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Dental emergencies / dental emergencies Cluj-Napoca, 24/7

Teeth pain, accidents or swelling in the face? You probably need emergency dental treatment. Dentocalm Dental Clinic offers you a NON-STOP (24/7) dental emergency service.

Dentocalm Dental Clinic is available to you 24 hours for dental emergencies, so that you can receive appropriate treatments immediately after the occurrence of dental problems.

Emergency services are sometimes the only solution to acute, sudden-onset dental conditions. Not all dental pain is a dental emergency, and some conditions that do not progress rapidly can be relieved with anti-inflammatory medication until the time of a dental appointment.

URGENȚE 24/7: TEL: 0774 070 690 ADRESĂ: Cluj-Napoca, str. Calea Turzii nr.7, et.3


dental emergencies Cluj > dentistry emergencies > dentistry children non-stop > emergency services Cluj > dental emergencies Cluj > emergency reception Cluj > dentistry non-stop > dental clinic non-stop > emergency dentistry > dentist emergency > dentist emergency > toothache > dental pain

Dental emergencies - definition

A dental emergency is a problem involving the teeth and supporting tissues that is important to be treated as soon as possible by a dentist. Dental emergencies do not always involve pain, although this is a common signal that something needs to be investigated. Acute dental pain can originate from teeth or tissues . In other words, often dental or facial pain can give the impression that it is coming from the teeth and is actually caused by a different source: ears, nose, eyes, jawbone, temple.

Depending on the type of pain experienced, an experienced clinician can determine the likely cause by careful history taking and treat the problem. In emergency dental problems, each type of tissue sends different messages with different symptoms.

There are many types of dental emergencies. These can range from bacterial, fungal or viral infections to a fractured tooth or a fractured dental restoration, each of which requires an individual response and unique treatment depending on the situation. Fractures (dental trauma) can occur anywhere on the tooth or surrounding bone, depending on the location and extent of the fracture, treatment options will vary. Falling or fractured dental restorations can also be considered a dental emergency as they can have a significant functional impact. All dental emergencies should be treated under the supervision or guidance of a dental health professional to preserve teeth for as long as possible.

If we generalize the definition of emergencies across the medical spectrum we will understand that a medical emergency is often more precisely defined as an acute condition that poses an immediate threat to life, limb, sight or long-term health. Therefore, dental emergencies can rarely be described as medical emergencies in these terms. There are often differing opinions between clinicians and patients as to what constitutes a dental emergency! For example, a person may suddenly lose a filling, a crown, or a bridge and, although not in pain at all, still have great aesthetic concerns about the appearance of their teeth may seek emergency treatment on the basis of a subjectively perceived social handicap. When do patients usually arrive at our clinic calling the emergency service? Most patients seek emergency care when they are in pain! However, there is also a category of patients who seek our services outside the presence of pain, either with a coronary fracture in the aesthetic area, or with unresolved prosthetic work or any situation that cannot be delayed emotionally.

Tooth pain - definition

Pain is described as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage" (Wikipedia). It is one of the most common reasons patients seek emergency dental treatment.

More about toothache

Toothache, also known as dental pain, is pain in the teeth or their supporting structures caused by dental disease or pain transmitted to the teeth by diseases other than dental disease. When severe, it can impact on sleep, eating and other daily activities.

Causes of teeth pain

Common causes include inflammation of the pulp, (usually in response to tooth decay, dental trauma or other factors), dentin hypersensitivity, apical periodontitis (inflammation of the periodontal ligament and alveolar bone around the root apex), dental abscesses (localized collections of pus), alveolar osteitis (dry alveolitis or wet alveolitis, a possible complication of tooth extraction), acute necrotizing ulcerative gingivitis (an infection of the gums) and temporomandibular disorder.

Dental pulpitis is reversible when the pain is mild to moderate and lasts a short time after a stimulus (e.g. cold); or irreversible when the pain is severe, spontaneous and lasts a long time after a stimulus. Left untreated, pulpitis can become irreversible and progress to pus accumulation inside the tooth (purulent pulpitis), pulp necrosis (pulp death), apical periodontitis (pus accumulation in the bone at the tip of the tooth) or even dental abscesses.

Dental abscess Depending on the tissue from which the infection originated, abscesses are of several types Apical abscesses usually occur after pulp necrosis, pulpitis purpura or even after incorrectly performed root treatments. Pericoronal abscess (around the dental crown) is usually associated with acute pericoronitis of a lower wisdom molar. Periodontal abscesses are usually a complication of periodontal disease (a condition in which the health of the gums and bone-supporting structures - periodontal ligaments and the bone around the tooth - is affected).

