Clinical Notes : ENT

44. Dental Conditions

Inherent problems

  • GPs are not trained to treat dental problems

  • Antibiotics are not indicated in most dental conditions presenting to OOH services

  • Deferring referral to dentist may increase morbidity

  • Potential for medicolegal complications


Goals in OOH service

  • Identify cases requiring referral to hospital

  • Educate patients as to cause of pain

  • Refer to dentist where indicated

  • Prescribe analgesia

  • Prescribe antibiotics only if there is localised or facial swelling but no possibility of access to dental care in the next few hours

  • low dose short course of amoxicillin



  • Exclude non-dental causes

    • TMJ pain

    • headache

    • sinusitis

    • parotids

    • trigeminal neuralgia

    • giant cell (temporal) arteritis

    • etc

  • Pulpitis (most common cause of dental pain)

    • inflammation of the pulp, the soft fibrous tissue within the tooth which contains the neurovascular structures

    • Severe pain in mouth and jaw, stimulated by hot and cold

    • tooth pain when biting

    • Pain may be localised or radiate, including to the ear

    • There is no infection of the surrounding tissue or associated swelling

    • does not respond to antibiotics

    • prescribe analgesia

    • refer to dentist

  • Acute dental abscess

    • Refer to dentist or drainage

    • Antibiotics should not be prescribed even if it is not possible to start dental treatment immediately

    • Antibiotics should only ever be prescribed in patients with significant immune compromise or if there are signs of local or systemic spread

    • Prescribe analgesia


Management of common dental conditions


Referral  to A+E :

  • Signs of spreading infection / rapid progression

  • Peri-orbital cellulitis

  • Signs of sepsis (check vital signs)

  • Difficulty swallowing, breathing or speaking

  • Difficulty opening the mouth (trismus, with mouth opening of less than 2 finger breadths)

  • Swelling in the floor of the mouth (the raised tongue sign) or drooling

  • Dehydration

  • Trauma, lacerations, fractures

  • Inhaled tooth or tooth fragment

  • Uncontrollable/persistent bleeding


Detailed guidelines :

nhs scotland.jpg

General practitioners’ attitudes towards the management of dental conditions and use of antibiotics in these consultations: a qualitative study.

Anwen L Cope, Fiona Wood, Nick A Francis, Ivor G Chestnutt.

BMJ Open .October 2015



Dental consultations in UK general practice and antibiotic prescribing rates: a retrospective cohort study.

Anwen L Cope, Ivor G Chestnutt, Fiona Wood and Nick A Francis

Br J Gen Pract 29. March 2016



Dental pain.

Yvonne MacAuley, Patrick O’Donnell, Henry F Duncan.

BMJ 2013; 347. November 2013


The attitudes and awareness of London based emergency department physicians towards the management of common dentofacial emergencies.

Trivedy, Chetan; Kodate, Naonori; Ross, Alastair; et al.

Dental Traumatology, 28 (2): 121-126. April 2012


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