Dental Toothache
Disclaimer
These guidelines have been produced to guide clinical decision making for the medical, nursing and allied health staff of Perth Children’s Hospital. They are not strict protocols, and they do not replace the judgement of a senior clinician. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline.
Read the full CAHS clinical disclaimer
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Aim
To guide staff with the assessment and management of toothache.
To recognise and treat those patients who need immediate review because of significant pain and appropriate referral for those who do not need immediate review.
Background
- PCH has a tertiary medical risk dental clinic but does not provide routine dental care for children. Refer to Dental Services (ED Guideline).
- Patients presenting with severe toothache associated with indicators of infection, require expedient treatment, often involving antibiotic prescription and may require admission. The Dental Department or on‐call Dentist must be contacted for these cases. Refer to Dental Department – (Internal WA Health only)
- Patients with intermittent toothache not associated with signs of acute infection should be referred to an appropriate dental provider for non‐emergency dental management.
- Please see Dental Services external to Perth Children’s Hospital for contact details of appropriate dental service providers.
Management
Child presents with toothache
Does the child present with indicators of infection?
- Fever
- Facial swelling
- Gum swelling
- Obvious abscess
- Severe pain not relieved by simple analgesia
- Woken from sleep by dental pain
- Recent antibiotics for same problem
- Recent unsuccessful attempt to manage same problem.
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Contact dental department 6456 3727 during office hours.
- After hours contact on call dentist.
- Analgesia
- Consider a KKIND (Keeping Kids in No Distress) e-referral if the child is to be admitted.
Consider topical local anaesthetic (EMLA®) if IV antibiotics required
- Nil by mouth.
Consider orthopantomogram (OPG) (discuss with ED consultant or dentist).
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- Provide appropriate analgesia
- Refer to the appropriate dental provider:
- Private General Dentist (Family Dentist)
- Specialist Paediatric Dentist
- School Dental Clinic
- Metropolitan Dental Clinic
- Oral Health Centre of WA
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| Endorsed by: |
Nurse Co-Director, Surgical Services |
Date: |
April 2025 |
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