Dental Emergencies

Patients with dental complaints commonly present to the emergency department for initial management. Immediate airway assessment and stabilization as needed are imperative. Based on clinical signs and symptoms, providers may assess the degree of dental decay and make an appropriate referral. Nonsteroidal antiinflammatory drugs are effective for most dental pain, and antibiotics are not indicated in the absence of overt infection. Emergency providers may drain simple odontogenic abscesses, but referral for definitive endodontic therapy is still required. Abscesses may extend into the deep fascial spaces of the face and neck. When “red flag” findings are seen, it is critical to protect the airway and obtain early consultation with specialists, along with advanced imaging and likely admission for drainage and intravenous antibiotics. Complications such as Ludwig angina, vascular erosion, and necrotizing fasciitis may lead to significant morbidity and mortality in otherwise healthy patients. Gingivitis and periodontitis are typically chronic, slowly progressing diseases but also have acute necrotizing variants that require antibiotics and prompt dental follow-up. Dentoalveolar fracture