EMERGENCY DENTISTRY !

                                    EMERGENCY DENTISTRY!

Have you ever suffered the most annoying or painful ache in your jaws? A stabbing horrifying pain that appeared out of nowhere, travelling through your jaws, into your head, and literally stopped you from doing whatever that you were currently doing at that moment? It throbs, hurts, and now all of your attention is suddenly on the pain. Well, the first thing you would think of is seeing a dentist! But just right then, you realized that most of the clinics were closed???

Most often an unfortunate incident occurs either only after working hours, or it happens to be a public holiday. It is always during times like these when a tooth decides to crack, or a painful cavity appears out of nowhere, or perhaps a swelling comes about, or worse... an accident occurs! Emergency situations like this need to be attended to as the pain can be unbearable. Fortunately we have 24 hour operating hospitals that would attend to our problems at the 11th hour, but even then we have to wait and survive through the night with all the pain until the dental surgeon on-call sees you. What do you do in the mean time? Well, here are some answers ...

If you ever woke up with a throbbing pain in the middle of the night not knowing what or how did it happen, firstly take a deep breath and relax! Throbbing pain running along your jaw, radiating to your head near the temporal region, and sometimes behind your ears and side of neck indicates a nerve issue. Due to the nature of our brain, any nerve pain originating from one tooth would be translated as the whole nerve bundle been triggered. Therefor, a simple trigger from the nerves of a tooth would trigger the entire distribution of the nerve course, relating in pain on the entire region of distribution. It is the similar situation for a patient undergoing a heart attack, where he feels his entire left arm and neck affected by the pain while the source of the sensation is actually the heart. It is known as "referred pain". 

Nerve pain can be a death sentence if left untreated. It is hard to point out where it is coming from, but most often it originates from a very deep cavity affecting the nerves, or simply your wisdom tooth! The best solution is to primarily have 2 tablets of Paracetamol 500mg stat! Note that if you are allergic to Paracetamol, you should consult your physician for alternative drugs - though Paracetamol allergy is extremely rare. Firstly, we will need to understand how does pain come about. When the tooth nerves are affected or infected, they send out signals to the brain. The brain perceives this as PAIN impulse, hence causing us to feel physical pain. At the same time, damaged tissue releases chemicals called prostaglandin which amplifies the electrical signal of the nerves to the brain. The purpose of having Paracetamol is to reduce the effect of prostaglandin at the brain level. This somehow temporarily increases our pain threshold and suppresses the pain. By this time, try contacting the hospital if necessary to get through the dentist on-call. 

While waiting, you could also try "warm salt water gargle". Salt is an hyper osmotic chemical that would help in killing the bacteria around the infected site, while increasing the pH balance in the oral cavity making it more alkaline - bacterias struggle to survive in this environment. However, the next step would be to take painkillers known as "NSAID" (Non Steroidal Anti-inflammatory Drug). These group of drugs reduces pain at a higher level as compared to Paracetamol, while having an anti inflammatory effect. The enzymes responsible for producing prostaglandins are known as Cox-1 and Cox-2. The NSAIDs work by chemically blocking these enzymes, causing less pain and less inflammation. Examples of such drugs are Aspirin, Ibuprofen, and Naproxen. However, it is important to remember that these drugs if consumed on an empty stomach could cause gastritis. Therefor, consume these drugs after a small meal as precaution. 

These steps should be enough to take care of the pain throughout the night. The following morning, it is important to seek dental treatment immediately to treat the source of infection. Remember, the remedies above are merely relieving us from the pain symptom and not treating it. Hence the causative factor for the pain needs to be addressed professionally. 

Tooth cavities are common findings in the mouth. The nature of pain that follows depends on the extent of toot decay- initial caries, progressive caries, advance caries. The deeper and more aggressive the decay process gets, the pain increases. This is due to the bacteria invasion of the enamel layer penetrating into the dentine, where the nerve endings are located. The distribution of the nerve endings are more dense towards the pulp horn and roof of the pulp chamber. This causes a sharp shooting pain in the tooth when hot or cold water touches the tooth. At this stage, restoring the cavity with some filling materials as long as the pulp is not exposed can save the tooth. However sometimes due to the nature of the bacterial invasion, the dentine lying just above the pulp chamber can get affected and result in a severe throbbing ache. In such cases, seeing a dentist becomes inevitable. In case you were unable to see a dentist right away, go to the local pharmacy and purchase a bottle of "clove oil". Get some clean cotton and roll it into a small pellet. Dip the cotton pellet with clove oil and immediately soak the tooth cavity with it. Leave it in there for sometime and you will find a huge sense of relief from the pain. It is important to try to clean the cavity with vigorous salt water gargle before soaking it with clove oil filled cotton pellet. Clove oil is an essential oil extracted from the clove plant. It contains Eugenol, which acts an a natural antiseptic and analgesic. Another alternative to clove oil would be benzocaine, which is an anesthetic agent in a form of gel sold in the pharmacy.

Accidents are the last thing that you need during a holiday. Unfortunately, it can happen at any time and in worst ways. It is important to understand the complexity of the situation as it could result in a long term damage and loss if the injury sustained from the accident isn't managed well. The first thing to do in an accident is to make sure that the victim did not loose consciousness. This is important as he/she could have swallowed or choke on any fractured tooth. If a fractured tooth was sustained, the broken piece of tooth should be located if possible. The exposed part of the tooth could be rinsed with saline (salt water), thereafter placing a "clean" gauze of the site. The patient could gently bite on the gauze to prevent further bleeding. If the tooth has avulsed completely (the whole tooth came out), immediately locate the tooth and wash it gently with salt water. Do not rub or scrub the tooth at all! Next, preserve the tooth in a bottle of milk, or saline, or the patient's saliva if possible. As for the exposed tooth socket, rinse gently with saline and get a clean gauze to bite on. Never use a tissue or cotton in replacement. At the worst case, a clean handkerchief would be good. The art to stop any active bleeding is good compression. Now, you could call the nearest available dental surgeon to attend to the situation immediately. There is a good chance of implanting back the avulsed tooth back into the socket (with a semi rigid splint) if it is done within the same day - ideally within 2 hours! 

The trick to such an emergency is to remain calm, save the tooth (if any), keep the affected area clear from infections via saline rinse, and not forgetting compression to reduce the bleeding. After that, get in touch with a dental surgeon who knows how to handle such a case. An early intervention makes a huge difference to the outcome of the treatment. 

For further tips and remedies for dental pain, kindly contact us at +6012-2621067, or email us at dryogeshbds@yahoo.com .