giovedì 20 novembre 2008

Better dental care promised for kids next year

Queen's Park Bureau

Ontario's underprivileged children should receive better access to dental care in 2009, Health Minister David Caplan said yesterday.

Complications from tooth decay, a disease affecting 6 to 10 per cent of all pre-schoolers, are an urgent problem that requires immediate preventive action, according to a new report from the Ontario Dental Association, the group representing 7,000 dentists.

Those most at risk for suffering from rotting teeth are low-income children who do not have access to dental care. For 10 years, the association has pressed the government to improve the Children in Need of Treatment program, which they say addresses only catastrophic dental needs for kids. Coverage kicks in only when the damage is already done, they say.

The government is aware of the program's limitations and is working to "expand the eligibility," Caplan told reporters.

"Although I haven't read the report from the (dental association) ... I do understand they make the case it is not just treatment but prevention that does need to be taken into account and we certainly agree. We do want to extend treatment and support for prevention."

In addition, the Liberal government's anti-poverty strategy, to be unveiled in December, will include a $135 million dental package promised earlier in the budget.

The dental association's report pointed out that tooth decay is the most common chronic childhood disease.

Dr. Larry Levin, president of the association, said there has been talk of increasing to 18 the age limit of kids covered under the Children in Need of Treatment program but that needs to be done in conjunction with improving preventive care.

"The preventative piece we feel is a key element to improve the lives of kids in Ontario," he said. "We can't keep repairing."

sabato 15 novembre 2008

Dental treatment plan to be scrapped

A scheme to help low income earners get dental treatment is to be scrapped despite an outcry from dentists.

The Government claims not enough people have shown an interest in the scheme which offers financial help.

But Association for Oral Health Chairman Hans Zoellner says the Government has been doing its best to make sure they don't even know about it.

Most of the 2 million Australians who are eligible don’t know about it and anybody who did know about it and was using the scheme got a letter incorrectly saying that the scheme was closed and threatening that if the scheme was halfway through a course of care medicare might just not pay.”

lunedì 10 novembre 2008

The relationship between oral health

Excerpt from
The relationship between oral health
and life expectancy

Many people may not understand how oral health may affect life expectancy. So the first step would be to recognise the mouth as a major gateway into the human body. It is the
upper part of the digestive system and has a structure that prepares food for the first phase of digestion.

The mouth contains the tongue, teeth, hard and soft palate, and gum, salivary glands and the mucosa.

The body has various inter-connected systems of organs. This means that if there is a problem with one part of the body, it may affect other parts. A disease of any part of the mouth
may be associated with some other organs in other parts of the body.

A person with gum infection may suffer from general body malaise and loss of appetite. A person with tooth ache may
also suffer from severe headache and earache.

Several diseases affecting the general health of the body have been linked to the health of the parts of the mouth.

venerdì 12 settembre 2008

Tips for Choosing the Right Dental Products

With so many dental products available, it can be overwhelming trying to choose which ones to buy.

Brushing twice a day, flossing daily and regular dental check ups are the key factors in maintaining a healthy mouth and avoiding dental problems.

The tips listed here will help you in choosing important dental products.

Choosing a Toothbrush

Any toothbrush that you choose should have soft bristles and feel comfortable in your hand. Choosing between a manual and an electric toothbrush is a decision that you can make depending on your lifestyle and situation.

# Manual Toothbrushes

If you prefer a manual toothbrush, make sure that the tip is small enough to reach all areas of your mouth easily. For children, be sure to choose a child size toothbrush with soft bristles. A manual toothbrush works just fine using the recommended back and forth brushing motion.

# Electric Toothbrushes

People with arthritis or arm and shoulder problems might prefer an electric toothbrush for convenience as well as comfort.

If purchasing an electric toothbrush, be sure that the head is soft and the bristles move in a back and forth motion.

Dental Floss

Whether you choose regular dental floss or dental flossers depends on your personal convenience and comfort. They are both designed to remove cavity causing plaque and food debris from in between your teeth.

