Caries, Toothache

Clinical Description

Acute or chronic inflammation of the pulp. Can be suppurative and could lead to necrotic pulp.

Signs and Symptoms

• Throbbing continuous or intermittent toothache which is worse at night.

Sometimes the pain is aggravated by hot or cold drinks. It is usually due to dental caries or trauma.

Investigations

• X−ray: Intraoral (PA, bite wing)
• Pulp testing.

Treatment

Depends upon the extent of caries and clinical judgment:

• If minimal and confined to the enamel, apply topical Fluoride
• If in enamel and dentine but not involving the pulp, do a Filling
• If involving the pulp and there is periapical infection and/ or pulp inflammation do

Root Canal Therapy

• If severe, do tooth extraction followed by

Analgesics e.g., Paracetamol 1 gm 8 hourly for 3 days or in severe cases give

• Ibuprofen 200 - 400 mg 8 hourly for 3 days or diclofenac 50 – 100 mg 8 hourly for 3 days
• When associated with abscess give Amoxycillin 250 - 500 mg 8 hourly for 5 days and Metronidazole 200 - 400 mg 8 hourly for 5 days

Note:

• •Antibiotics are not indicated unless there is infection
• •Reinforce oral hygiene practices including use of fluoridated toothpaste to all patients