Less commonly, non-dental conditions can cause toothache, such as maxillary sinusitis, which can cause pain in the upper teeth on the side, or angina pectoris, which can cause pain in the lower teeth. Correct diagnosis can sometimes be a challenge.

How can we prevent and relieve toothaches?

Proper oral hygiene and regular check-ups (at 6 months for adults and 4-5 months for children) help prevent toothache by preventing dental disease. Treatment of a toothache depends on the exact cause and may involve a filling, root canal, extraction, pus drainage or other remedial measures. Toothache relief is considered one of the main responsibilities of dentists. Toothache is the most common type of pain in the mouth or on the face. Toothache is the most common reason for emergency dental visits. Historically, it is believed that the demand to treat toothache led to the emergence of dental surgery as the first specialty of medicine.

Examination and diagnosis of dental emergencies

Diagnosing tooth pain can be challenging, not only because the list of potential causes is extensive, but also because dental pain can be highly variable. It can be localised, diffuse or radiate far away making diagnosis much more difficult. Dental pain can mimic virtually any facial pain syndrome. However, the vast majority of toothache is caused by dental rather than non-dental sources. Consequently, the saying "horses, not zebras" has been applied to the differential diagnosis of orofacial pain. That is, everyday dental causes (such as pulpitis) should always be considered before unusual, non-dental causes (such as myocardial infarction). In the broader context of orofacial pain, all cases of orofacial pain can be considered as having a dental origin until proven otherwise. The diagnostic approach to tooth pain is generally carried out in the following sequence: history, followed by examination and investigation. All this information is then gathered and used to build a clinical picture and a differential diagnosis can be made.

How do we examine emergencies at Dentocalm?

Clinical examination narrows the source to a specific tooth, teeth or non-dental cause. The clinical examination moves from external to internal and from general to specific. Outside the mouth, the sinuses, facial and neck muscles, temporomandibular joints and cervical lymph nodes are palpated for pain or swelling. In the mouth, the soft tissues of the gums, mucosa, tongue and pharynx are examined for redness, swelling or deformities. Finally, the teeth are examined. Each tooth that may be painful is impacted (knocked), palpated at the base of the root and probed with a dental explorer for tooth decay and a periodontal probe for periodontitis, then moved for mobility.

Sometimes the symptoms reported in the history are misleading and point the examiner to the wrong area of the mouth. For example, sometimes people may confuse pain from the pulp of a lower tooth with pain from the upper teeth and vice versa. In other cases, the apparent results of the examination can be misleading and lead to a wrong diagnosis and treatment. The pulp from a pericoronal abscess associated with a lower third molar may ooze along the submucosal plane and discharge over the tooth roots to the front of the mouth (a "migrating abscess"). Another example is tooth root decay that is hidden from view below the gum line, giving the incidental appearance of a healthy tooth if a careful periodontal examination is not performed.

Factors that indicate an infection include fluid movement in the tissues during palpation (fluctuation), swollen lymph nodes in the throat and fever with an oral temperature greater than 37.7 °C.

Prevention of dental emergencies

Since most toothaches are the result of plaque-related diseases such as tooth decay and periodontal disease, most cases could be prevented by avoiding a cariogenic diet and maintaining good oral hygiene. That means reducing the number of times a day refined sugars are consumed and brushing teeth twice a day with fluoride toothpaste and interdental cleaning. Regular visits to the dentist also increase the likelihood that problems will be detected early and prevented before toothache occurs. Dental trauma could also be significantly reduced by the routine use of mouthguards in contact sports.

Types of pain, by cause

Tooth pulp pain

Most pulpal toothache falls into one of the following types; however, other rare causes (which do not always fall into these categories) include galvanic pain and barodontalgia.

Dental pulpitis

Pulpitis (inflammation of the pulp) can be triggered by various stimuli, including mechanical, thermal, chemical and bacterial irritants or, rarely, barometric changes and ionising radiation. Common causes include dental caries, dental trauma (such as a crack or fracture) or a filling with an imperfect seal.

Because the pulp is encased in a rigid outer shell, there is no room to accommodate swelling caused by inflammation. Inflammation therefore increases the pressure in the pulp system, potentially compressing the blood vessels supplying the pulp. This can lead to ischaemia (lack of oxygen) and necrosis (tissue death). Pulpitis is reversible when the inflamed pulp is able to return to a healthy state (pulp hyperemia) and irreversible when the pulp tissue dies (serous pulpitis, purulent pulpitis, pulp necrosis).

