Many dental conditions can appear to be urgently in need of immediate attention when they really are not. Consider these dental concerns common to the correctional patient population.

Ulcers

Mouth ulcers, also known as aphthous ulcers, are usually very painful, but are not considered a dental emergency.  Often treatment with a salt water gargle is effective and nurses can provide this as part of their Dental Nursing Sick Call Protocol.  Ulcers of the gums can also develop from ill-fitting dentures.  In this case, a priority dentist appointment is required to evaluate the need for a denture adjustment. 

Infections

Bacterial tooth infections can irritate the tooth pulp and cause an abscess. Pain and swelling indicate that infection is present.  An extensive abscess may cause the face to look swollen on the affected side. Timely treatment is imperative so that the infection does not spread to the airway or eye socket.  A tooth abscess, unlike other conditions, will present as very tender and soft and the tooth may not appear defective.  In this case, short-term antibiotic treatment is needed. Long-term treatment may require tooth removal or root canal. Root canals are not typically done in jails, and they are infrequently done in prison. During assessment remember that facial trauma can result in tooth nerve death and lead to an abscess.  

Dental Tori

A condition of bony growth called dental tori can mimic an abscess, but is really benign and requires no treatment. When assessing for abscess, be sure that the growth or swelling is red, soft, and tender. Dental tori are usually a pink, natural color (if not irritated), firm, and non-tender.

Pericoronitis

Also common in the correctional population, pericoronitis may present as an abscess, but really results from an unerupted wisdom tooth. Gum tissue overgrowth can get in the way of chewing and become swollen and sore. Antibiotics will reduce swelling, if extensive. Otherwise, good oral hygiene – regular brushing, flossing and debris removal – will improve this condition. 

Severe Dental Caries and Decay

Patients may arrive with a severe dental condition brought on by chronic methamphetamine drug use that involves accelerated tooth decay and loss. The intense decay can appear as an emergency requiring immediate treatment. However, this is rarely necessary. The condition is caused by the loss of saliva (xerostomia) and an increased intake of sugar. Generally, the mouth does not feel painful to the patient. This decay happens quickly, often within 1 – 2 years of methamphetamine use. Long-term methamphetamines use leads to further damage and tooth loss. Sometimes teeth are broken off at the gum line. 

These are some of the dental conditions correctional nurses might see as they complete the dental screening of their incarcerated patients.  

This information is from The Correctional Nurse Educator class entitled Dental Concepts for the Correctional Nurse.

Our next Dental Post IV will discuss Dental Emergencies and Triage.