Q: I recently visited a local ER for an excruciating tooth ache. All they did was give me Motrin and an antibiotic and told me to see my dentist. Neither of the meds worked and I could not get to a dentist until after the Thanksgiving holiday. Should they not have done something better for me? What is proper ER dental emergency protocol?
A: When I was in my residency years at Beth Israel Medical Center in Manhattan back in the late 80’s, a man walked in claiming he had a tooth ache. We took an X-ray and found no dental problem at all. He explained that he “hears voices.” I asked him: “what are the voices saying?” He replied: “They are telling me that I need a foot long sub with roast beef and Swiss with a little mayo, no onion.” (We had a huge homeless situation in NY back then.) One day I will tell you the story of the woman who walked into the ER with grass growing out of her. (I could write a book.)
ER Dental Emergency Protocol
I am very sorry for your predicament. Unfortunately, most ER’s are not equipped for handling dental emergencies. (No dental X-ray units, no drills, no extraction forceps, nothing.) Unless they are a teaching hospital with a dental residency program. Only a handful of hospitals fit this category. Some have a dentist on staff, like JFK where I am on staff, but still no dental operatory to perform any dental procedure what so ever in the ER. This means you must get to a dental office. Referrals to oral surgeons are for broken jaws and infections that have spread to the face, neck and floor of the mouth, under the tongue. Most folks need to see a general dentist ASAP.
I was invited to speak to the ER staff on January 18th, 2018 on how to handle dental emergencies in the ER. Medical schools spend on average seven minutes on the oral cavity; I will give the docs a whopping fifteen minutes! (Break out the diplomas!)
One of the misconceptions committed by ER staff is that every patient with a tooth ache needs to walk out with an antibiotic. This is wrong. Without a dental X-ray, one cannot tell if a patient is suffering from an endodontic abscess or a periodontal abscess, (gum or tooth/root canal infection.) Nor can they see if a foreign body is stuck between the teeth or a myriad of other dental problems which do not warrant an antibiotic. A dental X-ray is required to decide which antibiotic is warranted. Penicillin is not always the drug of choice. Mostly, antibiotics are warranted if facial swelling is noted.
I have a bunch more items on my Dental ER Protocol “cheat- sheet” which I will be sharing with local ER departments. If you want a copy, just drop me an email.
The voices in my head are telling me I will be having a Ruben for lunch.
Dr. Mitchell Josephs practices Implant, Cosmetic and General Dentistry with an emphasis on implants, porcelain veneers, and complex crown and bridge treatment. He is on staff at JFK Medical Center and is a Faculty Advisory Board member at McGill University’s Faculty of Dentistry. He completed his residency at Manhattan’s Beth Israel Medical Center and Mt. Sinai Hospital.