26 Pain control and carious primary teeth
What questions do you need to ask regarding the pain?
Onset – what causes it? Is it in response to hot, cold or sweet stimuli, or does it occur spontaneously? Does it wake him up from sleep?
The characteristics of the pain of reversible and irreversible pulpitis are shown in Table 26.1.
| Reversible | Irreversible |
|---|---|
| Transient or short duration (minutes) | Long duration |
| Response to hot, cold, sweet | Response to pressure (chewing) |
| Sharp | Spontaneous |
| Doesn’t stop play or sleep | Throbbing |
| Stops play or sleep |
What dressings can help manage pulpitis initially?
After gentle excavation of the softest layer of coronal caries:
Poly-antibiotic and steroid pastes (e.g. Ledermix) placed underneath zinc oxide eugenol cement or glass ionomer cement (GIC).
An acute and/or spreading infection or swelling may require the prescription of antibiotics. This is discussed in Chapter 27. Antibiotics should only be prescribed for pain in the absence of swelling for immunosuppressed patients. Analgesics may be necessary for pain (Table 26.2).
| Drug | Dosage |
|---|---|
| Paracetamol | 20 mg/kg initially then 15 mg/kg every 4 hours |
| Maximum 24-hour dosage 90 mg/kg | |
| Ensure adequate hydration | |
| Ibuprofen (Non-steroidal anti-inflammatory drug (NSAID)) | 5–10 mg/kg every 8 hours |
| Can be used in conjunction with paracetamol | |
| Best given with food and drink |
Dressing open cavities has a number of advantages:
Oral mutans streptococci count is reduced when excavation of gross caries is accomplished. If the cavity is then completely sealed by a GIC there is evidence that the viability of the remaining organisms decreases and caries progression is greatly reduced. This buys the dentist time to institute preventive and behaviour management programmes before reassessing teeth w/>
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