Urgent Dental Pain

Urgent appointment Seen by: Dr. Emily Carter Assisted by: Dental Nurse, Sarah Jones M/H: signed and updated today S/H: - smoking: Smokes 10 cigarettes per day - alcohol: Drinks alcohol socially, 2-3 units per week - recreational drugs: Denies recreational drug use - cessation: Advised on smoking cessation resources. D/H: - attendance: Attends regular dental check-ups - anxiety: Patient reports mild anxiety related to dental procedures. - brushing: Brushes twice daily with fluoride toothpaste. C/O: Severe throbbing pain in the lower left molar, exacerbated by biting. HPC: Patient reports the pain started yesterday evening, increasing in intensity overnight. No history of similar pain. Reports sensitivity to hot and cold. Examination (VCG given): E/O: Temporalis, TMJ, MoM, glands, nodes checked. No swelling or asymmetry noted. Findings: No facial swelling or asymmetry. I/O Soft: Lips, buccal mucosa, gingiva, tongue, palate, FoM, tonsillar tissue checked. Gingiva around #36 is inflamed and tender to touch. Findings: Gingival inflammation around tooth #36. I/O Hard: #36 has a large carious lesion. Investigations: Radiograph report Justification: To assess the extent of the caries and the health of the pulp. Type/grade: Bitewing radiograph. Present: Large carious lesion present on #36. Caries: Extensive caries present on the distal surface of #36. Restorations: No existing restorations on #36. Endo: No periapical pathology noted. Bone levels: Normal bone levels around #36. Other: No other significant findings. Diagnosis: Irreversible pulpitis of tooth #36. Discussion/treatment options: Explained diagnosis. Treatment options explained, including root canal treatment and extraction, including how the treatment will be carried out, the risks and benefits of each option. Discussed cost for both NHS and private options entailed. Prevention advice given today. Treatment options: - Urgent treatment £150 VCG given for Tx: Informed consent obtained for root canal treatment. LA: 2% lidocaine hydrochloride w/ 1:80,000 adrenaline SITES: Inferior alveolar nerve block and buccal infiltration. EXP: 01/01/2026 BATCH: ABC123 AMOUNT: 2.2ml ASP: -VE 4% articaine hydrochloride w/ 1:100,000 adrenaline SITES: N/A EXP: 01/01/2026 BATCH: ABC456 AMOUNT: N/A ASP: -VE 3% Mepivacaine Hydrochloride plain solution SITES: buccal infiltration EXP: 01/01/2026 BATCH: ABC789 AMOUNT: 2.2ml ASP: -VE Post-op instructions given. NV: Review in one week.