Toothache

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of toothache

Tooth location: ‍upper right ‍upper left ‍lower right ‍lower left

Rated at ‍012345678910 / 10 ‍

Described as ‍dullaching

Pattern ‍persistentintermittent

Worsening factors: ‍none

Alleviating factors: ‍none, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍gum swelling

‍jaw swelling

‍jaw pain

‍redness

‍discharge

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills

‍difficulty breathing



Dental history reviewed: ‍tooth abscess, ‍cavities, ‍gum disease, ‍tooth grinding, ‍cracked teeth, ‍fillings, ‍extractions, ‍root canals, ‍crowns, ‍bridges, ‍implants, ‍dentures

Last dental visit: ‍ ‍



Contributing factors:

‍poor oral hygiene

‍tobacco use

‍alcohol consumption

‍lack of regular dental check-ups

no history of: ‍bruxism, ‍temporomandibular joint disorder, ‍sinusitis





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Mouth: mucosa ‍normal, dentition ‍normal

Throat: ‍normal, ‍erythema, ‍exudate, ‍

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍





ASSESSMENT:

‍Dental caries ‍likelysuspectedpossible

DDx: dental caries, pulpitis, dental abscess, periodontal disease, impacted tooth, temporomandibular joint disorder, sinusitis, trigeminal neuralgia, herpes zoster, dental trauma, cracked tooth syndrome, neoplasm of the jaw





PLAN:

Investigations:

- Blood work: ‍CBC, ‍CRP

Treatments:

- ‍Acetaminophen

- ‍NSAIDs

- ‍Antibiotics

- ‍Topical Analgesics

- Salt water rinses

Further care:

- Referral to dentist

- Follow-up in ‍ ‍daysweeks

- Return if pain worsens, if new symptoms develop such as fever or swelling