mg 8 hourly for 5 days and Metronidazole 200 - 400 mg 8 hourly for 5 days

Note:

Antibiotics are not indicated unless there is infection

Reinforce oral hygiene practices including use of fluoridated toothpaste to all patients