Diagnosing Dental Pain:

RMH - how long? medications? (dose, frequency, how long?) particular area? stable? severity? family history?

Units of alcohol - how many? how frequent? of what?

Smoking - how regular? how long? of what? how much?

C/O - SOCRATES

SH - occupation, hobbies, lifestyle, accessibility

RDH - attendance and anxiety scale

E/O and I/O

Special investigations

Diagnose

Treatment Plan

Gain consent

Risk Assessment

Dentine Sensitivity:

Site - generalised, diffuse, difficult to locate

Onset

Character - sharp, non-throbbing

Radiation - widespread

Associated symptoms - none

Time - a few secs-mins, lasts as long as the stimulus, intermittent, does not keep awake, initiated by a stimulus

Exacerbating - cold, hot, sweet =, mechanical (relief - painkillers, LA, etc)

Severity - mild-moderate

O/E - gingival recession, hypersensitivity, radiographs show bone loss, exclude caries, not reversible pulpitis (no cracks)

  • SDF application

  • Desensitising toothpaste

  • High fluoride toothpaste

  • Diet advice

  • Analgesic advice

  • Dentine sealant

  • FV

Irreversible Pulpitis

Site - generalised, diffuse, may be difficult to locate

Onset - definitive

Character - dull, throbbing ache

Radiation - widespread

Associated symptoms - none

Time - minutes-hours, intermittent, keeps pt awake, spontaneous

Exacerbate - hot, cold, sweet (relief - analgesics, cold, LA, etc)

Severity - severe

O/E - gross caries, cracks, widening of PDL, response to vitality test

  • Extract tooth

  • RCT

Reversible Pulpitis

  • Prescribe high fluoride preparation

  • Restore tooth if necessary

  • Diet analysis and advice

BPE 1+2 and Gingivitis

  • PI and GBI

  • OHE

  • Supra PMPR

Generalised Stage 2 Perio

  • PI and GBI

  • OHE

  • FPA

  • Sub PMPR where indicated

Risk of caries

  • OHE

  • Diet advice

  • FV

  • High fluoride toothpaste

  • Sealants

Risk of Perio

  • Sub PMPR

  • Remove plaque retentive factors

  • OHE

  • Smoking cessation

Risk of oral cancer

  • Alcohol advice

  • Smoking cessation

  • DIe advice

Risk of tooth wear

  • OHE

  • DIet advice

  • Mouthguard

  • Stress management

  • Alcohol advice

  • Discuss social history

Smoking

  • Refer to GP

  • Smoke-Free NHS services

  • NHS stop smoking services