When flossing with either product, be sure to gently insert the floss in between the teeth, without snapping, which could damage the gum tissue. Gently move the floss up and down into the spaces between the gum and teeth moving towards the gumline. Floss each side of your tooth, even if there isn't a tooth next to it.

# Dental Flossers

I personally prefer to use a dental flosser because it seems to make flossing so much easier than conventional dental floss.

# Conventional Dental Floss

If you decide to use regular dental floss, tear off a piece at least 18 inches long and wind it around your two index fingers. Hold the floss tightly between your index fingers and thumbs and guide the floss softly in between your teeth.

# Floss Threader

If you have a fixed dental bridge in your mouth, you can floss underneath it using a floss threader. Floss threaders also work great for people who wear braces.


In June of 2007, the FDA issued a poisonous toothpaste alert for any toothpaste made in China. A week after this alert was issued, counterfeit tubes of Colgate toothpaste that possibly contain the deadly chemical Diethylene Glycol, were found in the United States. If you live in the United States, you can check dental products to make sure that they contain the seal of acceptance from the American Dental Association (ADA), which ensures that they have been tested and found to be safe. If you live outside of the United States, make sure that Diethylene Glycol is not listed in the ingredients of any toothpaste products that you are considering purchasing or using.

Choosing a toothpaste that contains fluoride, will help to prevent cavities. Some factors of choosing toothpastes are usually personal preferences, such as flavor, whitening, tartar control and price. If you have small children, you might want to try some fun flavored children's fluoride toothpaste. When applying toothpaste to your toothbrush, you only need to use about a pea size amount.


Mouthwash can be beneficial to kill germs and fight bacteria that can lead to cavities. A mouthwash containing fluoride can even help protect your teeth from cavities. Ingredients, flavor and price are factors to considering in choosing a mouthwash. Many mouthwashes contain alcohol, which can dry up the protective saliva in your mouth, so you may want to ask your dentist to recommend one for you. A mouthwash is a great dental product, but it cannot replace flossing and brushing. If you decide to use a mouthwash, be sure to use it in conjunction with brushing and flossing.

The Bottom Line

There are many dental products available to make brushing and flossing easier, but the bottom line is that you don't have to spend a lot of money to have good oral hygiene. Be sure to have regular check ups with your dentist and ask him / her for any personal recommendations on dental products if you have special conditions. Most dentists will also provide you with samples of various dental products. This is a great way to find out if you like a certain dental product before investing in it.

giovedì 28 agosto 2008

Do you need to find a dentist in London

Do you need to find a dentist in London

Due to difficulty of finding dentists in London and the surrounds of London, has been developed.

The aim of is to provide members of the public in the London area, and General Dental Practitioners in London, with a list of London Dentists.

Whether you are looking for an NHS London dentist, Private London dentist, London Cosmetic Dentist or even a London Emergency Dentist
london dentist

Each of the dentists in the London area listed on have a web site, and a link is provided through to their web site.

