The provision of analgesia in the ED simply serves as a temporising measure until the source of pain is treated i.e. a dental practitioner can be seen.

When non-dental causes of pain have been ruled out, dental pain is managed by identification of the source of the pain and judicious use of analgesia. Non-steroidal anti-inflammatory drugs (NSAIDs) are the recommended first line analgesics for dental pain, with ibuprofen being the drug of choice due to its low incidence of gastrointestinal side effects [5].

Paracetamol also has a role to play both as an analgesic and anti-pyretic, either in addition to a NSAID or when NSAIDs are contra-indicated.

Opiod analgesia is traditionally used in moderate and severe pain, however opiates are relatively ineffective when dealing with dental pain [6]. Opiates should therefore be reserved for adjunctive analgesia in situations where paracetamol and NSAIDs have failed to achieve adequate pain relief.

Learning bite

The vast majority of patients with toothache presenting to the ED should be managed with simple analgesia and advised to attend a dental practitioner as soon as possible.