Dental - Toothache

Disclaimer These guidelines have been produced to guide clinical decision making for the medical, nursing and allied health staff of Perth Children’s Hospital. They are not strict protocols, and they do not replace the judgement of a senior clinician. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline.  Read the full PCH Emergency Department disclaimer.

Aim

To guide staff with the assessment and management of toothache.

Background

Patients presenting with severe toothache associated with indicators of infection require expedient treatment. Indicators of infection include:

• Gum swelling
• Obvious abscess
• Recent antibiotics for same problem
• Woken from sleep by dental pain
• Severe pain not relieved by simple analgesia
• Recent unsuccessful attempt to manage the same problem
• Pyrexia and/or malaise
• Facial swelling.

All require treatment (often needing antibiotic prescription) and may require admission. The Dental Department or on‐call Dentist must be contacted for these cases.

Patients with intermittent toothache not associated with the above signs of acute infection should be referred to an appropriate dental provider for non‐emergency dental management.

• Please see Dental Services external to PCH for contact details of appropriate dental service providers. 

Management

Child presents with toothache

Does the child present with indicators of infection?

• Fever
• Facial swelling 
• Gum swelling
• Obvious abscess
• Severe pain not relieved by simple analgesia 
• Woken from sleep by dental pain
• Recent antibiotics for same problem
• Recent unsuccessful attempt to manage same problem.

Yes	No
History and examination Contact dental department during office hours After hours contact on call dentist Analgesia EMLA® NBM Consider OPG (discuss with ED consultant or dentist)	Provide appropriate analgesia Refer to the appropriate dental provider: Private General Dentist (Family Dentist) Specialist Paediatric Dentist School Dental Clinic Metropolitan Dental Clinic Oral Health Centre of WA

Endorsed by:	Director, Emergency Department	Date:	Feb 2018
		Review date:	Feb 2020

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