Allocate sufficient time to form a diagnosis and record both the diagnosis and the treatment indicated in the patient’s record.
A general dental practitioner agreed to see a patient (male aged 70) at short notice, following a sleepless night with severe pain in the mandible. The patient’s dentition was sound, with no visible swelling and no mobility whilst the x-ray showed no evidence of any pathology. The dentist prescribed a course of antibiotics and a strong analgesic, and invited the patient to return after five days. The appointment was not kept, because in the meantime the patient had suffered a stroke and was now hospitalised.
The dentist had no diagnostic reason for prescribing antibiotics since he had not established a diagnosis for the pain, which in this instance may well have been trigeminal neuralgia and an early indication of the stroke that followed. The patient made a reasonable recovery and the dental pain never reoccurred.
We know that the inflammatory process involved in pulpitis does not respond to antimicrobials, but will respond to an analgesic. On the other hand, the pain from an acute dental abscess will respond very quickly if the abscess can be drained regardless of any prescription that might subsequently be given. However, the patient in question did not have a focus of infection to drain. In a busy dental surgery, it can be difficult to undertake the definitive treatment during an emergency appointment. The diagnosis is essential if the best use of antimicrobials and analgesics is to be achieved.
A flow chart for the management of acute pain may help ensure best practice in cases where the initial diagnosis is provisional. Reducing the escalation of antimicrobial resistance is not only in the best interests of patients, but also serves as part of a bigger picture, in which clinicians are being asked to create a sea-change, by reversing a worldwide problem and a major threat to public health.