Toothache / INFECTION

Pain at a precise tooth, awakened by the sweet or cold, is usually caused by dental caries, which is close to the pulp cavity containing nerves. This pain is usually temporary. The patient will avoid triggers, to use systemic analgesic and should be treated quickly.

Dental persistent pain which is usually aggravated by the heat or cold and is sometimes relieved by cold usually indicates irreversible damage to the flesh (v. Pulpite, Ch 106). Often, this disease leads to periapical inflammation, which can be diagnosed by the sensitivity to percussion with a lower language. If most or all of the posterior maxilla are sensitive to percussion on the one hand, on suspicion of maxillary sinusitis (see Sinusitis, Ch 86). The tt by analgesics (eg. Phenacetin 650 mg with 60 mg of codeine orally every 4 h) and an antibiotic (eg. V penicillin, erythromycin or cephalosporin 250 to 500 mg every 6 h) may be reported until the dental tt can begin.

Periapical infection, often accompanied by a soft tissue swelling neighbors typically develops as a result of untreated pulpits. The emergency has tt painkillers and antibiotics (see above) if the dental tt is not possible immediately. The périapical abscess that has spread beyond the alveolar bone, causing swelling and a fluctuation in the adjacent soft tissues, will be incised and drained, and the dental tt will be involved. Antibiotics alone are insufficient and are not usually indicated. In general, a Intraoral incision is appropriate, but the sloping drainage by transcutaneous incision may be indicated. If necessary, antibiotic therapy must be adapted to the antibiogram.

The eruption or the isolation of molars, especially the wisdom teeth, can be painful and cause inflammation of the surrounding tissue (péricoronarite) or a severe infection. The tt is instillations of hypertonic saline solution (one teaspoon of salt in a glass of hot water, no more hot coffee or tea). The salt water is kept in the mouth of the affected side until it cools, then it is dismissed and immediately replaced by another warm salt water. Rinsing daily with 3 or 4 glasses of salt water is usually sufficient to control the inflammation and pain. Si la consultation dentaire est retardée, un tt antibiotique est nécessaire (p. ex. érythromycine, pénicilline V, ou une céphalosporine, 250 à 500 mg per os 4 fois/j).

The rare causes acute edema péribuccal include periodontal abscess, infected cysts, the antrite, allergy, infection or obstruction of salivary glands, and infections périamygdaliennes.