Emergency dental care forms a part of any dental practice. Patients regularly call dentists for help beyond that offered in appointment times, and dentists organize their time or services so that this need can be met.
If you are really concerned about a problem with your teeth, whether it involves pain, bleeding, or physical trauma to the jaw, your dental office will assist you in treatment or direct you to the appropriate location for help. Dentists want to be sure that your pain is relieved and that your dental condition does not worsen overall because of a missed or belated emergency response.
One of the most time-sensitive dental problems that patients encounter is loss of a tooth through injury to the jaw. This might occur in sports or military activities, or, perhaps, through an unexpected fall. A permanent tooth can often be restored to function in the jaw if it is replaced immediately or within a period of an hour. Generally, the longer the period that a tooth is avulsed (absent from the jaw), the less the chance of successful reparation. If you find that you have lost a permanent tooth through traumatic impact, you should, ideally, rinse it off and replace it in the jaw. You must be very careful not to handle or bruise the root portion of the tooth because successful re-implantation of the tooth depends on the health of the periodontal ligament still partially attached to the root. If you are successful in replacing the tooth, you should continue holding it in place while seeking dental help. Your dentist will be able to splint a support system in place for the tooth while it regains its position in the jaw. When the tooth is fully re-implanted, a root canal is normally done to ensure the tooth is retained.
If you are squeamish about doing the initial replacement yourself, or if the replacement seems to require force, you should place the tooth in milk or your own saliva and take the tooth with you to your dentist or to the clinic suggested by his or her office or answering service. If the tooth is avulsed in an institutional setting, such as school or the army, there may be a special chamber provided to carry the tooth and help maintain its vitality. Such containers use a mixture of minerals in solution which chemically mimic the natural environment of the mouth and substantially expand the time frame for successful re-implantation of adult teeth.
If the tooth avulsed is a child’s first or baby tooth it should not be re-implanted as doing so may impede later growth patterns for permanent teeth. In this case, you might want to make an appointment for the child’s examination after the event, or, if there is excessive bleeding or pain, for emergency consultation with your dentist or a clinic as he or she suggests. A warm, salt rinse will aid in keeping the area clean before examination.
Sometimes a tooth is not avulsed but has been knocked out of alignment in a condition known as luxation of the tooth. Teeth may be pushed forward or back from normal alignment, or they may be partially extruded from the socket. Teeth pushed forward or back should be pressured firmly into place and held there. If there is no real resistance to pushing back extruded teeth, they should also be pressured into place. Teeth which are intruded further into the gum, however, should be left untouched for dental assessment. In any of these cases, a dentist should be seen as soon as possible.
In the case of a chipped tooth, the patient should keep the chip and make an appointment with his or her dentist as soon as possible.
Sometimes, a great deal of bleeding can result, with mouth injury, from a patient’s biting the tongue or the inside of the mouth. Bleeding can be controlled by putting pressure directly on the area involved, and swelling can be reduced by the application of cold packs to the exterior of the tooth area. Warm salt rinses may be soothing and will keep the area clean. Any unexplained or persistent bleeding in the mouth, however, should be assessed by your dentist. Heavy, uncontrollable bleeding should be seen in a hospital emergency room.
In cases where head trauma involves damage to a wider area of the face, or severe pain or bleeding outside of the area of the jaw, the patient should seek emergency service first from a hospital.
Not all dental emergencies are accidental. Other emergencies can be signalled by the onset of pain or swelling around the teeth. Even remarkable tooth sensitivity can signal a possible dental emergency. Sensitivity to heat is especially accurate in predicting more serious dental problems such as developing infections. If such symptoms arise following dental treatment, your dentist will probably have advised you of the need to report the events. If symptoms occur spontaneously, it is important to contact your dental office for assistance with diagnosis, advice, and medication for pain management even when such symptoms are later handled within regular office appointment times.
Toothache often signals serious problems which may progress rapidly. One such problem is the occurrence of a localized gum infection known as a tooth abscess. It appears as a rounded swelling on the gum, often near the tooth root. The area around an abscess can appear to be inflamed, and there may be a head of pus. Any such sore, whether it occurs with or without pain or visible pus, should be seen by a dental professional. Treatment of the abscess will not only relieve the immediate symptoms, but serve to prevent wider gum and tooth damage in the mouth.
Sudden changes of environmental pressure such as those experienced in aviation or diving may also produce severe dental pain. Such pain is generally caused by defects in previous dental work whereby a small cavity of air expands suddenly, causing pain. Again, a dental examination should be scheduled.
A tooth cracked inadvertently in eating or during nighttime bruxism (tooth-grinding) may also cause a great deal of pain. Again, a dental assessment is necessary to find the problem and repair any damage caused by the tooth fracture.
Tooth pain can sometimes be eased at home by flossing carefully around the tooth. Taking an oral pain reliever such as Advil or Aspirin that is available without prescription may also help to relieve toothache or mouth pain. In addition, a dentist may recommend certain analgesics that can be placed on the gum to relieve pain before dental treatment. Aspirin or regular pain relievers are not suitable for gum application as these medications can burn the gums. The application of oil of cloves to the area of pain can also relieve tooth pain though care must be taken not to swallow this preparation. Whatever home relief is available, however, persistent pain should always be assessed by a dentist.
Another dental emergency might involve an object trapped between teeth. Flossing between teeth will often loosen a trapped object so that it can be removed. Metal points should never be used on or between tooth surfaces as they may scratch the protective enamel. In cases where flossing or gentle pushing with a toothpick does not dislodge the obstruction, a dental professional should be called for assistance. When there is continuing tooth discomfort after home removal of an object, a dental visit should also be scheduled.
Sometimes an emergency involves the sudden failure of older dental work resulting in loss of fillings or loss of dental crowns. The holes left by lost fillings can be filled with tooth preparations available in some drug stores or even with a sugarless gum, but a dentist should be seen as soon as possible to properly replace the lost filling. The same is true of crowns. These can be re-cemented temporarily with denture adhesive or even toothpaste, but must be re-affixed by a dentist to minimize future damage and dental expense.
Problems with the wires of orthodontic appliances can be temporarily ameliorated by moving wires out of positions that irritate the mouth lining or tongue. The eraser portion of a pencil can be useful here. Additionally, offending wire ends can be affixed to orthodontic appliances with wax or cushioned with a piece of cotton while dental assistance is sought.
In any dental emergency, your best resource is your dentist. However, if you are not certain you are facing a dental emergency or are hesitant or unable to contact your dentist, or if you are travelling or do not have a regular dentist and are facing an emergency, you can contact the provincial health authority. Many provinces offer a twenty-four hour emergency helpline, staffed by medical professionals who will assist you in assessment of a patient’s condition and direct you towards help in the area.