If you are a London dentist working in a London dental practice and would like to be listed on then please complete the form at the top of the page . can take no responsibility for any content, statements or offers made on the web sites of the various London Dentists.
London Dental Practice
Ravenscourt Dental Practice W6 0SL Holistic dental care in Ravenscourt near Hammersmith London holistic dentist
AllClear Dental Practice CR0 1UX All Clear general dentist in Whitgift Shopping Centre Croydon dentists
Linda Greenwall's Dental Practice NW3 2LL Linda Greenwall's Dental Practice at Heath Health Care - Hampstead London
Park View Dental NW10 implant dentist London NW10 cosmetic dentist North London dentist NW10
Brokley Dentist SE4 2AQ SE4 dentist London Cosmetic Dentist Brokley SE4 London dentist Brokley
Barbican Dental Care EC14 9ET
Dentist London, barbican dental care located in canary wharf, London
Barry Blooms Dental Practice W1G OPN
London dentist, Dental Practice in Cavendish Square, London
Battersea Dental Care SW11 4LY
dentist battersea, dentist london: Battersea Dental Care, Battersea
Cambridge Court Dental Practice W2 1UL
London dentist: The Cambridge Court Dental Centre in W2, London
Camden Dental Surgery NW1 7JL
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Carnaby Street Dental Practice W1V 1PQ
Mercury Free Dentist. West End Dentist. dentist in London
Clarke & Associates Dental Practice W4 4BH
Brentford, dentist Brentford, West London dentist
Corn Exchange EC3R 7NE
Cornhill exchange dental practice, london dentist W1
Dental Perfection NW3 6UG
Hampstead dentist, providing Nobel Biocare dental implants in London
DJJ Cowan NW9 9PL
Holistic dentist in Kingsbury for routine dentistry using holistic approach
Church Dental RH4 1JU
London Dentist. A team of dentists, located in the London area
Ella Clinic W1G 6LW
The Ella Clinic, dentist in London
Elite Orthodontics W1G 7BY
London Orthodontist. Elite Orthodontics near harley street in London
Farquharson London W1G 9PY
Harley street dentist, London. Cosmetic dentist in Harley St. London
Finchley Road Medical Centre NW11 7RX
London Medical Centre: Finchley Road Medical Centre in Golders Green.
Harcourt House Dental Practice W1G 0PN
zoom tooth whitening dentist Harley Street London
HK Dental Practice W1G 8YA
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Holford Partners Dental Practice W1G 0PL
London implant dentist in Cavendish Square near Harley Street, W1
Jenny Pinders Dental Practice SE26 4DJ
nervous of the dentist? Jenny Pinder, a dentist for phobics in London
Knightshill Dental Practice SE27 0SR
Dentist West Norwood : dentist South London : dentists London W1G 0PL
West End dentist Central London W1 dentist West End London
Medenta SW11 1TH
Cosmetic Dentist London Dentist Battersea SW11 and SW17 SW18
Millbank Dental Care SW1P 4PR
Pimlico Dentist, Westminster Dentist, SW1 dentist, London Dentist
Oracare Dental Practice HA8 6LD
Edgware dentist, Middlesex dentists, cosmetic dentist Edgware London
Phillip Davies W1N 1AF
Dentist harley street, London providing high quality dentistry in London
Sarah Burns Orthodontics TW9 3NL
Orthodontics Notting Hill orthodontist Notting Hill, London
Scarsdale Implant Clinic W8 6EF
dentist Kensington, implant dentist Kensington, implant dentist London
Southern Dental SE15 5RS
Maidstone dentist at Maidstone Dental Practice, dentist London
James Street W1U 1EQ The James Street Dental Practice, London
North Kensington W10 5NR NHS dentists, North Kensington,London
Implant and Cosmetic Dental Centre W1G 0PN Dental Implants and Cosmetic Dentistry for London
Tooth Implant Centre
SW6 6BS Dental Implants using BioHorizons Implant Systems in London
W8 4DB London Dentist in Kensington London
London Emergency Dentist London emergency dentist providing 24 emergency cover in London
Dr Forest & Ray
W1G 9PP Affordable London dentist in Harley Street, London save up to 70%.
My Local Dentists My Local Dentists is the leading Dental Directory for London Dentists
Church Hill Dentistry SM3 8NA Quality Dentistry at affordable Prices from a London Dentist in Cheam
Leather Lane Dental Practice EC1N 7TP The Leather Lane Dental Practice- 50 Leather Lane, London, EC1N
Chelsea dental and dermal clinic SW3 3NR Chelsea dental and dermal clinic, London, SW3 3NR
NW1 DentalCare NW1 Dentist Camden dentist at NW1 Dental Care 0207 485 4626
Nick & Polly Patsias BR3 2JE Polly Patsias Dental Practice a beckenham dentist in Kent, nr London
Family Dental Care E2 0QY Family dental care in Bethnal Green, E2 provided by Dr Karim Ali, E2 dentist
Century Dental Clinic SW15 6AW Putney Dentist SW15 London dentist in Century Dental Clinic in Ravenna Road
Contact London Dentist

