Emergency dentistry
What should I do in a dental emergency?
Phone a dental practice immediately. If a tooth has been knocked out, hold it by the crown, do not scrub it, keep it moist in milk or saliva, and get to a dental professional within the hour.
What do I do right now?
Phone a dental practice and say what has happened. Do that first — before searching further, and before deciding whether it is serious enough. Being told it can wait until morning is a useful answer; guessing wrong is not.
While you are waiting, work through the section below that matches your situation.
- Tooth knocked out — time-critical. Handle it by the crown only, do not scrub it, keep it moist, get seen immediately.
- Face or gum swelling — needs same-day attention. If it is spreading, near the eye, or affecting your breathing or swallowing, go to a hospital now.
- Bleeding that will not stop — bite firmly on clean gauze for twenty minutes without checking.
- Broken or cracked tooth — keep the fragments, avoid chewing on that side, cover a sharp edge if it is cutting your tongue.
- Lost filling or crown — keep the crown, do not glue it back, avoid the tooth.
- Severe pain — pain relief you normally take safely, salt water rinses, and an urgent appointment.
GO TO A HOSPITAL EMERGENCY DEPARTMENT, NOT A DENTAL PRACTICE, if you have any of the following: swelling closing your eye or spreading down your neck; difficulty breathing, swallowing or opening your mouth; a fever with facial swelling; bleeding that will not stop after twenty minutes of firm pressure; or a head, jaw or facial injury with loss of consciousness, confusion or vomiting. These are medical emergencies. A dental practice is not equipped for them and going there first costs time that matters.
A tooth has been knocked out — what do I do?
This is the one true race against the clock in dentistry. A permanent tooth that is replanted quickly can survive; the same tooth left dry for an hour usually cannot, because the delicate ligament cells on the root die once they dry out. Everything below exists to keep those cells alive.
Pick the tooth up by the crown — the white part you normally chew with. Never touch the root. If it is dirty, rinse it briefly in milk or saline, or under cold running water for no more than ten seconds. Do not scrub it, do not use soap or disinfectant, and do not dry it or wrap it in tissue.
If you can, put it straight back into the socket the right way round, and hold it in place by biting gently on a clean cloth. A tooth back in its socket is in the best possible storage medium. If you cannot manage that — and many people cannot, which is fine — put it in a cup of milk. Failing milk, hold it inside your own cheek so it stays bathed in saliva, or use saline. Never store it in water; plain water damages the root cells quickly.
Then get to a dental professional immediately, taking the tooth with you. Phone on the way so they are expecting you.
Do NOT replant a baby tooth. Pushing a knocked-out primary tooth back into the socket can damage the permanent tooth developing above it. Keep the child calm, control any bleeding with gentle pressure, and phone for advice. If you are unsure whether it is a baby or permanent tooth, take it with you and let the dental professional decide.
My face is swollen — how serious is that?
Facial swelling means infection has spread beyond the tooth into the surrounding tissue, and it is the dental problem most likely to become genuinely dangerous. It needs to be seen the same day, not next week, and antibiotics from a previous course sitting in a cupboard are not a substitute for being examined.
Some swellings need a hospital rather than a dental practice, and the difference is worth knowing before you are in it. Swelling that is spreading upward towards or around the eye, downward into the neck or under the jaw, or that is making it hard to breathe, swallow or open your mouth, is an emergency. So is facial swelling with a fever or with a feeling of being generally unwell. Go to a hospital emergency department.
For a localised swelling while you arrange to be seen: hold a cold compress against the outside of your face for fifteen minutes at a time, keep your head elevated including when sleeping, keep fluids up, and take pain relief you normally take safely. Do not apply heat to the outside of the face, and do not try to lance or squeeze a swelling.
If swelling is closing your eye, spreading down your neck, or you are struggling to breathe, swallow or open your mouth — go to a hospital emergency department immediately. Do not wait for a dental appointment.
My mouth will not stop bleeding — what should I do?
Most bleeding after an extraction or an injury stops with firm, sustained pressure. Roll a piece of clean gauze or a folded clean cloth into a pad, place it directly over the bleeding site, and bite down firmly for a full twenty minutes. Set a timer, and do not lift it to check — every check restarts the process.
Sit upright rather than lying flat, and keep your head above your heart. Avoid rinsing, spitting, sucking through a straw, hot drinks, alcohol and smoking, all of which dislodge the clot that is trying to form. A damp tea bag used in place of gauze can help; the tannins encourage clotting.
