ED Pathway for Dental Trauma or Infection URL: https://www.chop.edu/clinical-pathway/dental-trauma-or-infectionclinical-pathway Authors: E Szydlowski, MD; M Herring, MD; K Castelo, CRNP; B Pagliaro, RN; H Giannakopoulos, DDS, MD; E Hajishengallis, DDS, PhD Posted: August 2019 CLINICAL PEARLS AND PITFALLS Children often cannot distinguish between tooth pain and soft tissue pain from a lesion such as an aphthous ulcer (canker sore ) A careful intraoral examination should be performed to identify the source of the discomfort In the case of significant swelling secondary to infection, consider hospitalization for parenteral antibiotics to halt the potentially dangerous spread of facial infection Establishing drainage through the tooth or soft tissue is important to relieve the symptoms from an abscess, typically in conjunction with analgesics and antibiotics Heat can be applied extraorally for symptomatic relief, without concern for the development of an extraoral sinus tract Odontalgia—Simple Toothache Toothaches are common in the pediatric population The National Health and Nutrition Examination Survey (NHANES) data found that 42% of to 11 year olds have had caries in their primary teeth and 23% have unmet dental needs In addition, 21% of to 11 year olds have had caries in their permanent teeth Minorities and low-income populations have the greatest dental needs and are also least likely to seek dental care Presentation to the ED with odontalgia is common Tooth pain may be present without associated infection The emergency physician may note a grossly carious tooth or large restoration (i.e., filling) or ascertain a history of dental treatment Swelling or inflammation in the surrounding soft tissue may be present The tooth may be sensitive to percussion