Key Points
-
Highlights potentially fatal outcomes of poor management of acute severe dental pain.
-
Raises questions about access to emergency dental services for patients.
-
Discusses and advises approaches for management of acute irreversible pulpitis.
Abstract
The history of a patient who suffered encephalopathy and coma is presented. A 25-year-old female consumed large quantities of cold water over several weeks, to control long-term dental pain. This eventually led to dilution hyponatraemia, followed by a seizure and encephalopathy. The patient made a good recovery after spending three days in neurological intensive care. Conventional endodontic therapy immediately resolved her symptoms following recovery from this life-threatening episode. Prior to her admission the patient had experienced difficulties in gaining access to effective emergency dental care. Her problems could have been avoided if appropriate management had been provided sooner. The dental profession should be aware of the potential life-threatening risk when continued water consumption is used to control the long-term pulpitic pain. Primary care agencies should ensure that information on local emergency dental services is well disseminated to the population. Dental surgeons should be able to manage acute dental pain.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Bender I . Pulpal Pain Diagnosis — A Review. J Endod 2000; 26: 175–179.
Cohen S, Liewehr F . Diagnostic procedures. In Cohen S, Burns R (Ed). Pathways of the pulp. 8th ed. pp 26–29. St. Louis: Mosby, 2002.
Ogutembi B R, DeSchepper E J, Taylor T S et al. Post operative pain incidence related to the type of emergency treatment of symptomatic pulpitis. Oral Surg Oral Med Oral Pathol 1992; 73: 479–483.
Matthews R W, Peak J D, Scully C . The efficacy of management of acute dental pain. Br Dent J 1994; 176: 413–416.
Dummer P M, Hicks R, Huws D . Clinical signs and symptoms in pulp disease. Int Endod J 1980; 13: 27–35.
Michaelson P L, Holland G R . Is pulpitis painful? Int Endod J 2002; 35: 829–832.
O'Keefe E M . Pain in endodontic therapy: preliminary study. J Endod 1976; 2: 315–319.
Matthews R, Scully C, Porter K, Griffiths M . An analysis of conditions presenting to a dental hospital emergency clinic. Health Trends 1992; 24: 126–128.
Santini A . The diagnosis, classification and treatment of acute pulpal pain by UK general dental practitioners: Results of a survey. Prim Dent Care 1996; 3: 24–27.
Nusstein J M, Beck M . Comparison of preoperative pain and medication use in emergency patients presenting with irreversible pulpitis or teeth with necrotic pulps. Oral Surg Oral Med Oral Pathol 2003; 96: 207–214.
Thomas D W, Satterthwaite J, Absi E G et al. Antibiotic prescription for acute dental conditions in the primary care setting. Br Dent J 1996; 181: 401–404.
Nagle D, Reader A, Beck M, Weaver J . Effect of systemic penicillin in untreated pulpitis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000; 90: 636–640.
Dailey Y M, Martin M V . Are antibiotics being used appropriately for emergency dental treatment? Br Dent J 2001; 191: 391–393.
Petersson K, Soderstrom C, Kiani-Anaraki M, Levy G . Evaluation of the ability of thermal and electrical tests to register pulp vitality. Endod Dent Traumatol 1999; 15: 6–16.
Palmer N A, Pealing R, Ireland R S, Martin M V . A study of therapeutic antibiotic prescribing in National Health Service general dental practice in England. Br Dent J 2000; 188: 554–558.
Walton R E . The periodontal ligament injection as a primary technique. J Endod 1990; 16: 62–66.
Childers M, Reader A, Nist R et al. Anasthetic efficacy of the periodontal ligament injection after an inferior alveolar nerve block. J Endod 1996; 22: 317–322.
Dunbar D, Reader A, Nist R et al. Anaesthetic efficacy of the intraosseous injection after an inferior alveolar nerve block. J Endod 1996; 22: 481–486.
Meechan J G . Supplementary routes to local anaesthesia. Int Endod J 2002; 35: 885–896.
Claffey E, Reader A, Nusstein J et al. Anesthetic efficacy of articaine for inferior alveolar nerve blocks in patients with irreversible pulpitis. J Endod 2004; 30: 568–571.
McGrath C, Bedi R, Dhawan N . Who has difficulty in registering with an NHS dentist? – A national survey. Br Dent J 2001; 191: 682–685.
Moles D R, Frost C, Grundy C . Inequalities in availability of National Health Service general dental practitioners in England and Wales. Br Dent J 2001; 190: 548–553.
Eaton K A, Widstroem E A, Renson C E . Changes in the numbers of dentists and dental caries levels in 12-year-olds in the countries of the European Union and economic area. J R Soc Health 1998; 118: 40–48.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Porter, R., Poyser, N. & Briggs, P. A life threatening event from poorly managed dental pain – a case report. Br Dent J 202, 203–206 (2007). https://doi.org/10.1038/bdj.2007.144
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/bdj.2007.144
This article is cited by
-
An adolescent patient presenting with hyponatremic seizure: Answers
Pediatric Nephrology (2019)
-
Pity the GDP
British Dental Journal (2007)