Management of child with toothache
| Diagnosis | Emergency mx | Definitive mx |
| Reversible pulpitis | LA
Excavate soft caries Restore temporarily with ZnO or GIC If exposed and vital— dress polyantibiotic paste (e.g. Ledermix., Odontopaste.) |
Pulpotomy or xla
(if time and cooperation allows, definitive Rx should be completed at first visit) |
| Irreversible pulpitis | LA
Excavate soft caries Dress polyantibiotic paste Restore temporarily with ZnO or GIC |
Pulpotomy/ pulpectomy or xla |
| Acute periradicular periodontitis | LA (may not be necessary if loss of vitality is certain)
Excavate soft caries until pulp chamber accessed— dress pulp chamber with polyantibiotic paste on cotton wool Seal with temporary dressing |
Pulpotomy/ pulpectomy or xla |
| Acute periodontitis with facial swelling
If: -No or mild pyrexia (<38°C) -Localized acute erythematous tender ST swelling -No significant involvement of ‘danger areas’ -Not systemically unwell |
Antibiotics and analgesics
Ensure adequate fluid intake Establish drainage via tooth (and dress) if possible Review every 24h to ensure resolution |
Xla of tooth (or pulpectomy in selected
cases) once acute phase has resolved |
| Acute periodontitis with facial swelling
If: -Significant pyrexia >38°C -Poorly localized, spreading infection -Systemically unwell: dehydration, lethargy, nausea, and vomiting -Swelling involving a ‘danger area (FOM) *inability to feel the lower border of mandible is a serious sign -Trismus |
Immediate referral to specialist centre
Aggressive antibiotic Rx (e.g. amoxicillin and metronidazole) |
Xla of tooth &/ or IO/ EO drainage |