A Guide to Dental Emergencies

Conditions can change in the mouth quite suddenly for a variety of reasons. Illness, injury, certain medications, bacterial infections, aging restorations, and lapses in home-care routines can all contribute to situations where pain, swelling, bleeding, and even broken teeth can suddenly occur. In most of these situations, seeing a qualified dentist as soon as possible is recommended, but there are certain situations where a few extra days between the initial onset of symptoms and an actual appointment will not do any real harm.

This guide is designed to help you evaluate if you may be risking a potential emergency situation by waiting a few extra days or weeks before contacting a dentist. In general, any change that lasts more than a few days or increases in intensity over time should be looked at as soon as possible. If it is simply impossible to make an appointment right away, there can be some at-home remedies that may be helpful in the short term. However, we always recommend that you call your dentist before trying any home-care remedies to make sure that they are appropriate to your current situation and pre-existing conditions.

Bleeding

Bleeding can occur in the mouth for a variety of reasons. The most common kind of bleeding is seen at the gumline when brushing or flossing. It can be startling to spit into the sink and see blood, but minor bleeding while brushing or flossing is often simply an indication that there is minor inflammation or an increased level of bacteria present. Food particles stuck underneath the gum can also cause bleeding and inflammation in a specific area.

If you are experiencing minor bleeding while brushing or flossing, we encourage you to review the article How to Brush and Floss Your Teeth to see if your technique may be part of the problem. However, if these changes do not demonstrate any improvement in your bleeding within a few days, you should contact your dentist for an examination.

Call a Dentist

Bleeding in the mouth can be an indication that further treatment is needed. Dental care should be pursued as soon as possible when the following conditions are present:

•	Minor bleeding that does not improve within a week
•	Minor bleeding that persists more than 24 hours following a dental surgery or extractiong

Go to the Emergency Room:
Significant, unrelenting bleeding from the mouth is a serious condition and may be an indication of a clotting problem or serious systemic injury or disease. If your mouth is continuously filling with blood, go to an Emergency Room immediately.

Pain

A toothache should never be ignored. It is possible to sprain a tooth and experience a lingering achiness with chewing for a few days, or even to have generalized achiness in several teeth because of an increase in clenching or grinding habits. Teeth that have significant recession or have been recently bleached can also be quite sensitive to cold sometimes. But when a single tooth begins to constantly ache or throb, you can generally assume that something more serious may be going on and you should contact your dentist as soon as you can.

Some over-the-counter pain medications can alleviate a toothache in the short-term, but they do not heal the tooth. Do not be lulled into a false sense of security if regular doses of pain medication make the pain go away. The underlying conditions that created the toothache still exist and will continue to get worse whether you are masking the pain with medication or not.

Call a Dentist

You should always call your dentist when you experience significant or lingering pain in the mouth. Be sure to mention any of the following symptoms when speaking with your dental office about pain:

•	Shooting pain, or pain that lingers
•	Pain that is triggered by hot or cold temperatures
•	Pain that is triggered by biting pressure
•	Pain that wakes you up from sleep
•	Throbbing pain
•	Cheek or face swelling
•	Fever

Swelling

Like a toothache, swelling is a symptom that should never be ignored. When swelling occurs, the immune system is rushing to react to an infection and the inflammation can increase rapidly if not addressed quickly. A dental infection can cause swelling to occur in the cheek or on the gums in the form of a white bump or "pimple."" In either case, pain may not be present, but dental treatment should still be sought out as soon as possible.

Infection anywhere in the body puts stress on the entire immune system. Untreated tooth and gum infections can lead not only to significant tooth or bone loss, but also to massive systemic infection, and even death in extreme cases.

Call a Dentist

An abscess can develop very quickly once swelling sets in, even if no pain is present. Call your dentist as soon as possible if:

•	Your cheek is swollen
•	You notice a white bump on your gums

Go to the Emergency Room:
Facial swelling can also be an indication of a serious medical condition. Go to the Emergency Room immediately if you have:

•	Swelling that increases visibly
•	Discoloration of the skin
•	Swelling that spreads across the face or down the neck

Broken Teeth or Restorations

Teeth, fillings, and crowns can break for a variety of reasons. Accidents, gradual weakening over time, or biting on something very hard at just the right angle can fracture a tooth or a restoration. None of these conditions should be left unaddressed for long periods of time, but in most cases a broken tooth, filling, or crown can wait a few days or even a week before being restored without any increase in damage. Even if the breakage is slight and there is no pain, you should still contact your dentist in a timely fashion to determine how long may be appropriate to wait for an evaluation. A conversation with a qualified dental professional is the only way to determine how urgent your treatment needs may be.

When managing a broken tooth or restoration until you can see a dentist, there are a few things you can do at home to increase comfort. But be careful when researching home remedies online or considering advice from friends or colleagues. Only your dentist can offer you the safest advice on what you can do at home that will also take your specific medical history into consideration.

Don't try this at home!

There are many ways to make a broken tooth or restoration more comfortable while you wait for your treatment appointment. It is always best to consult with your treating dentist for the temporary home-care recommendations that are most appropriate to your situation and pre-existing conditions. There are, however, several things you SHOULD NEVER do at home in an attempt to fix your own broken teeth.

