What will your doctor look for?
Your doctor will look for signs, clear objective findings discovered during the examination.
Any time a patient has an oral complaint, a doctor will want to make sure there is no airway problem. “Can you breath ok?”
“Say ahh, ” I ask. The airway is clear and open.
I look at the gums. Are they swollen?
How does the tooth look? Is it cracked or Decayed? Is there a big pocket of pus? Or has the floor of the mouth been affected?
Quickcare or ER?
If you have severe pain and there are no other clinics around, it is understandable to go to the ER.
Also, if the infection has spread to the deep tissues under the chin, (Lundwig’s Angina) go to the ER.
But if there are no airway problems, no fever, no shortness of breath, the walk-in clinic is the most appropriate.
What your doctor will ask you?
Your doctor will want to know your symptoms.
A symptom is a description of your condition to your doctor. It is YOUR story.
Answering the following questions will help your doctor understand:
- Where is the pain?
- When did it start?
- What makes it better?
- What makes it worse?
- What is associated with the pain?
- Did you hurt yourself?
What is your doctor thinking?
Your doctor will make a mental list of possible reasons for your signs and symptoms. This list is called a differential diagnosis.
A severe toothache may be due to a broken tooth.
Another possible cause is an abscess, which is collection of pus around the tooth.
Root canal symptoms will trigger at terrible local dental pain
Dry socket (alveolar osteitis) is very painful. This condition may follow 2-3 days after a tooth extraction.
What is the treatment of dental pain?
Sometimes I personally use home remedies for toothache which includes liquid Benadryl or cloves. Many times I will get a moderated toothache relief.
When I am treating my patients, after I know that the airway is clear, pain control is addressed. Usually pills or maybe a shot in the butt will help.
More and more doctors will inject numbing medicine around the tooth kind of like a dentist would do.
Also, if there is a hint of an infection, most doctors would prescribe an antibiotic such as Penicillin.
If there is dry socket (bone exposure), the tooth needs to be covered.
How long will you be sick?
I have found that dentists make room in their busy schedules to see patients who had been in the ER….Especially at 2:00 am.
What can be done next? After pain control and antibiotic coverage, that is for the dentist to decide.
Let me tell you a story…..
2:00 am is a magical time. All the stimuli that keeps a person busy throughout the day just disappears. Empty. Quiet. Not a peep….
……Except that one little pain that has been bothering him the whole day. All the focus goes to that one spot. That’s what happened to Oscar.
He was fine the whole day. The darkness of night spoke to him. Fear. Pain. “What if this pain is an infection going into your brain,” said Mr. Darkness. “What if the infection spreads to my entire face?”
Naturally, he came to the ER to seek answers, a pain shot and assurance. He needed some form of an answer.
In Oscar’s case, the pain was local, throbbing, severe. But no fever or difficulty swallowing is associated. Oscar had no trauma or injury.
As with any toothache, Oscar needs a dentist for definitive care.
But what can I do as an Emergency Room doctor? At 2 am, I usually offer a pain shot of Toradol and a prescription of antibiotics such as penicillin (PenVK 500mg 4 times per day.)
With that, at least Oscar can get some sleep and see his dentist in the morning.
I hope this helps.