Pathology originating from the pulp or periradicular tissue is a common cause for emergency visits to dental clinics. A good knowledge of diagnostics and differential symptoms is crucial for adequate emergency care. A weighted assessment of the anamnesis, the clinical examination and associated X-ray examination are also important contributors to the diagnosis, without which, no invasive procedures should be performed. Treatment in the acute situation often focuses on pain relief and potential infection control. A suitable analgesic for mild to moderate pain is paracetamol. If there is an inflammatory component, non-steroidal anti-inflammatory drugs (NSAIDs) should be used as an alternative or supplement. In cases of severe pain or if sufficient pain relief is not achieved, inclusion of opioids are recommended. For infection control, incision of any swelling, trepanation of the crown and drainage through the root canals or extraction should be considered in the first instance. The indication for antibiotics is limited to when the general condition is affected or if the infection is spreading. In cases where antibiotic treatment is considered, penicillin V (clindamycin when PcV allergy) is a first-line drug.