ER or Not: Severe Toothache

Interviewer: All right. It's time to play along and see if you know the answer to today's "ER or Not" with emergency room physician Dr. Jeffrey Druck. Dr. Druck, are you ready?

Dr. Druck: I am. Let's have it.

The Scenario: Severe Toothache

Interviewer: All right. Here we go. It's a Sunday morning, and I get this killer toothache. So obviously my dentist's office isn't open. ER or not?

Managing Toothache in the ER

Dr. Druck: You know, that's a pretty common presentation that we have in the emergency department. And in general, you know, part of the problem that we have is that we are not dentists. And so the amount that we can do for a toothache is sort of focused more on what's the main cause and whether there's an infection in terms of treating it with antibiotics and then obviously pain control. But in terms of definitive treatment, in terms of making a difference long term, we can't pull a tooth. We don't have that skill set. And so we aren't able to do some of the things that your dentist needs to do, and honestly, the dentist is definitely the best place to go.

Now we definitely can address pain control. We can do some things in terms of a dental block or a tooth block. And we obviously have the ability to prescribe pain medications. But that being said, for long-term care, there's no question that the dentist is the right place to go.

Now there are some other concerns that you always have, and one of those is whether you have a dental abscess and that's an infection that's arising around the root of the tooth. And that's something that we can definitely address a little bit more abruptly in the emergency department, but we're still going to send you back to your dentist to get that definitive care.

Options for Pain Relief in Urgent Care

Interviewer: What about urgent care? Could urgent care do just the same things for a person with a toothache that the emergency department could?

Dr. Druck: Definitely, definitely. They have the ability to prescribe pain medications, and they have the ability to do dental blocks. And so that really would be a better place to go if you're just having a toothache.

ER for Facial Swelling and Fevers

Now if you start having any facial swelling, if you start running high fevers, or things like that, an emergency department might be a better place for you.

Interviewer: And why is that?

Dr. Druck: Well, because the concern would be that you have a systemic infection or that that infection has spread beyond just to that tooth and is actually getting into your bloodstream. That would be the first sign of sepsis, which is something that we get very concerned about in terms of it causing long-term consequences that might result in some serious issues that you would need IV antibiotics, which most urgent cares don't have the ability to do for you.

Follow-up with a Dentist

Interviewer: So Dr. Druck, ER or not, toothache, what is your final diagnosis?

Dr. Druck: Probably not. Those people should do urgent care unless they have facial swelling or fevers. Otherwise, really making sure they follow up with their dentist is the right way to go.