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EM Clerkship

Dental Pain

EM Clerkship

Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD

Health & Fitness, Science, Education, Medicine, Life Sciences

4.9816 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

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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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