Paediatric Acute care Guidelines PMH Emergency Department

Background

Patients presenting with severe toothache associated with indicators of infection, including:

  • Gum swelling
  • Obvious abscess
  • Recent antibiotics for same problem
  • Woken from sleep by dental pain
  • Severe pain not relieved by simple analgesia
  • Recent unsuccessful attempt to manage the same problem
  • Pyrexia and/or malaise
  • Facial swelling

require expedient treatment, often involving antibiotic prescription and may require admission. The Dental Department or on‐call Dentist must be contacted for these cases.

Patients with intermittent toothache not associated with the above signs of acute infection should be referred to an appropriate dental provider for non‐emergency dental management.

Assessment

Management

Child presents with toothache

Does the child present with indicators of infection?
              • Fever
              • Facial swelling 
              • Gum swelling
              • Obvious abscess
              • Severe pain not relieved by simple analgesia 
              • Woken from sleep by dental pain
              • Recent antibiotics for same problem
              • Recent unsuccessful attempt to manage same problem
YES NO
  • History and examination
  • Contact dental department during office hours
    • After hours contact on call dentist
  • Analgesia
  • EMLA®
  • NBM
  • Consider OPG (discuss with ED consultant or dentist)
  • Provide appropriate analgesia
  • Refer to the appropriate dental provider:
    • Private General Dentist (Family Dentist)
    • Specialist Paediatric Dentist
    • School Dental Clinic
    • Metropolitan Dental Clinic
    • Oral Health Centre of WA

See Dental Services External to the Children’s Hospital for contact details of appropriate dental service providers. 

Nursing

References

External Review
Dr Rodney Jennings, PMH Dental Health Service. February 2015

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