If the nerve inside a tooth is inflamed beyond the point when it can recover, or if the nerve has died as a result of trauma or decay, the only treatment is to either remove the tooth or carry out root canal therapy.
Root canal therapy (RCT for short) means taking the nerve out of the tooth but leaving the tooth in place so it can be rebuilt and a crown or cap made to restore it to function.
Severe toothache can mean that the nerve is very inflamed and that RCT is needed.
The emergency part of the treatment is to clean out the nerve tissue and place an antibacterial and anti-inflammatory dressing in the tooth with a temporary filling on top.
This will alleviate the pain, but the tooth will then need to have the root canals filled and sealed prior to rebuilding it.
This second stage will need to be carried out as soon as possible by a general dentist as it is not provided in our emergency clinics.
It is important to have this done because if it is left untreated, even if it is no longer painful after the first stage of treatment, there is the serious risk of an abscess forming.
The emergency phase of the treatment is carried out under local anaesthesia to make it as comfortable as possible. It can be a tricky procedure for the dentist and take longer than having a simple filling, but there is a high success rate when carried out properly.
Usually the pain is relieved quickly, but sometimes there is after-pain when the local anaesthetic wears off. Any after-pain fades away as the tooth settles down and it can be controlled by painkillers such as paracetamol or ibuprofen. The tooth may be tender when biting hard foods so these are best avoided for a couple of days.