If you'd like to have a link placed on to your web site, please complete the form below and click on the submit button, one of our team will then contact you:-

sabato 12 gennaio 2008

Homeopathy and Mercury-free dentistry

The uses of homeopathy in dentistry are manyfold. It is essential that the remedies used are provided by a qualified practitioner and that the remedies themselves are supplied by a bespoke manufacturer. Unfortunately, remedies from the high-street chains are can be less effective due to their lower strengths.
Homeopathic treatments in dentistry can help with fear, anxiety, surgical healing, pain, bruising and swelling. There are also remedies to help with periodontitis , teething babies, oral infection, and many other common oral conditions.
After a consultation and detailed discussion involving many aspects of the individual case history, remedies can be prescribed to treat the symptoms.Remedies are as equally effective in the old as the young and have no side effects.
Remedies are also used during mercury removal, along with other measures, to decrease the toxicity of mercury amalgam.
Mercury-free dentistry
The safety of the mercury contained within dental amalgam has been debated for many years. The use of dental amalgam is now prohibited in Sweden and Germany. Although no scientific evidence has yet conclusively proved the risk to health, it would seem sensible not to place a known poison into the mouth and leave it there for twenty years. It may also be worth noting that after placing an amalgam filling, the residual material cannot simply be disposed of in the normal bin-the residual amalgam must be disposed of in a special poisons container and then collected by a specialist removal company. The very same material that has just been placed into a person's mouth!
There are now many alternatives to the use of dental amalgam which are cosmetically superior and can be equally durable. At the Clock Tower Dental Clinic existing amalgam is removed carefully under rubber dam isolation and copious water irrigation. High-bore suction dramatically cuts down the emission of mercury vapour.
Homeopathic remedies are also used to decrease any toxicity.

mercoledì 26 dicembre 2007

Management of acute dental pain: a practical approach for primary health care providers

John Wetherell, Senior Lecturer, Lindsay Richards, Associate Professor, Paul Sambrook, Senior Lecturer, and Grant Townsend, Professor of Dental Science, University of Adelaide, Adelaide


A detailed history and examination will identify the cause of dentally-related pain in most emergency situations. Sharp, shooting pain can be caused by inflammation in the pulp or exposure of the dentine. Dull throbbing pain has several causes including ulcerative gingivitis, dental caries and food impaction. Simple treatment will usually alleviate the symptoms until patients can be seen by a dentist. Prescription of antibiotics is usually not indicated.

Key words: dental infections, sinusitis, temporomandibular joint.

(Aust Prescr 2001;24:144-8)

There is a comment for consumers on this article


General medical practitioners are often called upon to manage acute dental pain in emergency situations, for example, out of hours or in rural Australia, where it may not be possible for a dentist to provide immediate treatment. Common acute oral problems are usually easy to diagnose. Simple management can alleviate pain and further discomfort until a dentist can be called upon.

Most problems can be identified by the history and examination. Several dental conditions have typical symptoms with different types of pain.

History and examination

When investigating acute dental pain, the history should focus on the pain's:

  • location
  • type
  • frequency and duration
  • onset
  • exacerbation and remission (for example the response to heat or cold)
  • severity
  • area of radiation.

Associated pathology and referred pain should also be considered.

The following structures need to be examined carefully in order to be sure that the pain is of dental origin:

  • tongue
  • buccal mucosa
  • floor of the mouth
  • hard palate
  • teeth and periodontal tissues (see Fig. 1)
  • tonsils
  • temporomandibular joints
  • airway
  • ears
  • salivary glands
  • lymph nodes.

Which tests can assist in diagnosis?

There are several simple tests that may assist in diagnosis of dental pain.

Pulp sensitivity test

Dry ice, or an ordinary ice stick (made in a plastic or glass tube), is placed on the cervical third (neck region) of the tooth crown. A response to the stimulus indicates that the pulpal tissue is capable of transmitting nerve impulses. No response may indicate pulp necrosis.

Fig. 1

Diagram of a lower molar tooth

Percussion test

Using an instrument handle, the tooth is tapped in the longitudinal axis. A painful response suggests possible periapical inflammation.


