Dental emergency

A dental emergency is an issue involving the teeth and supporting tissues that is of high importance to be treated by the relevant professional. Dental emergencies do not always involve pain, although this is a common signal that something needs to be looked at. Pain can originate from the tooth, surrounding tissues or can have the sensation of originating in the teeth but be caused by an independent source (orofacial pain and toothache). Depending on the type of pain experienced an experienced clinician can determine the likely cause and can treat the issue as each tissue type gives different messages in a dental emergency. A dental emergency is an issue involving the teeth and supporting tissues that is of high importance to be treated by the relevant professional. Dental emergencies do not always involve pain, although this is a common signal that something needs to be looked at. Pain can originate from the tooth, surrounding tissues or can have the sensation of originating in the teeth but be caused by an independent source (orofacial pain and toothache). Depending on the type of pain experienced an experienced clinician can determine the likely cause and can treat the issue as each tissue type gives different messages in a dental emergency. Many emergencies exist and can range from bacterial, fungal or viral infections to a fractured tooth or dental restoration, each requiring an individual response and treatment that is unique to the situation. Fractures (dental trauma) can occur anywhere on the tooth or to the surrounding bone, depending on the site and extent of fracture the treatment options will vary. Dental restoration falling out or fracturing can also be considered a dental emergency as these can impact on function in regards to aesthetics, eating and pronunciation and as such should be tended to with the same haste as loss of tooth tissue. All dental emergencies should be treated under the supervision or guidance of a dental health professional in order to preserve the teeth for as long as possible. By contrast, a medical emergency is often more precisely defined as an acute condition which presents an immediate threat to life, limb, vision or long term health. Consequently, dental emergencies can rarely be described as medical emergencies in these terms. Some define a dental emergency in terms of the individual's willingness to attend for emergency dental treatment at any time at short notice, stating that persons who are fussy about when they are available for treatment are not true emergency cases.:702 There are often divergent opinions between clinicians and patients as to what constitutes a dental emergency. E.g. a person may suddenly lose a filling, crown, bridge, etc. and although they are completely pain-free, still have great cosmetic concerns about the appearance of their teeth and demand an emergency treatment on the basis of perceived social disability. Pain is described as 'an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. It is one of the most common reasons patients seek dental treatment and many diseases or conditions may be responsible for the cause. Odontogenic pain is pain associated with the teeth, originating in the dental pulp and/or the peri-radicular tissues. The following table shows the different classifications of pulp status. Peri- radicular pain can be of pulpal origin, most commonly due to disease in the pulp extending into the peri-radicular tissues but can also be of periodontal origin due to periodontal disease. Apical periodontitis is acute inflammation of the periodontal ligament surrounding the tooth. This can be caused by inflammatory mediators from irreversibly inflamed pulp, bacterial toxins from necrotic pulp, restorations that have not been property contoured and in some cases, from treatments such as endodontic treatment. There is both an acute and chronic form of this condition. Acute apical periodontitis features include moderate to severe pain, usually stimulated by touch and pressure and may also include spontaneous pain. The chronic form of the condition can be asymptomatic but may also include pain from surrounding tissues when stimulated. Apical abscess is an extension of apical periodontitis where the bacteria have infiltrated the peri radicular tissues and are causing a severe inflammatory response; there is also an acute and chronic form of this condition. An acute apical abscess can cause facial swelling and can cause other systemic consequences such as a high temperature and feelings of malaise. In some cases this condition can be life-threatening when the inflammation compromises the airway; this is termed Ludwig’s Angina. A chronic apical abscess can be asymptomatic as the pressure from the inflammation is being drained through a sinus tract; a draining sinus can usually be seen clinically. A periodontal abscess is a localised inflammation affecting the periodontal tissues. It is caused by bacteria pre-existing in a periodontal pockets, traumatic insertion of bacteria or foreign body or can occur after periodontal treatment. This condition has a rapid onset, is stimulated by touch and involves spontaneous pain. It is important to note that an apical abscess may drain through the periodontal pocket giving a false interpretation of periodontal abscess or a periodontal abscess may appear at the apex of the tooth giving a false interpretation of apical abscess; a tooth may also have both lesions at one point in time. Dental trauma refers to an injury on hard and soft tissues of the oral cavity and face. This includes the teeth and surrounding tissues, the periodontium, tongue, lips and cheeks. It is more prevalent with children between 8– 12 years of age but can still happen to anyone. The prognosis of the tooth is worse the longer it is out of the mouth.