Reversible pulpitis is characterised by short-lasting pain triggered by cold and sometimes heat. The symptoms of reversible pulpitis disappear when the harmful stimulus is removed such as when tooth decay is removed and a filling is placed,Over time, new layers of dentin (tertiary dentin) are produced inside the pulp chamber, which insulate against the stimulus. Irreversible pulpitis causes spontaneous and persistent pain in response to cold.

Dentin hypersensitivity

Dentine hypersensitivity is a sharp, short-lived toothache that occurs in about 15% of the population and is triggered by cold (such as liquids or air), sweet or spicy foods and drinks. Teeth will normally have some sensation to these triggers, but what separates hypersensitivity from ordinary tooth sensation is the intensity of the pain. Hypersensitivity is most commonly caused by a lack of isolation from triggers in the mouth due to gum recession (gum recession) exposing the roots of the teeth, although it can occur after scaling and root planing or tooth whitening, or as a result of erosion. The pulp of the tooth remains normal and healthy in dentinal hypersensitivity.

Many topical treatments for dentin hypersensitivity are available, including desensitising toothpastes and protective varnishes that cover the exposed dentin surface The treatment of choice is laser desensitisation. Treatment of the root cause is essential as topical measures are usually short-lived. Over time, the pulp usually adapts by producing new layers of dentin within the pulp chamber called tertiary dentin, increasing the thickness between the pulp and the exposed dentin surface and decreasing hypersensitivity.

Periodontal pain

In general, chronic periodontal disease does not cause pain. Rather, it is the acute inflammation that is responsible for the pain.

Apical periodontitis / abscess caused by infection in the tooth canal

Apical periodontitis is an acute or chronic inflammation around the apex of a tooth caused by an immune response to bacteria inside an infected pulp. . Bacterial cytotoxins reach the region around the roots of the tooth through the apical foramina (apex of the tooth) and lateral canals, causing vasodilation, nerve sensitisation, osteolysis (bone resorption) and potentially abscess or cyst formation.

The periodontal ligament becomes inflamed and there may be pain when biting or knocking on the tooth. On an X-ray, bone resorption appears as a dark area around the root end, although it does not show up immediately. Acute apical periodontitis is characterised by well-localised, spontaneous, persistent, moderate to severe pain. The tooth may be raised in the socket and feel more prominent than adjacent teeth.  

Impact of food

Food impaction occurs when food debris, especially fibrous foods such as meat, gets stuck between two teeth and is pushed into the gums during chewing. The common cause of food impaction is a lack of normal contour between two neighbouring teeth. Decay can lead to the collapse of part of the tooth or a dental restoration may not accurately reproduce the contact point. This results in irritation, localised discomfort or mild pain and a feeling of pressure between the two teeth. The gingival papilla is swollen, tender and bleeds to the touch. The pain occurs during and after a meal and may slowly disappear before being evoked again at the next meal or may be relieved immediately by using a toothpick or floss in the area involved. A gingival or periodontal abscess may develop from this situation.

Periodontal abscess

A periodontal abscess (lateral abscess) is a collection of pus that forms in the gingival fissures, usually as a result of chronic periodontitis in which the pockets are pathologically deepened more than 3 mm. A healthy gum pocket will contain bacteria and some tartar kept in check by the immune system. As the pocket (the periodontal pocket around the tooth) deepens, the balance is disturbed and an acute inflammatory response results, forming pus. Debris and swelling then disrupt the normal flow of fluids in and out of the periodontal pocket, rapidly accelerating the inflammatory cycle. Larger periodontal pockets are also more likely to collect food debris, creating additional sources of infection.

Periodontal abscesses are less common than apical abscesses, the key difference between the two is that the pulp of the tooth tends to be alive and will respond normally to pulp tests as it is not the cause of the infection but the collections in the periodontal pockets (the gum around the tooth) However, an untreated periodontal abscess can still cause the death of the pulp if it extends to the tip of the tooth. A periodontal abscess can occur as a result of tooth fracture, food debris in the periodontal pocket (with poorly contoured fillings), tartar build-up and decreased immune response (such as in diabetes). Periodontal abscess can also occur after incorrectly performed periodontal scaling, which causes the gums to clench around the teeth and trap debris in the pocket. Tooth pain caused by a periodontal abscess is generally deep and throbbing. The oral mucosa covering an early periodontal abscess appears erythematous (red), swollen, shiny and painful to the touch.

A variant of periodontal abscess is gingival abscess, which is confined to the gum line, has a more rapid onset and is usually caused by trauma from objects such as a fish bone, toothpick or toothbrush, rather than chronic periodontitis. The treatment of a periodontal abscess is similar to the management of dental abscesses in general. However, because the tooth is usually alive, there is no difficulty in accessing the source of infection and therefore antibiotics are more commonly used in conjunction with scaling and root planing. The appearance of a periodontal abscess usually indicates advanced periodontal disease, which requires proper management to prevent recurrent abscesses, including daily cleaning below the gum line to prevent the build-up of subgingival plaque and tartar.