Placing a fine, blunt probe gently into the gingival sulcus surrounding the tooth enables the health of the gingival tissues to be assessed. Bleeding and/or sulcus depths greater than 3-4 mm indicate gum disease.

Mobility test

Holding a tooth firmly on the buccal (cheek) and lingual sides between the fingers enables mobility to be assessed. All teeth have a small amount of mobility (<0.5>


Careful palpation around the area of concern may reveal tenderness and the type and extent of swelling.

Radiographic examination

If it is possible to obtain a screening radiograph, such as an orthopantomograph (OPG), this may assist in the diagnosis and localisation of the cause of the pain. The radiograph should show clearly the apical and periapical structures of teeth and associated tissues. The relationship of the maxillary molars and premolars to the floor of the maxillary sinus can be examined, and radiographs may reveal recurrent caries or periapical radiolucencies associated with an established infection (Fig. 2).

What are the common types of dental pain?

Common types of oro-facial pain likely to cause a patient to seek emergency care are categorised in Figure 3. The character of the pain can point to a diagnosis.

Short, sharp, shooting pain

This type of pain can be generalised or confined to one region of the mouth. The pain may be due to fluid movement through open tubules in the dentine or there may be some initial inflammatory changes in the dental pulp. It can be caused by caries, dentine exposure on root surfaces, split cusp, lost or fractured restoration or a fractured tooth.

Patients complain commonly of a sharp pain associated with hot, cold or sweet stimuli. The pain is only present when a stimulus is applied. In the case of a cracked cusp, grainy bread or hard food may create a sharp pain, that may be spasmodic, on biting or chewing.

With gingival recession, recent scaling, or tooth wear due to a high acid diet or gastric reflux, there may be generalised dentine sensitivity. However, with caries, fractured fillings and cracked cusps, the pain tends to be localised to the affected tooth.

Intermittent sharp, shooting pains are also symptomatic of trigeminal neuralgia, so care must be taken not to mistakenly label toothache as neuralgia.


For root sensitivity the use of a desensitising toothpaste and a reduction in acid in the diet will help resolve the symptoms. The use of a fluoride mouth-rinse may also help. In the case of caries, a lost filling or fractured tooth, coverage of the exposed dentine with a temporary restoration will usually relieve the symptoms.

Fig. 2

An orthopantomograph (OPG) showing extensive dental caries (radiolucent areas) affecting the crowns of several teeth, and abscess formation (radiolucent areas) around the periapical regions of the roots. Arrows show caries and abscess formation on two mandibular teeth.

Fig. 3

Causes of common types of dental pain

Dull, throbbing, persistent pain

This type of pain may have several causes. These include tooth problems, food impaction, pericoronitis, acute necrotising ulcerative gingivitis, temporomandibular disorder, or even maxillary sinusitus.

Painful tooth problems

The most common dental cause of dull, throbbing persistent pain is caries. In many cases this is recurrent and associated with an existing restoration. Where the pulp is affected irreversibly, necrosis may follow with possible development of a periapical infection. A fractured cusp involving the pulp, or a large deep restoration may also be associated with this type of pain. Affected teeth may be tender to percussion in the later stages of periapical inflammation.

There is considerable variation in the pain reported by patients, but it commonly starts as a sharp stabbing pain that becomes progressively dull and throbbing. At first the pain may be caused by a stimulus, but it then becomes spontaneous and remains for a considerable time after removal of the stimulus. The pain may radiate and be referred to other areas of the mouth. This type of pain tends to cause the patient to have difficulty sleeping and may be exacerbated by lying down. Heat may make the pain worse whereas cold may alleviate it. The pain may be intermittent with no regular pattern and may have occurred over months or years. If there is periapical infection present, patients may no longer complain of pain in response to a thermal stimulus, but rather of sensitivity on biting.


Treatment of affected teeth will involve either root canal therapy or tooth removal. In some patients, periapical inflammation can lead to a cellulitis of the face characterised by a rapid spread of bacteria and their breakdown products into the surrounding tissues causing extensive oedema and pain. If systemic signs of infection are present, for example, fever and malaise, as well as swelling and possibly trismus (limitation of mouth opening), this is a surgical emergency. Antibiotic treatment alone is not suitable or recommended (see box).

