2. Failed LA, bleeding, bits in the wrong place, infection

Failed local anaesthetic

Check anatomy, infection, and whether you are actually in the right place. Do not keep injecting toward a toxic dose. A different technique, time, or a senior colleague may be the answer. If you cannot get the patient numb, you do not start irreversible treatment. Reschedule with a plan — that is competence.

Bleeding

Pressure, packing, suture if you can do it, medical history (anticoagulants, liver disease, bleeding disorders). Follow current SDCEP-style advice your practice uses — this lesson will date. If bleeding will not stop, you need help and possibly emergency care. Do not send them to the bus stop with a wad of cotton and no instructions.

Displaced tooth, root, or restoration

Stop. Protect the airway. If something may have been inhaled or swallowed, that is an urgent medical/dental pathway, not “see if they cough it up at home” as your only plan. If a root is in the antrum, stop digging; stabilise, explain, refer or get your supervisor. Record what you think happened.

Spreading infection

Trismus, floor-of-mouth swelling, eye involvement, fever, and feeling very unwell are not “give antibiotics and review in a fortnight” without a real assessment. Antimicrobial Stewardship still applies: drugs are not a substitute for drainage and urgent care. Related: Sepsis Awareness.

Broken instrument in a canal

Stop. Tell the patient. Do not file blindly. Dress, radiograph if justified, supervisor or endodontic referral. Pride is not a retrieval strategy.