continue at 39:00
Today, I reviewed, link to, and excerpt from the The Curbsiders‘ #423 Dental Pain, Caries, Gingivitis, and Oral Care Tips & Tactics for Primary Care With Dr Lisa Simon.*
January 22, 2024 | By Kate Grant
*Grant CE, Simon L, Williams PN, Watto MF. “#423 Dental Pain:Caries, Gingivitis, and Oral Care Tips & Tactics for Primary Care”. The Curbsiders Internal Medicine Podcast. thecurbsiders.com/category/curbsiders-podcast January 22, 2024.
All that follows is from the above resource.
Transcripts available via YouTube
Join Lisa Simon, MD, DMD (@lisathedoc) as we discuss dental care for the PCP- from examination techniques, treatment options, emergencies in dental care, and general dental advice. Help your patients manage caries, gingivitis, dry mouth, and temporomandibular joint (TMJ) dysfunction. Be aware of dental side effects of medications, how to manage anticoagulants during dental procedures, and when to recommend antibiotic prophylaxis.
00:00 Introduction and Overview
09:13 Diagnosing Dental Pain and Examination Techniques
18:44 Treatment Options for Dental Pain
29:34 Complications and Emergencies in Dental Care
32:36 Post-operative Care and General Dental Advice
40:35 Dry Mouth and Treatment Options
49:39 Temporomandibular Joint (TMJ) Dysfunction
55:43 Medications and Dental Side Effects
56:12 Anticoagulants and Dental Procedures
01:00:55 Endocarditis Prophylaxis
01:03:15 Joint Replacements and Antibiotic Prophylaxis
01:04:10 Oral Health in Patients with Opioid Use Disorder
Dental Pain, Caries, Gingivitis, and Oral Care Tips & Tactics for Primary Care- Pearls
- Dental care is difficult to access for many patients due to lack of providers and high out of pocket costs, so even though PCPs are not well trained in dental care, it is important to know some basics.
- PCPs should feel comfortable offering short term symptom relief options for dental pain including local anesthesia, pain medications (such as NSAIDS and acetaminophen), and antibiotics.
- Complications and emergencies of dental infections, such as Ludwig’s angina and cavernous sinus thrombosis, require immediate medical attention.
- Preventative dental care includes maintaining good oral hygiene, avoiding sugar-sweetened beverages, and being mindful of medications that can cause dry mouth.
- Dry mouth can be managed with lifestyle changes, saliva substitutes, sugar-free candies, and, in severe cases, cholinergic medications.
Approaching Dental Concerns in Primary Care
Primary care providers typically do not receive training in oral health, but it is important to have a basic approach to addressing patients’ dental concerns. Smiles for Life is a great resource for providers to dive deeper.
Encourage patients to find a primary dental care provider, but be aware, dental insurance is different from medical insurance. Dental insurance is more often like a discount plan- coverage is limited and may have high out of pocket costs. For example, Dr Simon suggests that most dental insurance will cover the cost of an extraction, but a root canal may cost thousands of dollars. Acknowledge the high cost and limited access to dental care, especially for patients with financial constraints. Consider looking into what is covered in your state under Medicaid as it will differ by location.
Basic Differential for Dental Pain
Gingivitis is inflammation of the gums, which can be asymptomatic or uncomfortable but doesn’t cause deep tooth pain. Since the gums do not attach the teeth to the bone, gingivitis will not make teeth loose or fall out. However, gingivitis can be a precursor to worsening dental disease like periodontitis.
The basic tooth anatomy includes: enamel, the outer layer of tooth which is stronger than bone, dentin, the inner layer which is stronger than bone but not as strong as enamel, and pulp or the neurovascular bundle, the deepest layer, which transmits pain.
Tooth enamel and dentin is attacked by acid in the mouth, breakdown of this can cause cavities. Only superficial damage to the enamel and dentin can be fixed with a filling.
Periodontitis is deeper inflammation around the base of the tooth which can cause bone loss, tooth loosening, and a space can develop which can predispose to abscess. This deeper damage is what causes severe tooth pain as the nerve root gets involved (Stephens 2018).