First Aid for Dental Problems: Part 2 Dental Emergencies

Just like other organs or structures in the body, the teeth are susceptible to acute injuries, infections, and defects.  Knowing what do when one of these occurs can help minimize discomfort and improve the outcome.  In some cases, this may even mean the difference in saving or losing a tooth. Last week’s Health Tip discussed several urgent tooth issues that could, for the most part, be managed without requiring an emergency visit to the dentist. Today’s problems represent more serious conditions that typically would warrant immediate dental attention.  If the answer to any of the following is yes, you most likely have a true dental emergency:

•   Do you have persistent bleeding from the area of a tooth or gum?
•   Do you have severe pain from a tooth or structure within the mouth?
•   Have you lost a tooth or have teeth that have been loosened from injury?
•   Do you have fever, pain and/or swelling in the mouth or jaw region? 

Dental abscess   A dental abscess is a complication of a bacterial infection in which pus becomes trapped in a pocket.  Most often, an abscess is the result of tooth decay which allows bacteria to invade the center aspect (pulp) of the tooth. Symptoms of a dental abscess include a severe toothache, a bitter or foul taste in the mouth, and sensitivity when chewing or to hot or cold.  With more advanced infections there may be fever, pus appearing near the site of the pain, redness of the soft tissue or gums, or visible swelling of the jaw.   Depending on the severity of the abscess, treatment could involve taking a course of antibiotics, having the abscess drained through the tooth or gum, or in certain instances, removal of the affected tooth.  A root canal is usually required on the involved tooth if the abscess is successfully treated without the need for extraction.

Knocked-out tooth.  Dentists refer these as “avulsed” teeth.  The sooner that an avulsed tooth is re-implanted in its socket, the greater the likelihood that the tooth can be saved.  After finding the tooth, it should be picked up only by the crown (the enameled part that you see in the mouth) in order to avoid damaging the periodontal ligaments (PDL) that connect the root of the tooth to the bone of the jaw.  If the tooth is dirty, it should be gently rinsed in water, again avoiding damage to the PDL.  If the correct orientation of the tooth can be determined, replacing the tooth into its socket offers the greatest likelihood of reattachment. If the avulsed tooth cannot be slipped back into its socket, it needs to be protected while awaiting dental attention. One of the best ways to preserve the tooth is to place it into a balanced salt solution, marketed commercially as Save-a-Tooth.  This product is approved by the Federal Drug Administration (FDA) and American Dental Association (ADA).  Its manufacturer claims that up to 90% of avulsed teeth can successfully be re-implanted when this product is used as directed.  If a tooth preservation product is not available, other options are to place the tooth between the cheek and gum or in a container of milk.  An avulsed tooth is a true dental emergency, so it is important to get to the dentist as quickly as possible. This procedure applies only to permanent teeth. Re-implantation of completely avulsed primary (baby) teeth is generally not recommended.

Chipped or broken teeth.  Teeth may be chipped or broken from injury, from biting down on something hard or because decay or fillings have weakened the tooth.   Replacement of chipped or broken teeth should not be attempted.  The pieces should be preserved in the same manner as an avulsed tooth and taken to the dentist.  For bleeding, pressure should be applied to the tooth with a gauze pad. The mouth should be rinsed with warm salt water and a cold compresses may be placed on the face to help with pain. An OTC pain medication can be taken if needed.  If only a small piece of tooth enamel was chipped off, the dentist may be able to repair the damage with a filling.  For more serious breaks a crown may be required.  If the break was caused by a cavity, compromising the health of the tooth's nerve, a root canal may be necessary.

Partially dislodged (extruded) tooth. The best chance of saving a partially dislodged tooth is to see the dentist right away.  The dentist can relocate the tooth in the socket and use one of several methods of “splinting” the loose tooth to hold it in place.  Assuming the periodontal ligaments were not seriously damaged, they should heal, reattaching the tooth to the socket. Until you reach your dentist's office, to relieve pain, apply a cold compress to the outside of the mouth or cheek in the affected area. Take an over-the-counter pain reliever (such as Tylenol or Advil) if needed.