Irreversible Pulpitis - Root Canal Pain
Experiencing a constant throbbing pain ??
What is it ?

Irreversible Pulpitis is caused by a pre existing cavity or hole on a tooth which has become so deep, the nerve of the tooth is now exposed. The cavity on the tooth may not necessarily be visible. This is because the enamel of teeth are very hard, while the dentine underneath is very weak, in most cases when the dentine underneath becomes decayed, it will result in the enamel collapsing, thereby forming a hole. This is because the dentine supports the enamel. However in many cases there very well could be a large cavity underneath a tooth that looks completely fine from the outside. This is why regular X rays are so important. An Xray can ‘’ look through’’ the enamel into the dentine and a shadowing can be visualised which would indicate decay. It can also look through the gum and see the roots. If a radiouleucent area is visible, it would indicate there is also an infection, underneath the tooth. Therefore it is very important to have an x ray, because this will help us see whether you have decay in the tooth, how deep it is and weather it necessitates a normal filling  (not near the nerve , known as reversible pulpitis) , or a root canal (near the nerve known as irreversible pulpitis).

Symptoms and physiology

Irreversible pulpitis is recognised by a severe constant throbbing pain, made worst while sleeping or laying down, and worst with hot water. There may be a temporary relief while gargling cold water, however it is transitory and the pain returns immediately after.

The decay has become to deep, and the nerve is now reacting, there is increased pressure within the tooth. As the tooth is within a confined environment the pressure increases, it is made worst by lying down, because this increases blood pressure, warm water will expand the nerve, further increasing the pain. Cold water contracts it, decreasing it slightly. The emergency dentist will recognise and ask about these symptoms on arrival, this will give him/her  an indication of the final diagnosis.


First stage Root Canal treatment under LA is conducting by an emergency dentist. It is also known as an ‘extirpation’. This process aims at accessing the pulp chamber, and releasing the pressure within the tooth. The emergency dentist will numb you up so that you don’t feel any pain. The emergency dentist will then remove the decay known as caries first, and then access the pulp chamber, cleaning it out and sterilising it. He will then access the canals of tooth removing any debris and tooth tissue from them. A medicine is then placed to calm the tooth. The emergency dentist will finally place a temporary restoration on the tooth to keep it clean and sheltered from the oral environment. An appointment is then made in a few weeks time for the second stage root canal and final restoration. After the first stage a dramatic decrease in pain will occur. There may be small amount of pain for a few days after but this should be considerable less then the initial irreversible pulpitis pain initially felt.

​Dental Abscess

What is it ?

A Emergency Dental abscess is caused by collection of bacteria near the root apex. A dental abscess can be caused through two main ways. One is from decay (See aforementioned) and the other is via the gums, known as a periodontal abscess. The former is the most common. It is usually present on teeth that have had a long history of pain or large restorations in the past, and/or untreated decay. The decay contains bacteria and once they have reached the pulp chamber, the body should react with severe pain. When this happens, if the patient would have visited an emergency dentist, then a root canal would have been implemented. If there is bacteria left in the root canal system following a root canal, OR if no root canal has been carried out, the bacteria will proliferate and eventually cause an infection at the apex of the roots.

Symptoms and physiology

A dental abscess will be recognised by an abscess or leaking puss from the gum on top of the culpable tooth, with a bad taste or smell. There will be exclusive tenderness to percussion.  Eating may well be painful as every time the teeth meet, the tooth will be pressed against the infection thus causing pain. The tooth may also be slightly mobile.

The physiology behind a dental abscess comes down to one main ingredient, bacteria. When bacteria gain access into areas they are not usually present, the body reacts through an inflammatory response sending white blood cells to combat the source. This results in a swelling underneath the tooth that is extremely painful to touch. The swelling may also become visible from outside the face. This then necessitates an emergency dentist to be seen immediately.


The ultimate solutionfor the emergency dentist is to either extract the tooth, which is the source for the constant flow of bacteria to the root apex alternatively the emergency dentist could conduct a root canal procedure. This would clean the root canal system, sterilise the root and seal of the flow of bacteria to the root apex. The Emergency dentist will then presribe antibiotics. However this may not always be the case. If the abscess is caused by a gum infection, the gums are cleaned, and irrigation using an antibiotic solution, regular mouthwashes will then be prescribed by the emergency dentist  for aftercare. The tooth may eventually require extraction. In some very severe abscesses an oral surgeon will drain the abscess from the gum before extracting the tooth.
An implant can be placed after extraction or sometimes straight after extracting the tooth.
Pericorinitis - Wisdom Tooth Pain

Pericornitis is defined an inflammation of a gum surrounding a partially erupted tooth. It is made worst by the following factors. A weakened immune system, either an illness or a patient feeling run down. Stress, smoking, poor oral hygiene or the anatomy of the tooth. This means an impacted or inclined wisdom tooth.


The emergency dentist will irrigate and clean under the inflamed gum. The bacteria which are the source of the inflammation will then be removed. The emergency dentist may further prescribe some antibiotics, specific to gram negative anaerobic bacteria which are the guilty party in this case. Oral hygiene instructions and smoking cessation advice will be then conveyed. According to the NICE guidelines if a patient suffers from more then two cases of pericoinitis the emergency dentist may advice that the wisdom tooth is extracted.
A Chipped Tooth ..
A chipped tooth usually occurs during a recent accident. Its important to see a Dentist ASAP by virtue of the vitality of the tooth. The nerve may have become exposed, and emergency treatment could save the tooth from dieing. We use quality composites to help match the shade of the tooth  with the final restoration. You will also be shown the shade and colour before curing the composite to make sure you are happy with the result. If the chip is very large then a crown may be necessary
Crown Decementation ...
Lost crowns may have become decemented due to a variety of reasons most likely during functional eating. The important issue for the dentist is to ensure that the preparation itself has not been damaged. It is important to see the dentist immediately if the crown has become loose, as any exposure could result in an infection of the underlying dentine, or cause the shape of the preparation to change shape which may lead to a new crown being necessary.
The Vale dental practice specialised emergency dentist service caters to all forms of tooth pain and diagnosis. We have specialised clinicians, who are familiar with emergency patients. Our emergency dentists are specialised in endodontic, oral surgery, implants, orthodontics, and many other fields. Almost any procedure can be implemented at the vale dental practice with our emergency dentists. A truly 24 hour emergency dental service which caters to patients for 365 days a year. We are one of the only Dental practices to treat patients on Sunday and are open throughout the night. We also have emergency dentists working on Christmas day, New Year ’s Day, and throughout Easter. Our service is award winning and is offered at a reasonable price. The Vale dental practice offers a price match guarantee for other emergency dentist practices open. We will happily match any other price that you can find as we are confident that our service is the most competitively priced out there. While ensuring our prices remain low, we also ensure that our emergency dentists are well qualified to offer , and treatments that offer a pain free.