Correctional nurses regularly make decisions about the need for emergency treatment of dental conditions. These decisions occur during the triage of sick call requests or as a result of a “man down” emergency call in the facility. What are some key findings that indicate a need for emergency dental treatment?

Breathing and Swallowing

Emergency evaluation starts with the ABC’s (Airway-Breathing-Circulation). Dental conditions may affect the ability to breathe and swallow. Impairment of breathing or swallowing needs immediate emergency treatment.  The ability to breathe and swallow is affected by infection, traumatic injury, persistent bleeding in the oral cavity, or swelling

Pain

Tooth pain is one of the most frequent dental condition correctional nurses  evaluate. Nurses must make an assessment to determine if the pain requires immediate attention or can wait for the next dental opening. A proper dental pain assessment includes the following components:

• Assess the pain using the pain scale (1 -10) 
• Determine what incites the pain: thermal sensitivity (cold vs hot), biting pressure, constant pain, recent dental procedure
• Have the patient describe the pain: continuous, intermittent, transient, sharp, dull, throbbing
• Have the patient locate the pain by pointing to the tooth or area of the mouth. Sometimes the pain can be referred by an adjacent tooth or come from the opposite arch. 
• Check the tissue for swelling. Check to see if the tooth is fractured. This helps to determine if the pain is from the soft tissue or from the tooth itself.

Often the overall condition of the patient can indicate the intensity of the pain, and the level of treatment needed. Obviously, a toothache that has kept a patient up all night due to unremitting pain needs to be seen by the dentist immediately.  If no dentist is available, the patient should be referred to the onsite provider. Patients that are having intermittent pain can usually be treated with over-the-counter pain medications per a Nursing Sick Call Protocol.  This patient should be scheduled for a dental appointment at the next available opening. 

Infection

Severe infections, like severe pain, will affect the entire patient. Vital signs and general appearance will be altered. If the patient has facial swelling, a pulse greater than 100, and a temperature over **100.5 °F, they need to be evaluated by a dentist immediately. These symptoms may indicate a systemic infection or cellulitis that requires aggressive antibiotic treatment.  If a dentist is not available, the patient should be seen by the on-site medical provider or referred to the local emergency department. Staff should follow their local policy and procedure in these instances.

Indications of a milder mouth infection can be treated with over-the-counter pain medication.  The patient should be scheduled for a dental or medical staff appointment within the next 24 hours. Mild infection presents as localized swelling and a fever of less than *100.5 °F (*fever parameters are defined per facility protocol and nurses must be aware of the parameters at their facility). Supportive care such as a soft diet and heat application may also help.

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

In our next Dental Blog Post V, we will discuss Dental Clues to Medical Conditions.