Diagnosis and management of dental pain or infection - accessible version
Diagnosis and management of caries-related dental pain or infection in a child with no medical complications
A text version of the process to diagnose the cause of dental pain for a child with no medical complications and to determine a suitable management strategy is outlined below.
To use this version, follow the instructions at each decision point to determine the diagnosis and suitable management strategy.
1. Do the symptoms indicate pulpitis with reversible symptoms?
Typically: pain to cold/sweet, tooth is not tender to percussion, pain resolves on removal of stimulus, tooth difficult to localise
If yes: restore tooth or place a temporary dressing and restore later. If no dentine bridge visible, consider selective caries removal or pulpotomy.
If no: go to 2. Do the symptoms indicate pulpitis with irreversible symptoms?
2. Do the symptoms indicate pulpitis with irreversible symptoms?
Typically: pain to hot/cold which does not resolve on removal of stimulus and does not resolve with placement of a temporary dressing.
If yes: go to 3. Is the child cooperative?
If no: go to 4. Dental abscess/periradicular periodontitis
If yes: for primary teeth carry out extraction or pulpotomy; for permanent teeth, carry out pulpotomy, pulpectomy/root canal therapy or extraction.
If no: try to dress the tooth with sub-lining of corticosteroid-antibiotic paste and prescribe pain relief (see Notes). Then, for primary teeth refer for treatment/extraction with sedation or general anaesthesia; for permanent teeth, if the child becomes cooperative, carry out pulpotomy, pulpectomy/root canal therapy or extraction, otherwise refer for specialist care.
4. Dental abscess/periradicular periodontitis
Typical symptoms include: spontaneous pain that wakens child at night, tooth mobile and tender to percussion, swelling, malaise.
Consider local measures to control infection. If indicated, first prescribe antibiotics and pain relief (see Notes). Then, go to 5. Is the child pre-cooperative or are there multiple abscessed teeth?
5. Is the child pre cooperative or are there multiple abscessed teeth?
If yes: for primary teeth, carry out an extraction or if unable to extract, refer for sedation or general anaesthesia; for permanent teeth, carry out pulpectomy/root canal therapy or extraction (may require referral for specialist care).
If no: for primary teeth, carry out an extraction or pulpectomy; for permanent teeth, carry out pulpectomy/root canal therapy or extraction.
Antibiotics should only be prescribed if there is evidence of spreading infection (swelling, cellulitis, lymph node involvement) or systemic involvement (fever, malaise).
Refer to the SDCEP Drug Prescribing for Dentistry guidance for pain relief.
Note: each patient should receive an oral health assessment which may be carried out before or after diagnosis and management of pain, depending on its severity.