1.	Do not use super glue or any other type of glue to recement crowns or pieces of broken teeth at home. Glue of any kind is not safe for use inside the mouth. And super-glue can be particularly difficult for a dentist to remove without destroying a restoration that might have otherwise been salvageable.
2.	Do not wear a crown that has come off without using a dentist-recommended temporary cement to hold it in place. It is easy to forget that the crown is not cemented, and you risk the possibility of swallowing it while chewing or during sleep. If the crown has any sharp edges, it can damage your esophagus and other soft tissues. And if you happen to choke or cough at all while swallowing the crown, you risk the possibility of aspirating it into your lungs which is extremely dangerous. Temporary dental cement can be found at most pharmacies and is the best at-home solution until you can get in to your dentist to have the crown recemented permanently.
3.	Avoid waiting longer than a week to have a crown permanently recemented by your dentist. Temporary cement does not create an adequate seal to guard against decay over long periods of time. And if you choose not to wear the crown at all until your appointment, the position of the remaining tooth structure can shift over time. This can sometimes make it impossible to recement the old crown and require you to have an entirely new crown made.
4.	Do not use sticky food or gum to "glue" a crown or a piece of a tooth in place. Not only are these not effective, they can also feed cavity-causing bacteria and increase the damage to your existing tooth structure.
5.	Do not use any kind of power tool or sharp metal object inside your mouth in an attempt to smooth a sharp edge. If a broken tooth is sharp enough to cut your tongue or cheek, you need to see your dentist as soon as possible to have it smoothed and restored. A small ball of orthodontic wax (available at most pharmacies) placed over the sharp edge can help smooth the area until your appointment.

My tooth was knocked out!

Sometimes a tooth can be knocked completely out of its socket with the entire root intact following an accident. This is called an avulsed tooth.

Avulsed teeth are most common in children, but they can happen in adults. In these cases, the tooth may be viable for reimplantation. If you can locate the tooth, take the following steps to increase the chances of a successful reimplantation:

•	Rinse the tooth gently with plain water. Do not scrub or use any kind of soap or disinfectant.
•	Place the tooth in a cup of cow milk. Do not use soy milk or any other type of alternative milk product.
•	As long as any other injuries sustained during the accident are minor and do not require medical attention, get to a dentist as soon as possible.
•	Do not under any circumstances try to reimplant the tooth yourself.

Reimplanting an avulsed tooth is time-sensitive and the chances of success decrease the longer you wait for treatment. However, your life is more important than an individual tooth.

If you have any doubt as to whether or not your other injuries are serious, go to the ER immediately and bring the tooth with you in a cup of milk. There may be an oral surgeon available at the hospital to help with reimplantation while your other injuries are being attended to.

Call a Dentist

You should always call your dentist within a few days when a tooth breaks, even if there is no pain. It may be safe to wait several days or even up to two weeks before receiving treatment, but only a dentist can help you make that determination and offer you safe and effective advice for managing the breakage at home in the meantime.

Go to the Emergency Room:
If you have suffered a head injury that has also damaged your teeth or jaw in some way, go to the Emergency Room FIRST before seeking dental treatment. You may have a concussion which can be quite serious and cannot be treated by a dentist.

Severe bleeding from facial cuts or tears should also be treated in an Emergency Room before consulting a dentist about other injuries to the teeth or jaw.

Jaw Locking

The TMJ or jaw joint can sometimes lock in an open or closed position. It can be very frightening to suddenly be unable to open or close your mouth, but try to remain calm.

Do not attempt to force the jaw to open or close with your hands or any other object or device. Instead, try gently massaging and/or icing the cheek muscles to see if you can ease the lock and allow some motion again. If the jaw is locked open, sometimes it can be unlocked by placing your thumbs on the molars and gently pulling straight down. Do not yank.

Once the lock has eased, be sure to follow up with a dentist who is familiar with TMJ disorders as soon as possible to help you avoid locking up again in the future.

Call a Dentist

Even if you are able to loosen the lock yourself, you should always follow up with your dentist. Further treatment may be necessary for the prevention of future locking episodes, and your dentist may be able to help or provide you with a referral.

Go to the Emergency Room:
Facial swelling can also be an indication of a serious medical condition. Go to the Emergency Room immediately if you have:
It is very rare for a jaw lock to be so severe as to require emergency treatment. If you are having difficulty easing a lock, call your dentist or physician for advice on what to do next. In many cases, a physical therapist can help ease the lock and allow the mobility you will need to pursue further treatment.

Orthodontic Emergencies

Orthodontic emergencies are extremely rare. However, there are many situations that can develop that may be painful or uncomfortable. In general, any time you are experiencing pain or discomfort that you did not expect or is causing you concern during orthodontic treatment, you should call your dentist or orthodontist to discuss it. In most cases, arrangements will be made to see you as soon as possible, or specific advice will be given on how to address the issue at home.

Sometimes it's easy to identify that the problem is coming from a broken appliance, bracket, or wire. It can be tempting to try and fix these problems yourself at home, but you should always call your treating dentist or orthodontist first before attempting to make any at-home repairs to your orthodontia.

Don't try this at home!

1.	Do not repair your own broken retainers. Orthodontic retainers are designed to deliver specific amounts of pressure against particular teeth. Broken retainers can sometimes be repaired, but only your dentist or orthodontist can determine if the retainer will continue to deliver the appropriate amount of pressure in the right direction after the repair. Wearing a retainer that has been repaired at-home may render it ineffective, or even redirect pressure into the wrong areas.
2.	Do not try to glue your brackets back onto your teeth. There is no type of glue that is safe to use at home for the recementation of brackets. But even if there was, the placement of a bracket is specifically calculated to deliver the right pressure in the right direction to move your tooth into alignment. Only your treating dentist or orthodontist will know exactly where this bracket should go.
3.	Do not use any kind of power tool or sharp metal object to clip a wire or smooth a sharp edge inside the mouth. If your braces or retainers are sharp enough to cut your cheek or tongue, try placing a small ball of orthodontic wax (available at most pharmacies) over the sharp area, and then call your treating dentist or orthodontist for additional home-care advice or to schedule an appointment.

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