What is the emergency management for a patient with cracked tooth pain and facial swelling?

From the Guidelines

Emergency management for a patient with cracked tooth pain and facial swelling requires prompt dental evaluation while providing immediate pain relief and addressing potential infection. The patient should start with over-the-counter analgesics such as ibuprofen 400-600mg every 6 hours (not exceeding 3200mg daily) or acetaminophen 500-1000mg every 6 hours (maximum 4000mg daily) as suggested by general medical guidelines 1. For suspected infection causing the facial swelling, empiric antibiotic therapy is warranted, typically amoxicillin 500mg three times daily for 7 days, or clindamycin 300mg four times daily for 7 days if penicillin-allergic, although specific recommendations may vary based on the severity of the infection and patient's medical history 1. Some key considerations in managing dental trauma include:

• Apply cold compresses to the affected area for 20 minutes on, 20 minutes off to reduce swelling
• Avoid chewing on the affected side
• Maintain a soft diet
• Rinse with warm salt water (1/2 teaspoon salt in 8oz warm water) several times daily
• Avoid very hot or cold foods/beverages that could trigger pain Urgent dental consultation within 24-48 hours is essential as the cracked tooth requires definitive treatment, which may include root canal therapy, crown placement, or extraction depending on the extent of damage, and facial swelling may indicate spreading infection that could become life-threatening if it extends to deeper facial spaces, making timely intervention crucial 1.

From the Research

Emergency Management for Cracked Tooth Pain and Facial Swelling

• The first step in managing a patient with cracked tooth pain and facial swelling is to diagnose the source of pain and identify the underlying cause 2.
• A thorough examination, including firm percussion, should be performed to assess for tenderness and progression of infection into the subdental tissue 3.
• Localized facial swellings of dental origin require immediate referral to a dentist, while progressive facial swelling requires aggressive antibiotic therapy and referral to hospital for definitive management 3.

Pain Management

• Pain management for cracked tooth syndrome can be achieved through the use of non-narcotic analgesics, such as non-steroidal anti-inflammatory drugs (NSAIDs) or paracetamol, as an adjunct to dental treatment 2.
• Opioids, such as codeine, may be reserved for severe pain only, due to their significant side effects 2.
• Corticosteroids can also be used for managing inflammation, but their use in dentistry is limited to specific situations 2.

Restorative Options

• Restorative options for the management of cracked tooth syndrome include various materials and techniques, such as reinforced zinc-oxide-eugenol, acid-etch composite resin, and glass-ionomer cement 4.
• The choice of restorative material and technique depends on the severity of the crack and the patient's symptoms.

Antibiotic Therapy

• Systemic antibiotics are currently only recommended for situations where there is evidence of spreading infection or systemic involvement, such as fever or malaise 5.
• There is very low-quality evidence to determine the effects of systemic antibiotics on adults with symptomatic apical periodontitis or acute apical abscess, and their use should be based on clinical judgment and guidelines 5.