You take a tumble from your bike, knock out an incisor and calmly pick up your tooth from the road. Your preschooler’s baby tooth is hanging on by a thread despite all his twisting and you don’t feel happy about pulling it out. You’re the mother of the bride, the wedding’s this weekend but your dental crown falls out on Friday. Your root canal surgery seemed to go well but now your mouth is swollen, your tooth is throbbing, your gums keep bleeding — and it’s midnight.
When dental problems occur, you can’t always tell what’s an emergency and what can wait. “The decision tree that the patient has could be different than what the dentist has,” says Dr. Larry Williams, a spokesperson for the Academy of General Dentistry and an associate professor with the Midwestern University College of Dental Medicine–Illinois.
[See: 10 Surprising Habits Killing Your Teeth.]
Here are some clear-cut dental emergencies, other troubling tooth issues and how to get them addressed.
When a permanent tooth is separated from its socket, it must be replaced ASAP. You can help save a tooth by handling it with care. Preventing the tooth from drying out is a priority.
Avoid touching the root surface of the tooth, says Dr. Julius Manz, director of dental programs with San Juan College in New Mexico. “Just hold it by the crown, or the part that’s in the mouth. You can rinse off the tooth if it got dirt in it, or anything like that. But try not to remove any of the cells or tissue off the tooth.” You can also gently rinse the empty tooth socket.
“If you can put (the tooth) back in the socket, that’s the best,” says Manz, who is an American Dental Association spokesperson. “If not, you can put it into the cheek and just have it held between the gum and the teeth there.”
If the possibility of swallowing the tooth is a concern, for instance with a small child, then Manz suggests putting it in milk instead, and getting to the dentist right away. Milk is preferable to plain water for transport, he adds, to avoid leaching water out of the tooth’s cells. “We want to maintain the cells’ integrity on the surface of the root, so that when we put it back in there’s a hopeful chance of getting it to re-implant into the socket,” he explains.
Many dental emergencies involve wisdom teeth when gum tissue around them becomes infected, Manz says. “But you can also have emergencies with trauma to the lips or tongue,” he says. Jaw pain or fractures are another type of dental emergency.
Sharp, severe, throbbing or persistent dull tooth pain needn’t be endured. “Don’t be stoic,” Manz says. “That’s what we’re here for: to help our patients. So we don’t want you staying at home in pain. We’ll take care of you — that’s the idea.”
[See: 7 Strategies for Getting Over Your Fear of Going to the Dentist.]
Bleeding and Swelling
Swelling is another hallmark of a possible dental emergency. “Any swelling in the mouth that is associated with pain is usually an abscess,” Williams says. “That’s an infection in the mouth from some source, usually a tooth.” The sooner an infection is treated, the better.
Swelling without pain is different, William says. Although it may not seem as urgent, he says, it still should be evaluated as soon as possible by a dentist. Swelling in the mouth could be related to a range of health issues from a swollen salivary gland to cancer. Don’t assume painless swelling will just go away — take it seriously, too.
Bleeding in the mouth can be an emergency if you’re taking blood-thinning medication like Coumadin, Williams says. Unexplained bleeding could signal medication problems, liver problems, trauma, infection or inflammation, he says. Bleeding on your gums whenever you brush your teeth could be caused by irritants between the teeth, he adds, and the only way to remove those is to floss.
If you crack your front tooth before a major social or professional event, or dental work you’ve had done develops problems, it could constitute what Williams calls an “aesthetic emergency.” Even though it’s not “life or limb,” he says, when dental mishaps alter your looks, it’s distressing.
“You’ve got a beautiful resin filling on your front teeth — the gap has been closed — and it falls out,” Williams gives as an example. When that happens, he says, most dentists will make every effort to address the problem and restore your teeth’s good appearance.
Stubborn Baby Teeth
When children lose their baby teeth either by accident or in the normal course of growing up, it’s probably not an emergency. However, parents may become concerned when a dangling tooth just refuses to separate from their little one’s gums.
The call may come around 9 p.m., Williams says. “It’s a baby tooth that’s barely hanging on. My child can’t eat or sleep. It hurts — it’s a problem.” Some parents would rather not remove clinging baby teeth themselves, he says, and prefer that the dentist do so during an office visit.
[See: 10 Healthy Teeth Habits From Dental Hygienists.]
Finding Emergency Dental Care
Having a dental “home” is invaluable when an emergency occurs, dentists emphasize. “It’s really important for everybody to have a dentist that they go and see regularly,” Manz says. “That way, if and when you have an emergency, you have somebody you can call. They know you. They know your record and they’re willing to get you in.”
Your regular dentist will work with you to provide timely care. In some cases, however, you might have to find other providers. Here’s what to do:
— Squeeze into the office schedule. “The majority of practices have an extra chair that can be used,” Williams says. “Or they may be able to work a patient in at lunchtime, first thing in the morning, right at closing or just as a standby.”
— Use the emergency number. If you call your dentist’s office after hours, the phone recording should include an emergency number and general instructions. (So should the dental practice’s website.)
— Get an out-of-town referral. If you have a dental emergency while you’re away from home, give your dentist a call anyway, for a referral via his or her professional network.
— Head to the nearest ER. When serious dental problems happen in the middle of the night, the local emergency room may be your only option.
— Try urgent care. Similarly, an urgent care clinic could at least address your pain or other pressing issues until you can connect with your dentist.
— Seek follow-up care. Make sure to let your dentist know when you’ve been through any dental emergency and ask about a follow-up appointment.
Your dentist may not be able to see you right away, but could suggest an over-the-counter pain reliever or call in a prescription to keep pain from becoming unmanageable. In some cases, your dentist might start antibiotics from your description of symptoms before seeing you in person to treat a likely infection.
Preventing Dental Emergencies
You can to do a lot to stave off dental emergencies. Be proactive and break bad oral habits:
— Keep foreign objects out. Kids — and sometimes adults — may need to see a dentist for foreign objects like pencils accidentally stuck in their mouths.
— Put a mouthguard in. Wearing a mouthguard while playing soccer or riding scooters can reduce the risk of dental trauma. Many emergencies in kids are related to sports, Manz says: “If they would just wear their sports mouthguards, it would be very helpful.”
— Stop clicking your tongue stud. If you have tongue rings, studs, or other jewelry in oral piercings, avoid the temptation to click and clack them inside your mouth, Williams warns. Metal jewelry can crack teeth.
— Avoid chewing on ice. You wouldn’t chew on a rock. Ice is hard on teeth, too.
— Find a bottle-opener. The muscles of the jaw are strong, but teeth are vulnerable. Don’t use your back teeth (or any teeth) to open stubborn bottle caps.
— Be prepared. If you like to plan ahead for emergencies, you can stock certain DIY dental products. For instance, saline solution to keep fallen teeth moistened is available at some 24/7 pharmacies and retailers. Adhesive kits for temporary cap, crown or filling repairs can be ordered online. Your dentist may have specific recommendations.
Getting regular dental checkups may prevent future emergencies and allow your dentist to detect and treat potential trouble spots early on. Building a relationship with a dental practice comes in handy if you ever have to call in to say: “I have an emergency: Can you fit me in now?”