If bleeding continues after twenty minutes of proper unbroken pressure, repeat once. If it is still bleeding heavily after that, or if you take blood-thinning medication, or if you feel faint or lightheaded, go to a hospital emergency department.
I have broken a tooth, or lost a filling or crown
Keep any pieces you can find, in milk or in a clean container, and bring them with you — a fragment can sometimes be bonded back on. Avoid chewing on that side, and stay off very hot, very cold and hard foods, as an exposed inner surface is often sharply sensitive.
If a broken edge is cutting your tongue or cheek, orthodontic wax or a piece of sugar-free chewing gum pressed over it will cover it temporarily. That is a comfort measure for a few hours, not a repair.
For a lost crown, keep it safe and take it in — an intact crown can often be recemented, which is much cheaper and quicker than making a new one. Do not glue it back yourself. Household adhesives are not safe in the mouth, and a crown set in the wrong position may not be removable without cutting it off, which turns a simple appointment into a new crown.
A lost filling is usually less urgent than it feels, unless the tooth is painful. Keep the cavity clean, rinse after eating, and get it restored reasonably soon — an unprotected cavity picks up decay quickly and the weakened walls of the tooth can fracture.
How do I manage severe tooth pain until I am seen?
Take the pain relief you would normally take safely, at the normal dose, and take it before the pain peaks rather than after. Follow the packet, and check with a pharmacist if you take other medication or have any condition affecting what you can use. If pain relief that usually works is not touching it, say so when you phone — that is clinically useful information.
Rinse gently with warm salt water — roughly half a teaspoon in a cup of warm water — a few times a day. Hold a cold compress against the outside of the face. Sleep with your head propped up, since lying flat increases pressure in the tooth and is why dental pain so often peaks at night.
Never put an aspirin or a painkiller tablet against the gum next to a sore tooth. It does not work — pain relief acts through the bloodstream, not on contact — and it causes a chemical burn of the gum tissue. Avoid clove oil applied directly to gum tissue for the same reason. Do not use antibiotics left over from a previous course; antibiotics do not treat toothache and taking them without assessment can mask a worsening infection.
Pain that has been severe and then suddenly stops is not necessarily good news. It can mean the nerve inside the tooth has died, and infection can continue to develop silently. Keep the appointment.
What happens at an emergency appointment?
The priority is getting you out of pain and stopping the problem getting worse. Definitive treatment often follows later, at a normal appointment, once the acute situation is settled.
The affected area is examined and a radiograph is usually taken, since much of what matters — the extent of a crack, an abscess at the root tip, decay under a restoration — is not visible from the surface. Local anaesthetic is given where needed.
What follows depends on the diagnosis: reimplanting and splinting a knocked-out tooth, draining an abscess, dressing an exposed nerve, rebuilding or covering a fractured tooth, recementing a crown, replacing a lost filling, beginning root canal treatment, or in some cases extraction. You should leave knowing what was done, what still needs doing and when.
Where a tooth is badly damaged, ask before you agree to extraction whether it can be saved. It is not always possible, and an emergency visit is not always the moment to decide — but a conservative practice should be able to tell you what the options are and what each one commits you to.
Common questions
Can a knocked-out tooth be saved?
Often, if it is a permanent tooth and it is replanted quickly. The root's ligament cells die once dry, so keeping the tooth moist in milk or saliva and getting to a dental professional within the hour gives the best chance. Never store it in water.
When should I go to hospital instead of a dental practice?
If swelling is spreading towards your eye or down your neck, if you cannot breathe, swallow or open your mouth properly, if you have a fever with facial swelling, if bleeding will not stop after twenty minutes of firm pressure, or after a head injury. Go straight to a hospital emergency department.
Should I take antibiotics for a toothache?
Not on your own initiative, and never leftovers from a previous course. Antibiotics do not relieve toothache and do not treat the cause, which usually needs a procedure. They are prescribed for spreading infection alongside treatment, not instead of it.
Is a dental abscess dangerous?
It can be. Most stay localised, but infection that spreads into the tissues of the face, floor of the mouth or neck can compromise the airway and becomes a medical emergency. Swelling, fever or difficulty swallowing means being seen the same day.
My tooth stopped hurting on its own. Do I still need to be seen?
Yes. Severe pain that suddenly disappears often means the nerve inside the tooth has died, not that the problem has resolved. Infection can then develop at the root with little or no pain until it flares.
What does emergency dental treatment cost?
It depends entirely on what is wrong and what is done — an examination and pain relief, a recemented crown and a course of root canal treatment are very different. Ask for a quote at the appointment before treatment begins.