Acute necrotising ulcerative gingivitis

Common marginal gingivitis in response to subgingival plaque is usually a painless condition. However, an acute form of gingivitis/periodontitis, called acute necrotizing ulcerative gingivitis, can develop suddenly. This is associated with severe periodontal pain, bleeding gums, 'perforated' ulcerations, loss of interdental papillae and possibly halitosis (bad breath) plus an unpleasant taste. Factors that can induce it include poor oral hygiene, smoking, malnutrition, psychological stress and immunosuppression. The condition is not contagious, but multiple cases may occur simultaneously in populations sharing the same risk factors (such as students in a dormitory during an exam period). The condition is treated over several visits, first with debridement of necrotic gums, home care with hydrogen peroxide mouthwash, analgesics and, when the pain has subsided sufficiently, cleaning below the gum line, both professionally and at home. Antibiotics are not indicated in the management of this condition unless there is underlying systemic disease.

Perichoronarditis

Perichoronitis is an inflammation of the soft tissues surrounding the crown of a partially erupted tooth. The lower wisdom tooth is the last tooth to erupt and is, therefore, more commonly impacted than the other teeth. The lack of space for the eruption of the wisdom molar leaves the partially erupted tooth in the mouth and frequently there is a flap of gum covering the tooth. Bacteria and food debris accumulate under this covering gum (operculum), which is a difficult area to keep clean because it is hidden and very recessed in the mouth.

Also, the opposing upper wisdom tooth tends to have sharp cusps (tips) and erupt excessively because it has no opposing tooth to bite into, and instead further traumatizes the operculum. Perichoronitis can develop on either the third or second molar, and chronic inflammation develops in the soft tissues. Chronic pericoronitis may not cause any pain, but an acute episode of pericoronitis is often associated with the formation of a pericoronal abscess. Typical signs and symptoms of a pericoronal abscess include severe, throbbing pain that may radiate to adjacent areas of the head and neck, redness, swelling and tenderness of the gum above the tooth. There may be trismus (difficulty opening the mouth), facial swelling and flushing (redness) of the cheek covering the angle of the jaw. People usually develop pericoronitis in their late teens after the age of 18 because this is the age at which wisdom teeth erupt.

Treatment for acute conditions includes cleaning the area under the operculum with an antiseptic solution, analgesics and antibiotics if indicated. Once the acute episode has been controlled, definitive treatment is usually by extraction of the tooth or, less commonly, removal of soft tissue (operculectomy). If the tooth is retained, good oral hygiene is necessary to keep the area free of debris to prevent recurrence of infection.

Occlusal trauma

Occlusal trauma results from excessive biting forces exerted on the teeth, which overload the periodontal ligament, causing periodontal pain and a reversible increase in tooth mobility. Occlusal trauma can occur with bruxism, clenching and parafunctional (abnormal) grinding of teeth during sleep or wakefulness. Over time, attrition (tooth wear) can occur, which can also cause dentinal hypersensitivity and possibly periodontal abscess formation, as occlusal trauma causes adaptive changes in the alveolar bone.

Occlusal trauma often occurs when a newly placed dental restoration is built too "high up", concentrating biting forces on a single tooth. Height differences measuring less than one millimetre can cause pain. Therefore, dentists routinely check that any new restoration is in harmony with the bite and that the forces are correctly distributed over several teeth using articulating paper. If the high point is removed quickly, the pain disappears and there is no permanent damage. Over-tightening braces can cause periodontal pain and occasionally a periodontal abscess.

Alveolar osteitis

Alveolar osteitis is a complication of tooth extraction (especially lower wisdom teeth) in which the blood clot fails to form or is lost, leaving the socket in which the tooth lies empty and the bare bone is exposed in the mouth. The pain is moderate to severe and is dull, aching and throbbing. The pain is localised to the socket and may radiate. It normally begins two to four days after extraction The treatment of choice is by laser-assisted bone disinfection accompanied by dressings with local anaesthetic and disinfectants and antibiotics, which are usually required for five to seven days. There is some evidence that chlorhexidine mouthwash used before extractions prevents alveolar osteitis.


dental emergencies Cluj > dentistry emergencies > dentistry children non-stop > emergency services Cluj > dental emergencies Cluj > emergency reception Cluj > dentistry non-stop > dental clinic non-stop > emergency dentistry > dentist emergency > dentist emergency > toothache > dental pain

Dental emergencies. What do you need to know? How can you prevent it?

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