SCOPE OF THE PROBLEM

Complaints pertaining to the teeth and face are common and the vast majority of these are pain related. The incidence of dental-related complaints presenting to emergency departments (EDs) appears to be rising, ranging from 0.4% to 10.5% of ED visits with over 3 million patients seen in EDs between 1997 and 2000.

Although treating dental and facial emergencies can be challenging and frustrating, these injuries can also be immensely satisfying when the emergency physician has a basic understanding of dental and facial neuroanatomy as well as an understanding of the simple techniques required to relieve dental and facial pain. There is no more appreciative patient than one relieved of severe pain.

Many emergency physicians are called upon to treat dental problems, and it is therefore essential to have a diagnostic and treatment plan in place to facilitate patient care. Dental and facial blocks should be an integral part of such a plan. The emergency care provider should have a working knowledge of the names of the teeth and the facial anatomy (Figure 35-1).

CLINICAL ASSESSMENT

Before performing any local or regional anesthesia, the clinician should determine whether a patient can tolerate, both physically and psychologically, the planned procedure. This assessment is important because local and topical anesthetics may have systemic effects as well as local and regional effects. Likewise, many patients have psychogenic reactions, such as hyperventilation and vasodepressor syncope not from the medication, but from the procedure.