hola@ovidentalgo.com
Preface
Dental emergencies present a significant challenge in daily clinical practice, requiring a rapid and effective response to alleviate pain, control infections, and prevent major complications.
In many cases, the absence of a standardized protocol for managing these situations can lead to inadequate treatments or unnecessary progression of the pathology.
This guide has been developed as a practical and updated resource for general dentists and specialists facing emergencies in their professional practice.
Based on the best available scientific evidence and recommendations from international organizations, this guide provides a structured approach to the identification, evaluation, and treatment of the most common ambulatory dental emergencies.
We hope this material contributes to informed clinical decision-making, providing tools that facilitate proper patient management and ultimately improve the quality of dental care.
Index
1. Introduction
2. Definition and Classification of Dental Emergencies
3. Initial Patient Evaluation
4. Management of Major Dental Emergencies
- Acute Pulpitis
- Submucosal or Subperiosteal Abscess
- Acute Pericoronitis
- Acute Necrotizing Ulcerative Gingivitis (ANUG)
- Post-Extraction Complications
- Dent alveolar Trauma
5. Use of Antibiotics in Dental Emergencies
6. Pain Management and Recommended Analgesics
7. General Recommendations and Prevention
8. Conclusion
9. Bibliography
1. Introduction
Dental emergencies require immediate attention to relieve pain, prevent infections, and avoid serious complications.
These situations may arise from infections, trauma, or postoperative conditions.
Proper management is essential for the patient's health and the prevention of long-term consequences.
This guide provides a clinical approach based on evidence for evaluating and treating the most common ambulatory dental emergencies.
2. Definition and Classification of Dental Emergencies
Dental emergencies are defined as situations requiring immediate intervention to alleviate pain, prevent infections, and avoid significant complications. They are classified into:
A. Painful Emergencies
- Acute Pulpitis: Severe inflammation of the dental pulp causing persistent and spontaneous pain.
- Submucosal or Subperiosteal Abscess: Pus accumulation in the submucosal tissues or under the periosteum, usually due to dental infections.
- Acute Pericoronitis: Inflammation of the soft tissue surrounding the crown of a partially erupted tooth, commonly the third molars.
- Dry Socket (Alveolar Osteitis): Post-extraction complication characterized by premature loss of the blood clot in the socket, leading to severe pain.
B. Traumatic Emergencies
- Dental Fractures: May affect the enamel, dentin, or involve the dental pulp, requiring different restorative or endodontic treatments.
- Subluxation or Luxation of a Tooth: Abnormal movement or displacement of a tooth due to trauma.
- Tooth Avulsion: Complete loss of a tooth due to trauma, requiring immediate reimplantation.
C. Hemorrhagic Emergencies
- Post-Extraction Bleeding: May result from poor clot management or coagulation disorders.
- Trauma-Induced Bleeding: Caused by lacerations in the oral mucosa, lips, gums, or tongue.
D. Infectious Emergencies
- Acute Necrotizing Ulcerative Gingivitis (ANUG): Severe periodontal infection characterized by necrotic ulcers and intense halitosis.
- Odontogenic Cellulitis: Severe infection affecting soft tissues of the face and neck, with a risk of systemic spread.
3. Initial Patient Evaluation
For accurate diagnosis and management, the following steps should be followed:
- Anamnesis: Collect information on the reason for consultation, pain onset and evolution, medical history, allergies, and current medications.
- Clinical Examination: Visual inspection of the oral cavity, palpation of intraoral and perioral structures, pulp sensitivity tests, and percussion.
- Complementary Tests: Periapical, panoramic, or tomographic radiographs as needed to confirm the diagnosis.
- General Condition Evaluation: Identification of signs of systemic infection, such as fever, progressive swelling, or respiratory difficulty.
4. Management of Major Dental Emergencies
A. Acute Pulpitis
Treatment:
- In reversible cases: Caries removal and application of sedative materials.
- In irreversible cases: Pulp chamber opening and referral for endodontic treatment or extraction as needed.
B. Submucosal or Subperiosteal Abscess
- Treatment:
Surgical drainage of the abscess.
Antibiotic therapy in cases of systemic infection.
Treatment of the causal tooth.
C. Acute Pericoronitis
- Treatment:
Irrigation with saline solution and debridement.
