oral saline rinses (if age appropriate), and antibiotic therapy Amoxicillin or amoxicillin with clavulanate are the antibiotics of choice Alveolar Osteitis Alveolar osteitis, or dry socket, is a painful postoperative condition produced by a disintegration of the blood clot in the tooth socket This condition is usually seen in adults and only rarely in children younger than 12 years It generally occurs approximately 72 hours after mandibular extractions and results in throbbing pain Emergency dental treatment is variable, but the immediate goal is relief of pain Under local anesthesia, the socket may be debrided and then packed with ¼in iodoform gauze or BIPP (bismuth, iodoform, paraffin paste) Oral analgesic including nonsteroidal anti-inflammatory (NSAID) medications should be prescribed for pain Since it is an osteitis, antibiotics should be reserved for cases that present with infection, rather than inflammation alone PERIODONTAL SOFT TISSUE PATHOLOGY Goals of Treatment Soft tissue pathology may be painful and mistaken for odontalgia or dentoalveolar abscess The goal is to alleviate any pain and discomfort Referral to a dental specialist may be required Emergency treatment for pericoronitis includes local curettage, oral rinses, such as 0.12% chlorhexidine, heat, and scrupulous oral hygiene Amoxicillin or amoxicillin with clavulanate may be necessary when there are systemic symptoms of infection or associated facial swelling For patients with infection of the oral mucosa unrelated to the dentition, distinguishing bacterial versus viral etiology is important to direct subsequent therapies CLINICAL PEARLS AND PITFALLS The first priority is to rule out odontalgia and dentoalveolar abscess as sources of pain Pericoronitis is common with the eruption of permanent molars Acute necrotizing ulcerative gingivitis (ANUG) is extremely rare in young children, but when present can be easily mistaken for primary herpetic gingivostomatitis Primary herpes is usually seen in infants and toddlers, and ANUG is characteristically seen in adolescents and young adults