Should antibiotics be prescribed?

While antibiotics are appropriate in the management of certain dental infections, they are not indicated if the pain results from inflammatory (non-infective) or neuropathic mechanisms. The degree of pain is not a reliable indicator of acute infection.

There is evidence that Australian dentists and doctors are using antibiotics empirically for dental pain, rather than making careful diagnoses of the causes of the pain.1 Most dental emergency situations involve patients with acute inflammation of the dental pulp or the periapical tissues. Prescribing antibiotics for these conditions will not remove the cause of the problem nor destroy the bacteria within the tooth.

Antibiotics should be limited to patients with malaise, fever, lymph node involvement, a suppressed or compromised immune system, cellulitis or a spreading infection, or a rapid onset of severe infection.

If pus is present, it needs to be drained, the cause eliminated, and host defences augmented with antibiotics. The microbial spectrum is mainly gram positive including anaerobes. Appropriate antibiotics would include a penicillin or a `first generation' cephalosporin, combined with metronidazole in more severe cases.

Paracetamol or a non-steroidal anti-inflammatory drug is the recommended analgesic in the initial treatment of dental pain.

Food impaction and pericoronitis

Soft tissue problems that may cause dull, throbbing, persistent pain include local inflammation (acute gingivitis associated with food impaction) or pericoronitis.

Chronic periodontitis with gradual bone loss, rarely causes pain and patients may be unaware of the disorder until tooth mobility is evident. There is quite often bleeding from the gums and sometimes an unpleasant taste. This is usually a generalised condition, however, deep pocketing with extreme bone loss can occur around isolated teeth. Food impaction in these areas can cause localised gingival pain. Poor contact between adjacent teeth and the presence of an occluding cusp forcing food into this gap can also cause a build-up of food debris and result in gingival inflammation.

Acute pericoronitis involves bacterial infection around an unerupted or partially erupted tooth and usually affects the lower third molar (wisdom tooth). The condition is often aggravated by the upper molar impacting on the swollen flap of soft tissue covering the unerupted tooth. There may be trismus.


Food debris should be removed and drainage established, if pus is present. Irrigation with chlorhexidine and rinsing the mouth with hot salty water is recommended. Early referral to a dentist is indicated. Cellulitis can develop, requiring urgent referral to a surgeon.

Acute necrotising ulcerative gingivitis

Acute necrotising ulcerative gingivitis is a rapidly progressive infection of the gingival tissues that causes ulceration of the interdental gingival papillae. It can lead to extensive destruction. Usually young to middle-aged people with reduced resistance to infection are affected. Males are more likely to be affected than females, with stress, smoking and poor oral hygiene being predisposing factors. Halitosis, spontaneous gingival bleeding, and a `punched-out' appearance of the interdental papillae are all important signs.

The patients quite often complain of severe gingival tenderness with pain on eating and tooth brushing. The pain is dull, deep-seated and constant. The gums can bleed spontaneously and there is also an unpleasant taste in the mouth.


As there is an acute infection with mainly anaerobic bacteria, treatment follows surgical principles and includes superficial debridement, use of chlorhexidine mouthwashes and a course of metronidazole tablets. Treating the contributing factors should prevent a recurrence.

Dry socket

A dull throbbing pain develops two to four days after a mandibular tooth extraction. It rarely occurs in the maxilla. Smoking is a major predisposing factor as it reduces the blood supply. The tissue around the socket is very tender and white necrotic bone is exposed in the socket. Halitosis is very common.


The area should be irrigated thoroughly with warm saline solution. If loose bone is present, local anaesthesia may be necessary to allow thorough cleaning of the socket. Patients should be shown how to irrigate the area and told to do this regularly. Analgesics are indicated, but pain may persist for several days. Although opinion is divided as to whether or not dry socket is an infective condition, we do not recommend the use of antibiotics in its management (see box).

