What counts as an emergency?

A dental emergency is characterised by severe trauma to any part of the mouth. Problems that may be a dental emergency include: 

ü  Toothache

ü  Knocked out tooth

ü  Chips, fractures and cracks

ü  Bitten lips or cheeks

ü  Abscesses and swelling

ü  Excessive bleeding from the mouth

ü  Jaw pain

What to do in an emergency

Toothache

1. First rinse the mouth withwarm water to remove debris.
2. If swelling is present, place a coldcompress to the outside of the cheek (donot use heat).
3. Take paracetamol rather than aspirin, as aspirin may increase bleeding.
4. Do not place aspirin on the gum or achingtooth. This causes soft tissue to burn.
5. Always seek dental treatment as soon as possible.

Knocked out tooth

1. If a permanent tooth is knocked out, it can be saved but immediate action is required.

1. Remain calm and find the tooth. Handle the top of the tooth only (the crown). Never hold the tooth by its roots.

1. Do not scrape, rub or remove any tissue fragments from the tooth. Make sure the tooth is clean. If the tooth is dirty, rinse it in milk or very briefly in water. Alternatively, the owner can gently suck the tooth although this is not recommended for young children or adults who are unconscious, in shock or not fully calm and cooperative. Immediately replant the tooth in the socket and hold tooth in place.

1. If unable to replant the tooth, keep it moist by immersing it in milk, sealing it in plastic wrap, or placing it in the owner’s mouth next to the cheek (if the owner is able).Do not let the tooth dry out.

1. Seek immediate dental care – time is critical.

Chips, fractures and cracks

1. If a tooth chip or fracture is only minimal and there is no soft tissue trauma and no pain, do not panic. Seek dental advice within 24 hours.

1. If the tooth chip or fracture is large, seek dental advice as soon as possible. Look for any sign of ‘pink’ as this indicates the nerve is exposed. If the nerve is exposed, seek immediate dental treatment. Delaying treatment may mean the tooth cannot be saved.

Bitten lips or cheeks

A lip or cheek can be bitten during eating, as a result of a fall or after local anaesthetic. If the numb area is sucked, bitten or rubbed, it can be damaged without you realising. The traumatised area often looks like an unsightly chemical burn and may be misdiagnosed as such. When feeling returns to the area, it may be very sore. Swelling and infection may also occur.

Treat a bitten lip or cheek with warm saltwater mouth rinses to promote healing (add ¼ teaspoon of salt to 1 cup of water). Seek advice from a dental professional if an infection occurs.

Abscesses and swelling

Dental abscesses are pus-filled swellings caused by infection inside a tooth, infection of the gum and/or trauma to the tooth. Abscesses are often, but not always, painful. Dental abscesses can cause facial swelling and/or enlarged lymph glands.

For the control moderate pain as a result of dental abscesses, use over-the-counter pain medication. Take this in the usual way and do not apply the medication to the abscess itself. Use cold compresses to help control swelling. A dental professional or doctor may prescribe antibiotics to reduce infection. However, antibiotics will not remove the source of infection.

Seek prompt dental treatment. An abscess will not heal itself, and antibiotics will not fix the problem entirely.

Soft tissue trauma and bleeding

Apply a clean bandage or folded handkerchief to the wound and apply firm pressure. Sit down and maintain the pressure for at least ten minutes. Don not lie down flat. If the bleeding cannot be controlled, seek immediate medical attention. Apply a cold compress to relieve swelling and pain (for 20 minutes at a time only). Seek dental or medical advice. Use warm, saltwater mouth rinses until the wound has healed to reduce the risk of infection.

Jaw pain

If you are having trouble eating or opening your mouth due to jaw pain, or experience jaw pain on waking, seek medical or dental care. It is important for a dental professional or doctor to diagnose the source of the jaw pain. To alleviate jaw pain in the short term, apply a cold compress or take anti-inflammatory medication.

References

 Douglass, A., & Douglass, J. (2003). Common Dental Emergencies. American Family Physician, 67, 511-516.

Andreasen, J., & F, A. (1994). Textbook and color atlas of traumatic injuries to the teeth (3rd ed.). Copenhagen: Munksgaard.