Pathological changes originating from the pulp or periradicular tissue is a common cause for emergency visits to dental clinics. Having a good knowledge of diagnostics and differential diagnostics is of crucial importance for adequate emergency care. Of great importance for the diagnosis is a weighted assessment of the anamnesis, the clinical examination and the required X-ray examination. Without diagnosis, no invasive procedures should be performed. The treatment in the acute situation may in many cases be focused on pain relief and possible infection control. Suitable analgesics 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 as a supplement. In case of severe pain or if sufficient pain relief is not achieved, supplementation with opioids is 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.