Dental

Toothache

دانت کا درد

Very severe toothache with an inflamed mucosal lining and carious tooth. Treated with an antibiotic pair, an NSAID and a PPI, with referral to a dentist.

ICD-10: —
Source: OPD handbook pp.127–129
Status: Draft

Not yet reviewed by a clinician. Check doses and brands against current national guidelines before use.

Symptoms

Toothache, very severe

Diagnosis

Inflamed mucosal lining
Carious tooth

Treatment

Step 1 of 6

1. Oral antibiotics

Flagyl (metronidazole) and Amoxil (amoxicillin) are the drugs of choice

Prescription

MetronidazoleAntiprotozoal / antibacterial

DoseTDS (1+1+1)

Brand Tab Flagyl 400 mg

AmoxicillinPenicillin antibiotic

DoseBD in the approach; 1+1+1 in the sample prescription

Brand Tab Amoxil 500 mg

Also sold as Amoxil, Dispermox

Caution: Penicillin allergy

Step 2 of 6

2. Oral NSAIDs

Prescription

NaproxenNSAID

DoseBD

Brand Tab Neoprox 500 mg

Also sold as Neoprox, Neopron, Flexin, Synflex

NimesulideNSAID

DoseBD

Brand Tab Nims 100 mg (strength as written is hard to read)

Also sold as Nims, Nimusil

Step 3 of 6

3. PPI

Prescription

OmeprazoleProton pump inhibitor

DoseOD

Brand Cap Ruling 40 mg / Cap Risek 40 mg

Also sold as Risek, Teph, Ruling, Ruling sachet, Omega

Step 4 of 6

4. Counselling and dentist

Refer to a dentist
Take care of oral hygiene (Urdu note); in the sample, brush the teeth and get an opinion from a dentist

Step 5 of 6

5. Toothache and pregnancy

Amoxil and cefixime are safe
Keep xylocaine-soaked cotton near the affected tooth
Panadol is the safest painkiller

Prescription

AmoxicillinPenicillin antibiotic

DoseSafe in pregnancy

Brand Amoxil

Also sold as Amoxil, Dispermox

Caution: Penicillin allergy

Cefixime3rd-generation cephalosporin

DoseSafe in pregnancy

Brand Cefixime

Also sold as Cefspan, Cefim, Caricef, Tixomer, Cefiget

Rising resistance in Salmonella Typhi; not reliable as a sole agent in XDR typhoid.

Xylocaine (lignocaine) soaked cottonLocal anaesthetic

DoseSoaked cotton near the affected tooth

Brands Generic / hospital supply

Paracetamol (Acetaminophen)Analgesic / antipyretic

DoseSafest painkiller

Brand Panadol

Also sold as Panadol, Calpol, Febrol, Pedrol, Calpol 6 Plus (250 mg/5 mL)

Caution: Do not exceed 4 g/day in adults or 60 mg/kg/day in children; Avoid in severe liver disease

Step 6 of 6

6. Toothache in children

TSF = teaspoonful (5 mL).

Amoxil 15–30 mg/kg TDS: Syp Amoxil 250 mg/5 mL — 1 y, 10 kg → 1 TSF TDS; 4–5 y, 14–15 kg → 1½ TSF TDS; 7–8 y, 18–20 kg → 2 TSF TDS
Flagyl: loading dose 15 mg/kg, maintenance 7.5 mg/kg TDS: Syp Flagyl 200 mg/5 mL — 1 y, 10–12 kg → ½ TSF TDS; 7–8 y, 20 kg → ¾ TSF TDS; 25 kg → 1 TSF TDS
Tercica / Brufen 10 mg/kg TDS: 1 y, 10 kg → 1 TSF TDS

Prescription

AmoxicillinPenicillin antibiotic

Dose15–30 mg/kg TDS

Brand Syp Amoxil 250 mg/5 mL

Also sold as Amoxil, Dispermox

Caution: Penicillin allergy

MetronidazoleAntiprotozoal / antibacterial

DoseLoading 15 mg/kg, maintenance 7.5 mg/kg TDS

Brand Syp Flagyl 200 mg/5 mL

DexibuprofenNSAID

Dose10 mg/kg TDS

Brand Syp Tercica

IbuprofenNSAID

Dose10 mg/kg TDS

Brand Syp Brufen

Caution: Avoid in dengue (bleeding risk); Avoid in kidney disease, peptic ulcer, late pregnancy; Take with food

Sample prescription from the book (patient details removed)

Male, 35 y, toothache for 1 day, very severe; carious tooth with inflamed gum: Tab Amoxil 500 mg 1+1+1; Tab Flagyl 400 mg 1+1+1; Tab Neoprox 500 mg 1+1; Cap Ruling 20 mg 1+0; look after the cleanliness of the teeth; refer to a dentist.