Pain control with analgesics and anti-inflammatories.
Tooth extraction in severe or recurrent cases.
D. Acute Necrotizing Ulcerative Gingivitis (ANUG)
- Treatment:
Professional cleaning and chlorhexidine mouth rinses.
Antibiotic therapy in severe cases.
Oral hygiene education.
E. Post-Extraction Complications
1. Dry Socket (Alveolar Osteitis)
- Irrigation of the socket with saline solution.
- Application of a medicated dressing.
- Analgesics for pain management.
2. Persistent Post-Extraction Bleeding
- Compression with sterile gauze.
- Use of hemostatic agents.
- Suturing if necessary.
F. Dentoalveolar Trauma
1. Dental Fractures
- Immediate restoration in mild cases.
- Endodontic treatment if pulp involvement is present.
2. Tooth Avulsion
- Immediate reimplantation if possible.
- Transport the tooth in saline solution or milk if reimplantation is delayed.
- Splinting for 2-4 weeks and endodontic monitoring.
5. Use of Antibiotics in Dental Emergencies
The use of antibiotics in dentistry should be rational to prevent bacterial resistance.
They are recommended for infections with signs of systemic spread or in immunocompromised patients.
The following options are recommended:
First Choice:
- Amoxicillin + Clavulanic Acid 875 mg/125 mg every 8 hours for 5-7 days.
- For severe infections, the dose may be increased to 1 g every 8 hours.
Alternative for Penicillin-Allergic Patients:
- Clindamycin 300 mg every 8 hours for 5-7 days.
- Azithromycin 500 mg on the first day, followed by 250 mg daily for 4 days.
- Metronidazole 500 mg every 8 hours, especially for anaerobic infections.
For Severe Infections or Systemic Spread Risk:
- Cephalexin 500 mg every 6 hours.
- Ciprofloxacin 500 mg every 12 hours for severe periodontal infections.
- Combinations of Metronidazole with Amoxicillin for advanced infections.
Each clinical case should be evaluated to avoid unnecessary antibiotic prescriptions.
6. Pain Management and Recommended Analgesics
Pain management in dental emergencies depends on pain intensity and characteristics. The following are recommended:
Mild to Moderate Pain:
- Ibuprofen 400-600 mg every 6-8 hours.
- Naproxen 250-500 mg every 8-12 hours.
- Acetaminophen 500-1000 mg every 6-8 hours.
Moderate to Severe Pain:
- Ketorolac 10-20 mg every 6 hours.
- Diclofenac 50 mg every 8 hours.
- Tramadol 50 mg every 6-8 hours, only for intense pain.
Severe or Refractory Pain:
- Combination of Tramadol + Acetaminophen (37.5 mg/325 mg) every 6-8 hours.
- Opioids such as Codeine 30 mg every 6 hours, in extreme cases.
- Local anesthetic infiltration (e.g., lidocaine) for acute localized pain.
Patients with NSAID Contraindications:
- Acetaminophen 1 g every 6-8 hours.
- Metamizole sodium 500 mg every 6 hours.
Careful consideration of the patient's medical condition is essential to avoid adverse interactions.
7. General Recommendations and Prevention
- Maintain good oral hygiene to prevent infections.
- Schedule regular dental check-ups.
- Educate patients on the importance of immediate management of dental trauma.
- Use protective measures such as mouthguards for patients involved in contact sports.
- Instruct patients on recognizing early signs of infections and when to seek emergency dental care.
8. Conclusion
Dental emergencies require rapid and accurate evaluation for proper management.
Knowledge of the appropriate treatments allows dentists to provide effective care and prevent major complications.
This guide serves as a practical resource to support clinical decision-making and ensure optimal patient outcomes.
9. Bibliography
1. Ministry of Health of Chile (MINSAL). "Clinical Guide to Ambulatory Dental Emergencies."
This guide provides guidelines for the management of dental emergencies in outpatient settings.
2. American Association of Endodontists (AAE). "Management of Endodontic Emergencies: Pulpotomy Versus Pulpectomy." This document discusses treatment options for endodontic emergencies, such as pulpotomy and pulpectomy.
3. European Society of Endodontology. "Present status and future directions: Managing endodontic emergencies." This article provides an overview on the management of endodontic emergencies and future directions in this field.