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pem pearl: dental pain

Here is a review of management of pediatric dental pain in children.  Dental pain can affect over 1/3 of children and is often classified as severe (7-8/10). 
Causes of pain:
  • Dental caries (brushing with fluoride toothpaste is one of the primary preventative measures to avoid caries)
  • Pulpitis: untreated caries, trauma, multiple restorations and leads to bacterial superinfection
  • Trauma
Analgesia: 
  • NSAIDS (ibuprofen) outperformed acetaminophen in several studies
  • Alternating or combination therapy outperformed placebo (yep...)
  • Opioids are contraindicated, especially under 12 years of age 
Antibiotics: only if infection evident locally (cellulitis, neck abscess) or if there are systemic infectious symptoms (fever and/or swollen lymph nodes from hematologic or lymphatic spread)
  • Amox/clav is preferred if there are signs of infection
  • Amoxicillin: can also be used if definitive dental treatment is delayed or as prophylaxis in other higher risk situations (immunocompromised)
Bottom Line: dental pain is a common problem and can be quite uncomfortable. The current best analgesic recommendations are for ibuprofen and acetaminophen. Antibiotics are indicated only if there are active signs of infection or if patient has increased risk for developing an infection (delay to seeing dentist or immunocompromised)

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ABOUT US

Curriculae
Orientation
Salary & Benefits
Training Sites
Resident Life
PEM Fellowship

WHO WE ARE

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WHAT WE DO

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Tactical Medicine
Wilderness Medicine
EMS
Ski Patrol
Ultrasound

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LasVegasEMR.com is neither owned nor operated by the Kirk Kerkorian School or Medicine at UNLV . It is financed and managed independently by a group of emergency physicians. This website is not supported financially, technically, or otherwise by UNLVSOM nor by any other governmental entity. The affiliation with Kirk Kekorian School of Medicine at UNLV logo does not imply endorsement or approval of the content contained on these pages.

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  • Home
  • About Us
    • Curriculae
    • Orientation
    • Salary & Benefits
    • Training Sites
    • Resident Life
    • PEM Fellowship
  • Who We Are
    • Faculty
    • Residents >
      • PGY1
      • PGY2
      • PGY3
    • PEM Fellows
    • Alumni
  • What We Do
    • Events Medicine
    • Tactical Medicine
    • Wilderness Medicine
    • EMS
    • Ski Patrol
    • Ultrasound
  • Students
    • Residency Applicants
    • Military Applicants
    • Diversity & Inclusion
    • Social EM Elective
    • URM Second Look
  • Research
    • Recent Research & Publications
    • Research Assistant Program
  • VegasFOAM
  • Student Evaluations
  • Pediatric Pearls
  • Faculty