Dental Pain
EM Clerkship
Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD
4.9 • 816 Ratings
🗓️ 15 January 2017
⏱️ 10 minutes
🧾️ Download transcript
Summary
Minor complaint. Huge SLOE points!
Step 1: Identify Which Tooth is Causing Pain
* Bonus points if you number teeth correctly!* Number 1-32* Tooth #1 is top right* Tooth #32 is bottom right* Refer to dental chart for reference
Step 2: Correct Terminology When Making Diagnosis
* Pulpitis* Pain in the tooth itself* Reversible* Triggered by hot/cold etc (then goes away)* Irreversible* Does not resolve* Gingivitis* Pain of the gingiva around the tooth* Periapical abscess* Pain with percussion of tooth
Step 3: Give Pain Medicine
* NSAIDS have been shown to work best* Naproxen* Ibuprofen* Opiates for breakthrough pain* Hydrocodone-acetaminophen (Norco)* Oxycodone-acetaminophen (Percocet)
Step 4: Consider Antibiotics
* Pulpitis does not require antibiotics* Gingivitis/Periapical abscess frequently improve on antibiotics* Penicillin VK
Step 5: Inferior Alveolar Nerve Block
* Watch HERE
Additional Reading
* Inferior Alveolar Nerve Block (YouTube)* Common Dental Emergencies (AFP)
Transcript
Click on a timestamp to play from that location
| 0:00.0 | Hello, med students. My name is Zach Olson, and thank you for downloading this episode of the EM |
| 0:09.0 | Clerkship Podcast. This week we're talking about another big topic, but this one's less important for your test, |
| 0:17.4 | but it's really, really important clinically. Today we're talking about dental pain. |
| 0:23.5 | So just a personal story. My wife has a huge sweet tooth. I remember we were watching American |
| 0:28.7 | Idol one night, and she's eating her bowl of ice cream, and she starts to hold her jaw, |
| 0:33.3 | and she stops eating her ice cream. And I knew that something was wrong at that point. |
| 0:38.5 | And this is going to happen to you too. |
| 0:40.8 | Your family members expect you to fix everything. |
| 0:44.2 | So she's all like, Zach, my tooth hurts, help me. |
| 0:46.7 | And I had no idea what to do. |
| 0:49.7 | Middle of the night. |
| 0:50.9 | And so I pretty much faked it. |
| 0:52.8 | I got out my cell phone light. |
| 0:55.1 | I looked in her mouth, didn't see anything, and I went, oh, this looks bad. You need to go to the dentist. |
| 1:02.4 | And then all the way through med school, in my ED rotations, and even residency, I said the |
| 1:07.9 | exact same thing every time a patient comes in with dental pain. |
| 1:13.8 | Ah, this looks bad. |
| 1:15.9 | You need to go to the dentist because I didn't know this stuff. |
| 1:20.4 | And this is really good news for you because lots of your peers aren't going to know this stuff. |
| 1:25.6 | Some of your attendings don't even know this |
| 1:27.7 | stuff very well, but you will have these cases. So you have the potential to sound really smart |
| 1:35.2 | if you can just articulate your way through them. So let's go here. Let's make you sound smart |
... |
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