| Condition | Signs and Symptoms | Management |
|---|
| Periodontal disease | | |
| Periodontal abscess | Localized pain; swelling of gingivae; possible sinus tract; lack of response to percussion; periodontal pocketing | Curettage to establish drainage; antibiotics; warm saline rinses; soft diet; referral to dentist |
| Pericoronitis | Pain and generalized soreness; inflamed operculum over partially erupted tooth | Irrigation; warm saline rinses; gentle massage with toothbrush; antibiotics for fever and lymphadenopathy; referral to dentist for possible tissue excision or tooth removal |
| Necrotizing ulcerative gingivitis | Generalized pain; bleeding gums; fetid odor; generalized gingival inflammation; necrotic tissue; loss of interdental papillae; fever | General débridement; daily saline rinses; hydration; referral to dentist; antibiotics if necessary; dietary recommendations; rinse twice daily with 1.2% chlorhexidine; brushing and flossing after resolution |
| Primary herpetic gingivostomatitis (highly infectious) | Gingival ulceration; fever; punctate lesions of gingivae and possibly dorsum of tongue; buccal mucosa, floor of mouth, lips; malaise; headache; irritability; lymphadenopathy | Rest; diluted mouthwashes; increased fluid intake; soft diet; topical analgesics; referral to dentist |
| Pulpitis and periapical problems | | |
| Reversible pulpitis | Sharp, transient pain response to cold stimuli; recent dental restoration | Analgesics; avoidance of thermal stimuli; referral to dentist |
| Irreversible pulpitis | Spontaneous pain; persistent or lingering pain response to thermal stimuli | Referral to dentist for removal of pulp and root canal therapy or extraction of tooth |
| Periapical inflammation | Acute pain on percussion | Examination for lymph node involvement, intraoral and extraoral; swelling; fever; analgesics; referral to dentist |
| Periapical abscess | Tooth sensitive to touch; tooth mobile; fever; swelling or sinus tract; possible fever if systemic involvement | Thorough systemic examination; incision and drainage; antibiotics; analgesics; warm water rinses; referral to dentist |
| Post-treatment complications | | |
| Alveolar osteitis (dry socket) | Throbbing pain 2–4 days after extraction | Irrigation of extraction site; sedative dressing (eugenol); analgesics; gauze packs, bone wax, ; referral to dentist |
| Tooth sensitivity | Imbalance when teeth contact; thermal sensitivity; pain on closing mouth | Referral to dentist |
SOURCE: Adapted from Comer, RW, et al: Dental emergencies. Postgrad Med 85(3):63, Feb. 1989.