| Diagnosis . | Emergency management . | Definitive management . |
|---|---|---|
Reversible pulpitis | LA Excavate soft caries Restore temporarily with a zinc oxide/eugenol cement. If exposed and vital—dress polyantibiotic paste (e.g. Ledermix®) | Pulpotomy or extraction |
Irreversible pulpitis | LA Excavate soft caries Dress polyantibiotic paste. Restore temporarily with a zinc oxide/eugenol or GI cement | Pulpotomy/pulpectomy or extraction |
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 | |
Acute periodontitis with facial swelling If: No or mild pyrexia (<38°C) Localized acute erythematous tender soft tissue swelling No significant involvement of ‘danger areas’ (see below) Not otherwise systemically unwell | Antibiotics and analgesics Ensure adequate fluid intake Establish drainage via tooth (and dress) if possible Review every 24h to ensure resolution | Extraction of tooth (or pulpectomy in selected cases) once acute phase has resolved |
If: Significant pyrexia >38°C Poorly localized, spreading infection Systemically unwell: dehydration, lethargy, nausea, and vomiting Swelling involving a ‘danger area’, i.e. floor of mouth | Aggressive antibiotic Rx (e.g. amoxicillin and metronidazole) Immediate referral to specialist centre | Extraction of tooth &/or intra-/extra-oral drainage |
| Diagnosis . | Emergency management . | Definitive management . |
|---|---|---|
Reversible pulpitis | LA Excavate soft caries Restore temporarily with a zinc oxide/eugenol cement. If exposed and vital—dress polyantibiotic paste (e.g. Ledermix®) | Pulpotomy or extraction |
Irreversible pulpitis | LA Excavate soft caries Dress polyantibiotic paste. Restore temporarily with a zinc oxide/eugenol or GI cement | Pulpotomy/pulpectomy or extraction |
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 | |
Acute periodontitis with facial swelling If: No or mild pyrexia (<38°C) Localized acute erythematous tender soft tissue swelling No significant involvement of ‘danger areas’ (see below) Not otherwise systemically unwell | Antibiotics and analgesics Ensure adequate fluid intake Establish drainage via tooth (and dress) if possible Review every 24h to ensure resolution | Extraction of tooth (or pulpectomy in selected cases) once acute phase has resolved |
If: Significant pyrexia >38°C Poorly localized, spreading infection Systemically unwell: dehydration, lethargy, nausea, and vomiting Swelling involving a ‘danger area’, i.e. floor of mouth | Aggressive antibiotic Rx (e.g. amoxicillin and metronidazole) Immediate referral to specialist centre | Extraction of tooth &/or intra-/extra-oral drainage |
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