dental-emergency-triage

# Dental Emergency Triage The person deciding who gets today's emergency slot is usually the one with the least clinical training in the building. This gives them a script: the questions that separate a cracked cusp from a spreading infection, the handful of answers that mean stop booking and send them to hospital now, and the interim advice they can give without practising dentistry over the phone. ## What This Skill Produces - **Urgency banding** — see now / see today / see within 48 hours / routine, with the finding that puts a call in each band - **The question script** — the short ordered set that sorts most calls, in plain language a non-clinician can read aloud - **Red-flag escalation** — the answers that mean emergency department, not dental chair, stated unambiguously - **Interim advice within scope** — what front desk may safely say about pain, bleeding, and an avulsed tooth, and what they must not - **The callback rule** — who is rung back by a clinician, and how fast - **The documentation line** — what to record about the call, because triage decisions get reviewed ## Required Inputs Ask for these if not provided: - **What the patient reports** — pain, swelling, bleeding, trauma, a lost restoration, and how long it has been going on - **The escalation signs** — whether there is facial swelling, difficulty swallowing or breathing, fever, or eye involvement - **The context** — medical history if known, especially immunosuppression, anticoagulants, or diabetes; and whether they are an existing patient - **Your capacity** — how many emergency slots exist today and who is on - **Local escalation routes** — the out-of-hours service and nearest emergency department ## Framework: Rule Out the Medical Emergency, Then Band the Dental One 1. **Screen for airway and spread first.** Difficulty breathing or swallowing, swelling closing the eye or crossing the midline of the floor of the mouth, fever with rapidly spreading swelling — these are medical emergencies. Stop triaging and direct to emergency care. 2. **Then trauma with a time limit.** An avulsed permanent tooth is measured in minutes; this outranks pain. 3. **Then uncontrolled bleeding.** Especially post-extraction and especially on anticoagulants. 4. **Then pain, banded by what it tells you.** Keeping them awake, spontaneous, or lingering after cold suggests pulpal involvement and a today slot; pain only on biting or on sweet things usually holds. 5. **Then everything else.** Lost crowns, fractured teeth without pain, and orthodontic discomfort are genuinely uncomfortable and genuinely routine. 6. **Record the call either way.** What was reported, what band was assigned, what advice was given, and when they were offered. ## Output Format ### Triage: [caller] · [time] · taken by [staff] **Reported:** [complaint in the caller's words, duration] **Red-flag screen:** breathing/swallowing difficulty [Y/N] · swelling crossing midline or closing eye [Y/N] · fever with spreading swelling [Y/N] · uncontrolled bleeding [Y/N] → **Any yes: direct to emergency care now.** Record that this was done and the time. **Band:** ☐ See now ☐ See today ☐ Within 48h ☐ Routine **Reason for band:** [the specific finding] **Interim advice given:** [only from the approved list — analgesia as per label, saline rinse, cold compress, bite on gauze for bleeding, keep an avulsed tooth in milk or saliva and come now] **Appointment offered:** [date/time] · **Accepted:** [Y/N] **Clinician callback:** [required Y/N · by when] > Triage support, never diagnosis. This sorts urgency from a phone call; it does not establish what is wrong. Airway compromise, spreading infection, and significant trauma go to emergency medical care immediately. Adapt bands and scripts to your regulator's scope-of-practice rules for non-clinical staff. ## Quality Checks - [ ] The medical red-flag screen runs before any dental banding - [ ] Avulsed permanent teeth are treated as time-critical, ahead of pain - [ ] Interim advice stays strictly within what non-clinical staff may say - [ ] Every band has a stated reason recorded against it - [ ] The out-of-hours and emergency-department routes are named, not implied - [ ] The call is documented whether or not an appointment was made ## Anti-Patterns - **Triaging on pain score alone.** The most dangerous presentations are often not the most painful ones. - **Front desk offering a likely diagnosis.** 'Sounds like an abscess' is practising dentistry over the phone. - **Missing the swallowing question.** It is the single most important question in the script. - **Recommending a specific antibiotic or dose.** Never, and never on a phone call. - **Not recording declined appointments.** A refused offer is the record that protects the practice. - **Treating an avulsed tooth as a next-day problem.** The window is minutes to an hour. ## Example Trigger Phrases - "Write phone triage guidance for our front desk" - "A patient called with facial swelling — how urgent is this?" - "How do we decide who gets the emergency slot today?" - "What can reception safely tell a patient who has knocked out a tooth?" - "Triage script for dental emergency calls"