A 68-year-old woman with a toothache and several chronic medications requests over-the-counter relief. What is the most appropriate course of action?

• A. Advise acetaminophen only
• B. Refer her to the dentist
• C. Recommend NSAIDs
• D. Suggest mouthwash instead

Answer: (B)

When a patient with toothache presents along with multiple chronic medications, the priority is professional dental assessment rather than self-treatment. The pain may indicate a dental pathology such as decay, pulpitis, or an abscess that requires examination, imaging, and potentially procedures or antibiotics that only a dentist can provide. While acetaminophen is generally safer for pain management, the combination with other chronic drugs raises safety concerns, and NSAIDs carry risks in older adults—gastrointestinal, renal, and cardiovascular effects, plus potential interactions with anticoagulants, antihypertensives, or diuretics. Mouthwash may help with oral hygiene or minor irritation but does not address the underlying cause of toothache. Therefore, referring her to a dentist for a thorough evaluation and definitive treatment is the most appropriate course.