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Toothache, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

  • Tooth pain is caused by irritation of the root nerves located in pulpal tissue:

    • The pulp is the tooth's center and its neurovascular supply

  • Other etiologies, both inside the mouth and ...

Diagnosis

Signs and Symptoms

History

  • Tooth pain:

    • May be referred to jaw, ear, face, eye, and neck (sensory distribution of 5th cranial nerve)

    • Pain often associated with chewing, changes in temperature, an...

Treatment

Pre-Hospital

  • Maintain patent airway in patients with severe facial swelling or trismus

  • The patient should be kept in a sitting position if possible

Initial Stabilization/Therapy

  • Airway managemen...

Follow-Up

Disposition

Admission Criteria

  • Suspicion of deep-space infections (e.g., Ludwig angina, retropharyngeal abscess)

  • Facial cellulitis proximal to the eye

  • Extensive trismus

  • Inability to maintain nutr...

Pearls and Pitfalls

  • Mistaking a deep infection for local infection

  • Failing to identify source of referred pain to the mouth

Additional Reading

  • Annino  DJ Jr, Goguen  LA. Pain from the oral cavity. Otolaryngol Clin North Am.  2003;6:1127–1135.

  • Lockhart  PB, Hong  CH, van Diermen  DE. The influence of systemic diseases o...

Codes

ICD9

  • 521.00 Dental caries, unspecified

  • 522.0 Pulpitis

  • 525.9 Unspecified disorder of the teeth and supporting structures

  • 522.5 Periapical abscess without sinus

  • 521.81 Cracked tooth

  • 523.10 Chronic gingi...

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