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Emergency Dentistry Flow: Pain, Swelling & Trauma in 10 Steps

A fast, examiner-approved workflow to manage acute pain, swelling, infection and trauma.

Quick Answers

What is the first step in any acute dental emergency?

Assess airway, swelling, fever, and red flags before touching the tooth.

When should you prescribe antibiotics?

Only for systemic involvement: fever, spreading infection, cellulitis, trismus, lymphadenopathy.

What is the emergency treatment for irreversible pulpitis?

Pulp extirpation or opening the pulp chamber for immediate pain relief — not antibiotics.

What is the first step in dental trauma?

Check for concussion/LOC, soft tissue injuries, and rule out head/neck injury before dental care.

1. The universal emergency flow

Emergency stations test whether you can identify risk, act safely, and provide fast relief. A predictable structure helps you score consistently.

10-step emergency flow

1. Assess airway & breathing
2. Assess swelling & fever
3. Medical history & allergies
4. Pain history (SOCRATES)
5. Tooth tests (EPT, percussion, palpation, mobility)
6. Radiograph selection
7. Diagnosis
8. Immediate relief treatment
9. Antibiotics only if indicated
10. Follow-up + safety advice

2. Acute pulpitis (severe spontaneous pain)

Classic presentation: hot/cold sensitivity, night pain, lingering pain, no swelling.

  • Diagnosis: Irreversible pulpitis.
  • Emergency treatment: Access cavity + pulpotomy/pulpectomy.
  • Antibiotics: Not indicated.

3. Acute apical abscess (swelling present)

Often accompanied by swelling, tenderness, fever, and difficulty chewing.

Management

Drainage via access or incision
Debridement of canal
Antibiotics only if systemic signs
Analgesics + warm saline rinses

4. Cellulitis and spreading infection

A red-flag situation examiners expect you to recognize immediately.

  • Facial swelling crossing midline
  • Difficulty swallowing or breathing
  • Trismus
  • Fever, malaise

Action: urgent referral, IV antibiotics, airway assessment.

5. Fractured tooth (crown fracture)

These OSCE stations test your ability to choose the correct Ellis classification and provide fast comfort.

  • Enamel only → smoothen edges.
  • Enamel–dentin → cover dentin; composite restoration.
  • Pulp exposure → pulp cap or pulpotomy.

6. Avulsion

One of the highest-yield trauma topics.

  • Handle tooth by crown only.
  • Rinse gently in saline if dirty.
  • Replant immediately if permanent tooth.
  • Splint for 2 weeks.
  • Start systemic antibiotics (e.g., doxycycline or amoxicillin).

7. Pain with no swelling (pulpitis vs cracked tooth)

Examiners may give vague symptoms — focus on differentiating sharp trigger pain (crack) from lingering thermal pain (pulpitis).

8. Pain from third molars

Pericoronitis presents with foul taste, swelling around operculum, and soreness.

Management

Irrigation + debridement
Analgesics
Antibiotics only if spreading infection
Extract if recurrent

9. What NOT to do in emergencies

  • Do not prescribe antibiotics for pulpitis.
  • Do not attempt drainage in cellulitis.
  • Do not delay referral for rapidly progressing swelling.

10. How DentAIstudy helps

DentAIstudy can turn any emergency scenario into:

  • 10-step OSCE flows
  • Diagnosis shortcuts
  • Red-flag checklists
  • Viva-style reasoning lines

Try Study Builder →

References

  • AAE Guidelines on Emergency Management.
  • Malamed SF. Medical Emergencies in the Dental Office. Elsevier.
  • IADT Dental Trauma Guidelines.