Dental Caries (Cavities)

Cavities are tiny cracks or openings/break that permanently harm the strong enamel of your teeth. Cavities, also known as tooth decay or caries, are caused by a variety of factors, such as oral bacteria, frequent eating, drinking sugary beverages, and insufficient teeth cleaning. Dental caries (cavities) result from bacterial erosion through the enamel into the dentin and pulp.

CLINICAL FEATURES

1. Symptoms: The chief complaint is usually a “toothache” or jaw pain. The pain is exacerbated by hot and cold liquids or food. The tooth is often sensitive to touch as well. Pain can be referred to the jaw or ear.

2. Physical examination reveals pitting of the tooth surface. Percussion of the tooth or probing of caries may elicit pain.

DIFFERENTIAL DIAGNOSES 

1. It includes apical abscess, periodontal abscess, and fracture of the tooth. 

2. Myocardial infarction can present as tooth or jaw pain and should be considered in a patient who is short of breath or ill-appearing and in whom no caries can be readily identified.

EVALUATION: Physical examination is the sole means of evaluation.

THERAPY: In the ED, supportive care can be provided (e.g., analgesics, local anesthesia with a lidocaine or mepivacaine injection at the root of the tooth, and placement of dental wax in the cavity to reduce sensitivity).

Disposition: Patients are discharged with instructions to see a dentist as soon as possible.