Dental emergencies and what to do

Dental problems are frequently endured because access is difficult and cost is a barrier, and a small number of them are urgent.

The genuine emergency

Spreading dental infection.

Features requiring immediate medical attention, not merely dental: facial swelling that is spreading, particularly towards the eye or under the jaw; difficulty swallowing or opening the mouth; swelling of the floor of the mouth or the tongue; difficulty breathing; fever with a swollen face; and feeling systemically unwell.

Dental infections can spread into the spaces of the neck and face, where they compromise the airway — which is a life-threatening situation that still causes deaths.

This is an emergency department presentation rather than a wait-for-the-dentist situation.

Toothache

Urgent but not usually an emergency.

Severe persistent pain, pain waking you at night, pain that lingers after hot or cold, and pain with swelling all indicate that the pulp is involved and that treatment is needed rather than analgesia.

Analgesia while waiting: paracetamol and ibuprofen together where both are appropriate, which is more effective than either alone for dental pain.

Antibiotics do not treat toothache and are not a substitute for treatment — they are used where there is spreading infection, alongside addressing the source.

Which is why a course of antibiotics that relieves the pain temporarily is followed by recurrence.

Clove oil and similar remedies provide brief relief and can irritate soft tissue.

Knocked-out teeth

Where minutes matter and most people do the wrong thing.

For a permanent tooth: handle it by the crown, not the root.

If dirty, rinse briefly with milk or saline — not tap water, and do not scrub.

Reimplant it into the socket immediately if possible and bite gently on something to hold it.

If reimplantation is not possible, store it in milk, or in the person's own saliva held in the cheek if they are able, and seek immediate dental care.

Do not store it dry, and do not store it in water.

The prognosis falls sharply with time out of the socket, so this is a same-hour matter.

Baby teeth should not be reimplanted, since this can damage the developing permanent tooth.

Broken and displaced teeth

Prompt attention.

Keep any fragments in milk, since they can sometimes be bonded back.

A displaced or loosened tooth should be seen the same day, since repositioning and splinting are time-sensitive.

Sensitivity after a chip may indicate exposed dentine or pulp, which needs covering.

And any dental trauma warrants assessment even if the tooth looks intact, since the nerve can die later and produce a painless abscess months afterwards.

Bleeding after extraction

Common and manageable.

Bite firmly on a clean gauze or a rolled handkerchief for twenty minutes without checking, since repeated checking disturbs the clot.

Sit upright rather than lying flat.

Avoid rinsing, spitting, smoking, alcohol and hot drinks for the first day.

If bleeding continues after repeated pressure, contact the dentist or an emergency service.

Anyone on anticoagulants should have mentioned this before the extraction, and should seek advice promptly if bleeding persists.

Dry socket

Severe pain a few days after an extraction, frequently with a bad taste and radiating pain.

It occurs when the clot is lost and the bone is exposed.

Risk factors include smoking, rinsing too early and difficult extractions.

It is treated by the dentist with cleaning and a dressing, and analgesia alone is generally inadequate.

Lost fillings and crowns

Not urgent unless painful.

Keep the crown, which can frequently be recemented.

Temporary dental cement is available from pharmacies and can protect an exposed tooth for a few days.

Avoid chewing on that side.

And arrange proper treatment, since an exposed tooth deteriorates and a temporary fix is not a solution.

Soft tissue and other problems

Ulcers lasting more than three weeks require assessment, since this is the presentation of oral cancer.

Persistent white or red patches similarly.

Bleeding gums, which indicate inflammation rather than a need to brush more gently.

Jaw locking or severe restriction of opening.

And any lump in the mouth or neck.

Access when you have no dentist

Practical routes.

Emergency dental services exist in most countries even where routine access is difficult, frequently through a helpline or an urgent care route.

Dental schools provide treatment at reduced cost.

Community and charitable clinics exist in many areas.

General medical services can provide analgesia and antibiotics for spreading infection but cannot treat the tooth, which is why they are not a substitute.

And emergency departments handle facial swelling, airway compromise and significant trauma, and are not the place for toothache.

General information only, not dental advice. Seek emergency medical care for facial swelling, difficulty swallowing or breathing, and same-day dental care for a knocked-out permanent tooth.