Pain. Pain that interferes with swallowing, eating, or other normal activities requires expeditious (i.e., within 24 hours) treatment by a dentist, physician, or appropriately trained MLP. As with dentoalveolar infections, the inmate may be triaged and stabilized by MLPs or physicians and seen by the dentist at dental sick call. The system must be designed to allow for inmates to be seen within 24 hours for stabilization of their pain and an evaluation of its source. Pain associated with denture irritation can be stabilized by leaving the denture out until the inmate may be seen by a dentist. Level two is primarily associated with the dental daily sick call or other requests for urgent care. Inmates with intermittent or constant pain, an inability to eat, and other dental symptoms that cause discomfort should have access to assessment and the initiation of treatment within 24 hours by a dentist, physician, or appropriately trained MLP. Examples of Level 2 care are toothaches, infections, and pain of apparent maxillofacial origin. Level 3 is disease control or routine care. The acute problems have been stabilized in Levels 1 and 2. Inmates who enter this level require a comprehensive treatment plan. When an inmate progresses to Level 3, he should be free from infection; and pain that interferes with normal daily activities. Carious lesions progress slowly and an early lesion takes several years to progress through the enamel of a permanent tooth.
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