Temporomandibular disorders

Temporomandibular disorders may lead to pain that is confused with toothache. Patients usually complain of unilateral vague pain occurring in the joint area and in the surrounding muscles of mastication. If the patient bruxes (clenches or grinds) at night, then pain in the temporal area on waking is common. Patients who clench during the day may find they get symptoms at the end of the day. The symptoms are often cyclical, resolving then recurring again. On questioning, patients will frequently be able to reveal stressful incidents that may have triggered this process. Palpation of the muscles of mastication will elicit tenderness, usually unilaterally. There may also be tenderness around the temporomandibular joints, limitation in mouth opening and obvious wear of the teeth. This wear may contribute to dentine sensitivity, as the enamel is worn away by the tooth grinding. Wear facets will be seen on restorations as well as natural teeth. Quite often, neck and shoulder muscles are tender to palpation. There may be joint pain with clicking and grating.


Reassurance about the self-limiting nature of the problem and its reversibility may be all that is needed. Anti-inflammatory drugs and muscle relaxants can also help. Construction of a night-guard and muscle exercises may be indicated subsequently. These exercises may include gentle passive stretching, or resistance and clenching exercises.2


This is caused by infection of the maxillary sinus, usually following an upper respiratory tract infection. However, there can be a history of recent tooth extraction leading to an oro-antral fistula. Patients usually complain of unilateral dull pain in all posterior upper teeth. All these teeth may be tender to percussion, but they will respond to a pulp sensitivity test. There are usually no other dental signs.

The pain tends to be increased on lying down or bending over. There is often a feeling of `fullness' on the affected side. The pain is usually unilateral, dull, throbbing and continuous. Quite often the patient feels unwell generally and feverish.


Pain originating from the sinus arises mainly from pressure. Decongestants can help sinus drainage. Antibiotics probably have only a minor role in mild cases. Referral to an otorhinolaryngologist for endoscopic sinus surgery may be indicated in chronic cases.3

Managing dental trauma

Avulsed tooth

Avulsed deciduous (baby) teeth are generally not reimplanted, as they may become fused to the alveolar bone and impede subsequent emergence of the permanent successor.

It is essential to reimplant permanent teeth as soon as possible. However, while the tooth is out of the alveolus it should be stored in a physiological medium, for example, normal saline, milk, or the vestibule of the mouth.

Before reimplantation, the root surface should be cleaned gently with normal saline to remove debris, but the root should not be touched with the fingers. The tooth socket should be irrigated gently with normal saline to remove any blood clot that has formed. The tooth should then be replaced into the socket using minimal pressure, and splinted to the adjacent teeth with a flexible splint (e.g. aluminium foil, bluetack).

When a tooth is reimplanted, an antibiotic is prescribed for five days and a tetanus booster is given if immunisation is not up to date.

Fractured tooth

If the crown of a tooth is fractured by trauma and the broken fragment is available, it should be stored in a physiological medium until a dentist can assess the patient. Coverage of exposed dentine on the fractured crown with a temporary restoration is desirable to protect the underlying pulp tissue.

Placement of temporary restorations

Although it is unlikely that many general medical practitioners will have temporary filling materials available in their surgeries, dentine that has been exposed by caries, a lost filling or tooth fracture can be covered relatively easily with glass ionomer cement (GIC) or zinc oxide eugenol (ZOE) materials. Most GIC materials are dispensed in capsules but a hand-mixed material is available, consisting of a powder, liquid and conditioner. The surface of the cavity is painted with the conditioner, then rinsed and dried, before placement of the filling. Zinc oxide eugenol materials consist of a powder and liquid (oil of cloves) that are mixed to a putty-like consistency before placement in the tooth.



  1. Abbott PV. Selective and intelligent use of antibiotics in endodontics. Aust End J 2000;26:30-9.
  2. Okeson JP. Management of temporomandibular disorders and occlusion. 4th ed. St. Louis: Mosby; 1998.
  3. Wormald PJ. Treating acute sinusitis. Aust Prescr 2000;23:39-42.