The most common oral condition and
dental emergency is dental caries, which is
a destructive disease of the hard tissues of
the teeth due to bacterial infection with
Streptococcus mutans and other bacteria. It
is characterized by destruction of enamel
and dentine. Dental decay presents as
opaque white areas of enamel with grey
undertones and in more advanced cases,
brownish discoloured cavitations. Dental
caries is initially asymptomatic and pain
does not occur until the decay impinges on
the pulp, and an inflammation develops.
Treatment of caries involves removal of the
softened and infected hard tissues, sealing
of exposed dentines and restoration of the
lost tooth structure with porcelain, silver,
amalgam, composite plastic, gold etc.
The common dental emergencies are:
Pulpitis- If the caries lesion progresses,
infection of the dental pulp may occur,
causing acute pulpitis (Pulpal
inflammation). The tooth become sensitive
to hot or cold, and then severe continuous
throbbing pain ensues. In reversible
pulpitis, filling is an option but in case of
irreversible pulpitis, root canal therapy
(RCT) becomes necessary. The contents of
the pulp chamber and root canals are
removed, followed by thorough cleaning,
antisepsis and filling. Alternatively,
extraction may be indicated.
Apical peridontitis- A severely
inflammed pulp will eventually necrose,
causing apical peridontitis, which is the
inflammation around the apex of the
tooth. It is characterised by severe
spontaneous and persistent pain and
regional lymphadenopathy can be present.
Management is root canal treatment or
extraction. Antibiotics are generally not
necessary but patients should be advised
to report back to dentist/physician, if
swelling or other evidence of infection
occurs.
Periapical abscess- It is pulpal
inflammation characterized by localized
pain and swelling. If the pulpitis is not
treated successfully, infection may spread
beyond the tooth apex into the peridontal
ligament. This infection causes acute
inflammation with pain on chewing or on
percussion is present. The treatment of