What to Do in a Dental Emergency

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Having a dental emergency? Don’t panic! Most dental emergencies are nowhere near the severity of other medical emergencies. You should still call your dentist right away, but here are some tips just in case you can’t get an appointment quickly.

by Dr. Burhenne

What to Do in a Dental Emergency
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Having a dental emergency? Don’t panic! Most dental emergencies are nowhere near the severity of other medical emergencies. In most cases, it’s the potential of extreme pain that is the issue, not health. You should still call your dentist right away, but here are some tips if you can’t see your dentist right away.

Quickly skim this article to find the issue that applies to you to find my advice on what to do in your specific situation.

If your face swells up

What it could mean:

  • A serious dental infection that needs immediate response by a dentist. Typically, these types of conditions don’t get better on their own.
  • It could be an infected tooth, bone infection, or gum infection.

What to do:

  • Don’t wait. Go see a dentist right away. If you delay, it is possible to die from an infection in or around the mouth.
  • Stay upright and don’t lie flat, even during sleep.
  • Drink fluids. Getting dehydrated while you have an infection could make complications more likely.

If you knocked out a tooth

What it could mean:

  • If you lose the tooth, you’ll need an implant. An implant fills the space where the root used to be in the gum.
  • If you are able to reimplant the tooth within the hour (meaning, stick it back in), there’s a good chance that it’ll take. If the tooth is reimplanted properly, there’s still a likelihood that you’ll need a root canal, but at least you’ll have your own tooth and won’t need an implant.

What to do:

  • Pick it up by the crown, not the root. The crown is the part of the tooth you bite with and the root is the pointy end of the tooth. Touching the root damages the tissue that helps with reimplantation.
  • For an adult tooth only, try placing the tooth back in the socket. Before you do this, look at the teeth on the other side of the mouth that are mirror images of the tooth you’re trying to reimplant in order to visualize how it should be placed back in so that you don’t place it the wrong way. This might make you squeamish, but I’ve coached patients through doing this over the phone and it’s been successful. Make sure you do this without touching the root. Only do this if you know what you’re doing. I’ve seen knocked out teeth re-inserted facing the wrong way!
  • Call your dentist and let them know you’re coming to the office. Either your dentist or the dentist on call should see you right away. If not, head to the emergency room. This should all be done within the hour.

Read tips for what to do when your child knocks out a tooth.

If you have a broken, cracked, or chipped tooth

What it could mean:

  • Typically, if it’s a small crack you’ll need a filling and if it’s a large piece you’ll need a crown. If the tooth is cracked all the way through, that would call for a tooth extraction and need for an implant. If a crown breaks in half or if it falls off, you can wait a few days to have it fixed/replaced.

What to do:

  • Don’t panic! If you’re not in pain, that buys you a lot of time. Most often, teeth will break and there’s no pain. It’s normal for there to be, at least initially, some sensitivity to cold and heat—all that means is that the piece that broke off was large enough to expose the inner structure of the tooth called dentin. This sensitivity will go away in a few hours to a few days as saliva will remineralize and insulate that area.
  • Call your dentist. Your dental office won’t know if they should schedule you for a filling, crown, or extraction, so chances are, they’ll schedule you for a consult and then you’ll go in a second time to actually have the work done. To minimize dental appointments, the more info you give them over the phone, the better. You could say to them something like, “one cusp broke off” or “one half of my tooth broke off” or “a filling fell out.” Better yet, email or text them a photo!

If you are bleeding from the mouth

What it could mean:

  • It could be a chronic condition or an acute condition. If you’re seeing blood on the floss, then you have gum disease or gingivitis. But if you’re seeing blood in your saliva, that’s a different story—it could be due to an advanced stage of cancer or a very advanced stage of gum disease.
  • Bleeding from the mouth is not normal. The mouth is very good at preventing bleeding, so it’s rare for gums bleed from abrasions or cuts.
  • If you’ve had an extraction and you’re bleeding and it won’t stop, you need immediate care.

What to do:

  • If you’re seeing blood on your floss, see your dentist and get treated for gum disease. The sooner, the better. Blood on your toothbrush or floss is not normal and indicates that you may have a chronic disease that will lead to the loss of your teeth. Book an appointment within the month!
  • If you’re bleeding after a procedure, go back right away to the dentist who did the surgery. It is not normal for the bleeding to continue the night after your procedure. If your dentist is not available, call an oral surgeon right away. Keep your head elevated. Just like you keep your hand elevated if it’s injured, you want to do the same with your mouth. Keep your mouth above your heart at all times—especially during sleep.

If you think you have a gum abscess

What it could mean:

  • A gum abscess looks like a yellow, red, clear, or whitish pimple on the gum.
  • It could mean the tooth is infected or the gum is infected, meaning you need a root canal or an extraction. In some cases, antibiotics and an x-ray will be needed.
  • This could lead to permanent gum recession, but the sooner you get to it, the less likely that will happen.

What to do:

  • You need to be seen immediately. Schedule an appointment with your dentist.
  • Do not pop the gum abscess like a pimple.
  • Make an appointment for the next day.
  • Keep brushing and flossing that area as usual.

If you think you have a tooth abscess

What it could mean:

  • It’s hard to know whether you have a pulpal (the inner substance of the tooth) abscess without an x-ray and an exam, but, if the tooth has lingering sensitivity to hot and cold, severe tenderness upon chewing, pain after positional movement, or is causing spontaneous pain, chances are good that you have a dead or dying tooth.
  • A pulpal abscess is an infection inside of the tooth and typically means the living tissue inside the tooth is necrosing (slowly dying) and will need a root canal.

