Dental Emergencies: What to Do Before You Get to the Office

Dental emergencies have an unusual property: for a few of them, what you do in the first thirty minutes determines the outcome more than anything a dentist does afterward. For most of the rest, prompt attention converts a serious problem into a routine one.

The purpose of this guide is to help you tell which is which, and to know the right first move before you are standing in a bathroom at ten at night trying to decide.

A knocked-out permanent tooth

This is the true time-critical emergency. A permanent tooth that has been completely knocked out can often be replanted successfully if it is handled correctly and reimplanted within the hour. Every additional ten minutes outside the socket reduces the chances.

Pick the tooth up by the crown, the chewing part, never the root. The cells on the root surface are what allow reattachment and they are damaged by touching or scrubbing. If it is dirty, rinse it briefly in milk or saline. Do not use tap water, do not scrub, and do not let it dry out.

If you can, place it back in the socket immediately and hold it in place by biting gently on a cloth. If that is not possible, store it in cold milk, or in saline, or in the patient's own saliva by holding it inside the cheek if the person is old enough not to swallow it. Then get to a dentist or emergency department immediately. A knocked-out baby tooth is not replanted, because doing so can damage the permanent tooth developing above it, but it should still be evaluated.

Swelling and infection

A dental abscess with facial swelling is the emergency most people underestimate. Pressure from an untreated infected tooth eventually breaks out into the surrounding tissue, and infection in the floor of the mouth or spreading toward the eye is genuinely dangerous.

Go to an emergency department immediately, not to a dental office, if there is difficulty breathing or swallowing, swelling that closes the eye, swelling under the jaw or in the neck, fever with rapidly increasing swelling, or inability to open your mouth. These are signs the infection is spreading along tissue planes.

Otherwise, call the same day. Antibiotics alone do not cure a dental abscess: they buy time. The source has to be addressed with root canal treatment, drainage or extraction, and until that happens the infection will recur. If a gum boil drains and the pain suddenly stops, that is not resolution, it is a pressure release.

Broken and displaced teeth

A tooth that is loosened, pushed out of position or driven up into the bone should be seen within a few hours. Repositioning and splinting early gives the best chance of the tooth surviving, and a tooth left in the wrong position begins to stabilize there.

For a fractured tooth, save any pieces in milk and bring them, since a clean fragment can sometimes be bonded back on. Rinse with warm water, apply cold to the outside of the face, and keep pressure with gauze if the gum is bleeding. If the fracture exposes the pink pulp in the middle of the tooth, it needs urgent attention.

A small chip with no pain is not an emergency and can wait for a normal appointment, though sharp edges can be smoothed quickly and it is worth calling to describe it.

The urgent but not dangerous list

Severe toothache that wakes you at night, lingers after hot or cold, or throbs is nerve inflammation and should be seen promptly. Over-the-counter ibuprofen and acetaminophen taken together on a schedule is usually the most effective interim measure. Do not place aspirin against the gum, which causes a chemical burn.

A lost crown or filling is uncomfortable and leaves the tooth vulnerable but is rarely urgent. Keep the crown, clean it, and if it seats easily you can hold it in place temporarily with over-the-counter dental cement. Do not use household adhesive.

Something wedged between teeth should be removed with gentle flossing, never a pin or a knife point. Broken orthodontic wires can be tucked with wax or clipped if they are causing injury. A partially erupted wisdom tooth with a painful, swollen gum flap needs attention but is usually manageable with irrigation and cleaning.

Prevention, and what to have on hand

The large majority of dental emergencies are the end stage of something that was detectable months earlier. Regular examinations find cracked teeth, failing restorations and early infections while they are silent, and a mouthguard for sport prevents most traumatic injuries outright.

A small kit is worth keeping: gauze, a small container with a lid, dental wax, temporary cement, a cold pack, and our phone number stored in your contacts.

If you are unsure whether what is happening counts as an emergency, call and describe it. Cedar Creek Dentistry in Portland can be reached at the number on this page, and it is always better to ask than to wait through a weekend.

Questions about your own care? The team at The Best Dentist In Portland, Oregon is happy to help — call us at (503) 646-1811.

This article is for general information only and is not medical advice.