Once the inflammation from acute irreversible pulpitis has spread into the tissues surrounding the tip of the root of the tooth the tooth becomes very tender to touch and the pain can be very well localised. This is because of the presence of proprioceptors in the now inflamed tissues. The tooth may become slightly extruded from the socket and painful to touch or bite on. Management involves the physical intervention of the process by a dentist under local analgesia. The treatment will either be to extract the tooth or to open the pulp chamber and root canal system, debride away necrotic debris, irrigate with an antiseptic and dressing with a combined steroid and antibiotic paste. The use of antibiotics is ineffective and they should not be prescribed. Patients who attend their General Medical Practitioner should be given the Health Board Dental helpline number to be allocated an emergency dentist.