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What's your emergency patient IQ?

May 24, 2011
Dr. Donald Crumb offers some hypothetical situations to help you determine your knowledge about various clinical issues and to make sure you're properly prepared to deal with emergencies.

By Donald A. Crumb, DDS

How well does does your office manage dental emergency telephone calls? Is your dentist ever frustrated when patients arrive in the office for emergency treatment because he has been given inaccurate information and inadequate treatment time to effectively treat them? Your patients may be telling you enough about their dental symptoms in their emergency telephone calls to recognize the dental problem and schedule appropriate clinical time, but something is lost in the translation. It may be time to review the following dental emergency dialogues that are common to most general dental offices. How would you identify the problem and schedule appropriate clinical time in each of these instances?

1. “Sometimes when I chew on my right side I experience a sharp, piercing pain of short duration. It hurts so much that I don’t eat on that side anymore. Hot and cold liquids do not seem to bother though.”

2. “I have this sore on my gums over my front tooth. It comes and goes every three or four months. A few days after it appears, it swells up and then it pops and I get a funny taste in my mouth. It doesn’t hurt.”

3. “I have a constant, dull ache from my lower left molar area. It started last week, but now it is getting worse and over-the-counter pain medication doesn’t help anymore. I can’t chew on that side and it even hurts to swallow now. My final exams start tomorrow ... please help!”

4. “I just had a filling done at my dentist’s office one week ago. Every time I have something hot or cold, it hurts. The pain doesn’t last very long. My bite doesn’t feel the same as it did before either.”

5. “I woke up this morning and my eye was almost swollen shut! I think that I may have lost a filling in my eyetooth a while ago but I hate to go to the dentist. The pain is now unbearable ... a sharp, throbbing pain.”

6. “My husband complains that my breath always smells bad. I try not to eat foods with garlic or onions. Sometimes my gums bleed when I brush my teeth. When they get sore, I try not to brush them so I don’t irritate my gums. Do you think I need a mouthwash?”

7. “When I wake up in the morning, the left side of my face aches. It hurts when I yawn. I can’t even eat granola for breakfast anymore. After a while the pain subsides.”

8. “When I drink something hot or cold, I get this sharp, throbbing pain in my tooth. The pain usually lasts for about a half hour and then gradually subsides. Sometimes it just starts aching on its own. Nothing seems to help. Maybe my bite is off because it hurts when I bite on that tooth.”

9. “I have this swelling on the inside of my upper molar. It is very sore when I touch it. It feels huge! It has been there for about three days now and it is not getting any better. I am worried.”

10. “My son just fell off his bicycle and knocked his front tooth out. His lip is cut and bleeding, and I think he may have broken some other teeth. What should I do? (Mother is hysterical and crying)
(a) Patient is 5 years old.
(b) Patient is 12 years old.

11. “I just noticed that I have these bumps on the roof of my mouth. They don’t hurt but my mother has just been told that she has cancer and I am worried.”

12. “I have this dark spot above my upper lip. I have had it a long time, but recently it started bleeding a little and I think it is getting bigger. My wife wanted me to call you and tell you about it. The kids are all grown up now and she worries about me a lot.”

“The whole side of my face is swollen like a football! It is getting increasingly difficult for me to swallow. I think that I have a temperature because I’m sweating, and I have the chills. The swelling started two days ago but now it is much worse and it really hurts.”

“I am not sure if I should be calling the dentist about this or not. I have this sore just under the side of my tongue that bleeds occasionally. I first noticed it as a little irritation about two years ago. It just doesn’t seem to heal.”

“Every time I went jogging this past week I got this throbbing, constant pain in my upper back teeth. Sometimes it bothers me to chew on that side. The pain seems to get worse whenever I lie down. I’m just getting over a bad head cold. Could it be from the medications I’m taking?”

16. When I went home from Christmas vacation last week, I was having a problem with my wisdom tooth on the lower right side. My dentist extracted the tooth and the pain pretty much went away for two days. Now I have more pain than ever in that area constantly, and my breath has this disgusting foul odor!

17. “I have this sore on my lips that burns if I touch it with anything, especially fresh fruit or spaghetti sauce. I have had them before several times. They always seem to appear when I am on vacation trying to relax in the sun.”

“My tooth has ached constantly all day long. When I tried to drink my coffee this morning, it started throbbing. The only thing that helps is to rinse repeatedly with ice water.”

“When I touch my tooth with a toothbrush along the gum line, I experience a sharp, momentary pain. It hurts in the same area and is sensitive to sweets and occasionally cold.”

“I have a constant, throbbing pain in my upper back teeth that is quite severe. A dentist once told me to rinse sore teeth with warm salt water. I have been doing that and it seems to help. It also feels better when I stay closed against those teeth.”

After completing this training exercise, you should have a fairly good assessment of your dental emergency IQ. As a guideline use this metric:

Number of correct answers (answer key below)

  • Less than 10 = Needs basic training
  • 10 to 15 = Average, could do better
  • 15 to 19 = Worthy of praise, needs a little encouragement to be a superstar
  • 20 = Superstar

Improvements may need to be made in listening and communication skills, as well as general dental knowledge to nurture more “superstars.” This is where staff training is so important. Dentists can’t expect their staff members to understand what an emergency patient’s clinical symptoms mean unless they teach them. The more you know as a dental assistant, the easier life will be for the entire office.

The problem in most dental offices is that the patient doesn’t give you all of this information without being prompted by some logical questions. Front office staff personnel need to know the basics of dental triage when they take calls. Once they learn to recognize the dental problem, they need to know how the doctor wants them to schedule their clinical time. Your patients will appreciate well-trained staff members when they call with a dental emergency in the future.

Answer key

  1. Cracked tooth
  2. Fistula from necrotic tooth
  3. Pericoronitis
  4. Traumatic occlusion
  5. Acute endodontic abscess
  6. Some degree of periodontal disease
  7. TMJ problem
  8. Irreversible pulpitis/pulpal necrosis
  9. Periodontal abscess
  10. (a) Avulsion of deciduous tooth, (b) Avulsion of permanent tooth
  11. Maxillary torus
  12. Possible basal cell or squamous cell carcinoma
  13. Severe endodontic abscess with cellulites
  14. Possible squamous cell carcinoma
  15. Maxillary sinusitis
  16. Alveolar osteitis (dry socket)
  17. Herpes labialis
  18. Pulpal necrosis
  19. Cervical root hypersensitivity possibly from gingival recession
  20. Advanced periodontitis
Donald A. Crumb, DDS, received his BS degree from the University of Notre Dame in 1971 and his DDS at NYU in 1975. He completed a general practice residency at Northwestern University in 1976. Since 1976, he has practiced general dentistry in Syracuse, N.Y. Dr. Crumb is the founder of Crumb’s Cranium, LLC, which markets dental triage software designed to help schedule dental emergencies. For more information, visit