Dental Trauma or Infection Clinical Pathway — Emergency Department

Dental Infection: Toothache, Abscess

Dental infections can range in severity from localized inflammation to significant cellulitis/abscess requiring debridement and IV antibiotics. The etiology is usually related to untreated dental caries, poor oral hygiene, and poor follow-up post-dental trauma.

Signs/Symptoms	Clinical Signs	Treatment	Follow-Up
Pain/Local Inflammation	Associated with: Dental caries Fractured teeth Impacted teeth Gingival erythema or edema Active bleeding Purulent discharge Draining sinus tract Pain on percussion of teeth Pain on palpation of oral mucosa Localized intraoral soft tissue edema and erythema of gingiva and oral mucosa with or without small areas of fluctuance or induration No trismus	Analgesia NSAIDs/acetaminophen Oral Care Chlorhexidine gluconate 0.12% Antibiotic Recommendations	Prompt follow-up with personal dentist or referral to Penn Dental Medicine Clinic for possible tooth extraction
Facial Cellulitis/Abscess	Associated with: Presence of dental caries Fractured teeth Impacted teeth Fever Moderate-to-severe edema, fluctuance or induration of gingiva and oral mucosa by tooth/teeth in question Deviation of uvula or tongue from the midline Extra-oral facial swelling spreading superiorly to the orbit or posteriorly to retropharyngeal or submandibular spaces Trismus Upper airway obstruction and dysphagia due to severe edema	Consult OMFS for incision and drainage of abscess Antibiotic Recommendations Oral Care Chlorhexidine gluconate 0.12%	Follow-up with personal dentist, Penn Dental Medicine, or OMFS for definitive care

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

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Dental Trauma or Infection Clinical Pathway — Emergency Department

Dental Infection: Toothache, Abscess

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Dental Trauma or Infection Clinical Pathway, Emergency Department – Dental Infection: Toothache, Abscess

Dental Trauma or Infection Clinical Pathway — Emergency Department

Dental Infection: Toothache, Abscess