Are you prepared for a dental emergency?
Basically, any situation involving ongoing tissue bleeding, facial swelling, painful fractured teeth or spontaneous dental pain is considered a dental emergency.
Dental emergencies are experienced daily in the dental office and your dentist should be the first person to call. Be sure to keep your dentist’s after hours contact information readily available at all times. Because it can happen at any time or place, it is best to be prepared and remain calm. Pack a dental emergency kit and keep it in a safe place for quick retrieval. It should contain the following:
- A small container with airtight lid
- Gauze (2”x2” is best)
- Tea bag (when moistened with saliva can stop bleeding)
- Empty clean pill bottle (for parts if necessary and can catch saliva to place knocked out tooth in if unable to keep in side of cheek)
- Pop&Go Ice Pack
- Small tube of toothpaste and popsicle stick (can be placed inside of crown and reapplied to tooth until can visit dentist
- Name and phone number of your dentist and family physician
- Name of medications , allergies and list of medical problems (Note: Ambesol gel may burn the gum tissue and should not be used without advice of dentist.)
Knocked Out Tooth
A knocked-out or “avulsed tooth” means the tooth has completely separated from the bone and socket. If it is a primary (baby) tooth, it should not be reimplanted. If it is a permanent tooth, it is important to handle the tooth appropriately and time is of essence.
- Keep the patient calm, quiet and reclined
- Find the tooth and pick it up by the white portion of the crown only, careful not to touch the root.
- If the tooth is dirty, wash it briefly with saliva or cold water (only 10 seconds max) and reposition it into the socket until the edge of the tooth is in the same position as before the accident (some firm repositioning may be required as the socket quickly collapses.) Bite on the handkerchief or pieces of guaze to hold into position.
- If unable to reposition, place tooth in the vestibule (side pocket of cheek) if the patient is mature enough not to swallow the tooth and seek emergency dental treatment immediately. Avoid storage in water! Milk is a third alternative. (Pieces of tooth do not need to be saved in milk.)
- If the patient has additional lacerations and the bleeding can be controlled, it is more important to address reimplantation of the tooth and follow treatment with suturing of laceration, oral antibiotics (tetracycline or amoxicillin, depending upon child’s age), and possible tetanus vaccination (if not current.) Each minute that a tooth is out of the socket, decreases successful reimplantation time. Each passing 15 minute increment decreases reimplantation success by 25%. These teeth must be carefully monitored for a minimum of 5 years and may require root canal therapy (usually within 10 days of reimplantation). They may “ankylose” or attach to bone without the resected ligament, causing malposition and discoloration of the tooth. *The patient should keep their mouth very clean, brushing carefully, and eat only soft foods for up to 2 weeks. Rinse with Peridex (chlorhexidine) mouthrinse twice a day for one week. A splint may be attached to several teeth by the dentist. Avoid contact sports.
- Obtain a new athletic mouthguard. The dentist will remove the splint in 2 weeks. Obtain xrays after 4 weeks, 3 months, 6 months then yearly thereafter.
If more than one hour has passed, do not attempt to reimplant the tooth. See your dentist to preserve the socket for esthetic, functional and psychological reasons and to maintain bone contour for future prosthesis such as an implant.
Fractured, Chipped or Cracked Natural Tooth
If the tooth is chipped and doesn’t hurt, it is usually not a dental emergency. You can call the dentist and be treated within a few days. However, it is important not to injure yourself further if it is sharp or jagged. Your dentist will restore the tooth with composite resin and evaluate if further restorative care is needed.
A fractured or cracked tooth does constitute a dental emergency. These teeth usually suggest that damage occurred on both the inside and outside of the tooth. The position and extent of the fracture as well as remaining structure of the tooth determines if the tooth can be saved. If you suffer this type of emergency, call your dentist immediately and follow these steps: *Clean your mouth by rinsing with warm water *If trauma caused the fracture, apply cold compress (bag of frozen peas or corn works great!) *Take acetaminophen to relieve pain, even if it has not started to hurt yet.
An x-ray will usually be necessary for the dentist to determine the proper diagnosis and treatment of your tooth. If the internal “nerve” or “pulp” is injured, it may be necessary to have a root canal treatment to preserve the tooth and prevent a future abscess. If the nerve does not appear to be damaged, the tooth may only require a crown or a more conservative restoration. If your tooth cannot be saved, your dentist will discuss methods of tooth replacement.
Facial Tissue or Traumatic Injury
Trauma or injury to the inside or outside of the mouth, such a cuts, burns, punctures, falls, traumatic injury, lacerations, acute joint pain, inability to open or close your jaw, or acute change in your bite is considered a dental emergency. It is important to clean any injured area with warm water. Apply pressure if bleeding is continuous using gauze or a moist tea bag. Never take Ibuprofen or anti-inflammatory medication if excessive bleeding occurs because the medicine may prolong the bleeding. Apply cold packs (frozen packaged vegetables?) and see your dentist, oral surgeon or hospital as soon as possible.
Crown (Cap) Fallen Off
Having a restorative crown that has come off but does not emit pain is not an immediate dental emergency. When a crown comes off that has previously been permanently cemented, it has either lost the grip of the cement under the crown, has recurrent decay under the crown causing it to become loose, or has insufficient structure or shape remaining to retain the crown. If possible, place toothpaste inside the crown and replace onto the tooth. If it has retention, the toothpaste will dry and serve as temporary cement until you can see the dentist. If the tooth has previously has root canal therapy, it should not hurt unless it is either fractured or infected. If the tooth is sensitive, this is considered a dental emergency and you should see your dentist within the next few days. If the crown was a temporary crown, clean of the excess adhesive and replace onto the tooth with toothpaste. You should always see your dentist within a couple of days to protect your tooth and keep it from repositioning as it might prevent your new permanent crown from fitting properly.
Biting Pain on Tooth
If you have new biting pain on a tooth that has not recently received a restoration, the tooth or supporting bone may be diseased. If an ice cube is placed against the tooth (not the gums), and the tooth does not feel the cold sensation, the nerve inside the tooth may be dead and becoming necrotic. Often these teeth feel loose. This may require root canal therapy. This is a dental emergency and an infection can spread quickly. You need treatment ASAP even if the pain seems to have resolved. These can become serious infections.
If the tooth is more painful when biting pressure releases, the tooth may be cracked. If cold is felt and the temperature resolves in less than 10 seconds, the tooth may have decay, a crack, a damaged restoration, a new restoration approximating the pulp, gum recession or periodontal disease. These scenarios are usually treatable and reversible. These are best evaluated by a dentist within a few days.
Loose Permanent Tooth
If you have a tooth or teeth that are loose or unusually and acutely out of alignment, you should be seen by your dental for an emergency appointment right away. In the meantime, try to push the tooth back into the original position with very light pressure. Do not force it. If it hurts, do not proceed with pressure. If the tooth tastes salty or has pus around it, do not push on it and be seen by a dentist immediately. The tooth has lost the ligament and bone support surrounding it and will need to be evaluated quickly for the possibility of infection, need for stabilization or possibly replacement.
Most dental emergencies can be avoided by not chewing on ice or hard foods that can fracture your teeth and seeing your dentist for a routine check-up every 6 months is very important.
Your dentist can make sure that you don’t have any loose crowns or teeth, decay including that close to the nerve of a tooth or an abscess that could cause you pain or abscess and a dental emergency later. The wearing of a bite guard for teeth clenching (bruxism) and athletic mouthguards for sports activities will help prevent teeth from being damaged.