What to do:

  • Don’t put this off too long. In my experience, pulpal abscesses lead to facial swelling and potentially severe systemic complications, always at the worst possible time, like right before a vacation, exams, or leaving on a business trip. Make an appointment for the next day.
  • If you can’t get ahold of your dentist, ask friends and family who have had a root canal for a referral from an endodontist. You don’t have to wait for a referral from your dentist. Unlike the medical world, you can bypass the generalist and self-refer to the specialist.

If you have pain when you bite

What it could mean:

  • It could mean cracked tooth syndrome. If you catch this early, the sooner you crown it, the less likelihood there will be a root canal or loss of the tooth because you’re stopping the cracking from progressing by stabilizing it with a crown.
  • It could also mean it’s not tooth pain, but muscle pain when you bite, caused by nighttime grinding or daytime grinding. These aren’t emergencies, so book an appointment within the month.
  • It could also be a pulpal abscess (see above).

What to do:

  • Make an appointment to see your dentist within the week.
  • Don’t chew on that tooth because the next chew or bite could result in loss of the tooth with a crack that goes all the way through the tooth.

If you had an injury, fall, or accident

What it could mean:

  • It depends. Consequences can range from minor to severe. Sometimes, it’s how quickly you’re seen that determines whether you get to keep the tooth or not, which means you need to be seen by an oral surgeon or dentist ASAP!

What to do:

  • Get seen by the dentist immediately!
  • If you’ve had some trauma, injury, or fall as you’re driving to the ER, call your dentist or have someone call for you. Ask your dentist if s/he can meet you at the ER. I’ve done this and I’ve even driven a patient to the ER myself! On that day, I put his tooth back in and I said, “We’re taking you to the ER!”
  • Ask your dentist if you could have a fractured jaw. Fractured jaws are sometimes overlooked and missed as a diagnosis in the emergency room.
  • Ice the jaw area (the area before the ear) aggressively for three days if you fell on your jaw and take an anti-inflammatory for three days (also see: The 3-3-3 Method for tooth pain).

If you were injured in a dental procedure

What it could mean:

  • This could cause an infection or a lot of pain for few days after your procedure.

What to do:

  • If the tongue or cheek is lacerated and the dentist doesn’t stitch it up, then you should be given a referral to an oral surgeon. The mouth is pretty resilient and heals quickly, but sometimes it’s better to have it stitched up rather than just wait to have it fill in and heal because then you get these little pieces of scar tissue that can take years to go away.
  • If you have a cut or burned tongue

The tongue is pretty tough, but when injured, it will swell and hurt a lot. It can also bleed profusely. Be seen ASAP if you think you’ve injured your tongue. Even if it seems minor, these injuries can get infected.

What it could mean:

  • The tongue can bleed a lot and can cause a great deal of pain. It may prevent you from being able to speak and you can stay swollen for weeks. Eating will be difficult. And the pain…did I mention how painful tongue injuries are?

What to do:

  • Go see an oral surgeon the same day.
  • Suck on an ice cube until you get to your dentist appointment.
  • To minimize bleeding, pack some gauze onto that area of the tongue and put pressure on it, maybe by biting on it.

If you have a toothache

What it could mean:

  • A toothache could mean tooth decay, a cavity, gum disease, or even that you’re grinding your teeth (bruxism).

What to do:

  • When getting out of tooth pain, it’s all about controlling swelling. Reduce the swelling and you reduce the pain. Short-term, the best way to reduce this inflammation is with the 3-3-3 method: that’s three Advils (600 mg total), three times a day, for three days.
  • It’s important to have a complete exam at the dentist to identify the root cause of a toothache in order to understand the best way to address it.

For more tips on toothaches, check out my post called How to Stop a Toothache and Get Out of Pain.

You have something stuck in between your teeth

What it could mean:

  • There’s something called a foreign body reaction, which happens when a poppy seed or popcorn hull gets stuck in between the teeth or between the tooth and gum fold. The body attacks it and sends blood to the area, causing inflammation and lots of pain.
  • To fix the problem long term, you’ll need to get the space between the teeth touching so that food can’t get lodged in there again—a new filling or crown can do this.

What to do:

  • The best thing to do is use dental floss with knots in it to dislodge the item. You may need one two or three knots. Tie the floss so that the knots close in on each other—the size of the knot (not how many knots in succession) is key. Flossing removes pain immediately in a lot of cases if it’s food causing the reaction. Don’t be afraid to do this and do it often (every meal).
  • If you’re struggling with regular floss, try a flossing stick. The long handle of a flossing stick can help you maneuver in tight spaces in the mouth.

Click here for video and instructions for how to floss properly.

If you don’t have dental insurance

What to do:

  • Find out about discount dental plans.
  • Contact your local dental school.
  • Search Google for free clinics and health centers in your area.

The most important thing to know: for all dental emergencies, things usually get worse the longer you delay dealing with the problem. And more expensive.

If you’re in too much pain to think straight, get a friend or family member to help you make a dental appointment and take the right steps to get out of pain until you can see the dentist.

We are here to help and stop the pain. We dentists don’t want to be remembered for the pain, but for stopping the pain, and working with you to help prevent as many dental emergencies as possible.

Dr. Mark Burhenne

read next: 9 Unexpected Ways Teeth Get Chipped

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