Kenneth Cheng, D.D.S.
Dental emergencies include any mishap of the teeth, their supporting structures or soft tissue of the mouth. Most dental emergencies can be quickly and effectively treated when the patient seeks prompt medical attention. However, untreated dental emergencies can result in complications that range from mild to serious.
There are many different types of injuries or other problems that can be categorized as dental emergencies. They include:
- Abscess. A buildup of pus in tissue resulting from bacterial infection that causes swelling and pain.
- Avulsed tooth. A tooth that is knocked out of its socket.
- Loose orthodontic brackets or wires (braces). Although problems with orthodontic appliances rarely rise to the level of dental emergencies, they may sometimes require prompt treatment by an orthodontist.
- Extruded tooth. A tooth that is partially pushed out of its proper alignment. Extruded teeth typically are loose or partially dislodged from the socket.
- Fractured tooth. A partial break in the tooth that can range from minor to severe.
- Lost crown or filling. Tooth restorations sometimes can crack, loosen and fall out.
- Pericoronitis. Occurs when a wisdom tooth does not fully erupt and part of the tooth remains covered by a flap of gum.
- Soft-tissue injuries. These are injuries to the tongue, cheeks, gums or lips.
- Jaw fractures. Breaks or cracks in the upper or lower jaws.
- Stuck foreign debris. Food particles such as popcorn hulls can lodge underneath the gum and irritate the tissues, which can eventually lead to infection.
Dental emergencies can result from many different factors, including accidents, athletic activity, tooth decay, accidentally biting oneself, burning oral tissue with hot food and chewing on hard objects that injure soft tissue of the mouth.
Patients who suffer injuries to their teeth or gums often can immediately identify them as dental emergencies because of the significant pain that accompanies the injury. Dental emergencies typically cause pain or discomfort that ranges from mild to severe. Some injuries to the tooth may not cause pain but instead cause structural damage that is visible, such as some tooth chips, fractures or bleeding.
People who visit a dentist as a result of a dental emergency will undergo a dental examination. The dentist will visually scan the site of the injury or area where pain is occurring. The teeth, lips, tongue and gums may be inspected. X-rays will likely be taken. A dentist often can determine the severity of the injury based on this examination.
Until patients are able to reach a dentist, there are several steps they can take to treat their condition and reduce their pain. Prompt treatment of dental emergencies allows the injury to be contained before more extensive damage occurs. A dentist may perform various types of treatments depending on the nature of the injury.
Not all dental emergencies can be prevented. However, people can often take steps to reduce the risk of injuries that can lead to dental emergencies, such as wearing protective equipment during athletics and seat belts while riding in a car. Regular dental examinations also allow a dentist to track potential weaknesses and other problems that could result in a tooth or soft-tissue injury down the line.
About dental emergencies
Dental emergencies include any mishap involving the teeth, their supporting structures or soft tissue of the oral cavity. If left untreated, some dental emergencies can advance to more serious conditions that may involve other parts of the body. However, most dental emergencies can be quickly and effectively treated when the patient seeks prompt medical attention from a dentist.
The severity of a dental emergency depends on which portion of the tooth or mouth has been damaged. The tooth is composed of several parts:
- Crown. Part of the tooth that is visible above the gum line.
- Enamel. The hard, translucent outer shell that covers the crown. The enamel is hard enough to handle the strain of a lifetime of biting, chewing and grinding. It also protects the tooth from bacteria and changes in temperature when eating hot or cold foods. Nonetheless, it is very brittle and may crack or chip, which can expose the inner part of the tooth.
- Root. Part of the tooth that is encased in the upper (maxilla) or lower (mandible) jawbone. A hard shell called cementum covers the root and attaches to fibers that fasten the root to the jawbone.
- Dentin. Layer of the tooth found beneath the enamel and cementum. It makes up most of the tooth’s structure and is responsible for the tooth’s color.
- Pulp. Located beneath the dentin at the core of the tooth and made up of blood vessels, nerves and connective tissue. The blood supply of the pulp provides the nutrients that keep the tooth alive.
Damage to any part of a tooth may result in a dental emergency. This includes damage to any restorative dental work (e.g., lost filling, cracked crown) in the tooth.
Teeth are also supported by soft tissue such as the gums (gingiva), which surrounds the roots of the teeth to help hold them in place. Other examples of soft tissue include the cheeks, tongue and lips. Damage to these areas of soft tissue is often considered a dental emergency.
Prompt treatment of dental emergencies allows the injury to be contained before more extensive damage occurs. For example, treating or restoring a damaged tooth quickly can prevent further damage to the deeper structures of the tooth. This substantially improves the odds of saving the injured or damaged tooth. Meanwhile, treating a lost filling promptly can keep a minor repair from turning into major, more extensive dental work.
Types and differences of dental emergencies
There are many different types of injuries or other problems that can lead to dental emergencies. They include:
- Abscess. A buildup of pus in oral tissue usually resulting from a bacterial infection that causes swelling and pain. An abscess can appear as a pimple-like swelling on the gums (fistula) in mild cases to massive swelling of the face in severe cases. The swollen area may appear as a lump that may be hot and fluid-like to the touch. Additional symptoms may include a loose tooth, the drainage of pus into the mouth, fever, tender neck lymph nodes and the inability to fully open or close the mouth (trismus).
Abscesses often form within 24 to 48 hours after the infection starts and usually cause intense pain that forces the patient to seek help. A dentist will usually treat an abscess by cleaning the area, draining the pus and prescribing antibiotics. Treatments such as root canal treatment or tooth extraction may also be necessary at this time or at a later date.
- Cellulitis. In contrast to an abscess, a cellulitis is characterized by a more diffuse swelling which is doughy to the touch. Pus is generally not present, and a cellulitis can have more serious consequences than an abscess. Treatment generally involves more antibiotics and removal of the source of infection (e.g., extraction). Drainage is sometimes performed if there is no improvement two to three days.
- Avulsed tooth. This is the dental term for a tooth that is knocked out of its socket. It is considered one of the most urgent dental emergencies because of the risk of tooth loss and the need for immediate treatment. An avulsed permanent tooth cannot survive unless the patient takes the proper steps to save the tooth and seeks immediate medical attention. This includes picking up the tooth by the crown at the top, not by the root of the tooth. The tooth should be rinsed (but not scrubbed) in saline (water and salt) solution or milk. If possible, it is best to gently reimplant the tooth immediately. The longer the tooth is out of the mouth, the less the likelihood that it can be reimplanted successfully. If reimplanting the tooth is not possible, the tooth can be kept in a glass of milk until the patient gets to the dentist. A dentist will clean the tooth socket before easing the tooth back into place. The tooth may be stabilized with a splint made of resin and wire. The tooth may require root canal treatment. Avulsed primary teeth are not replanted due to the risk of hindering normal development of permanent teeth.
- Loose orthodontic brackets or wires (braces). Although problems with orthodontics rarely rise to the level of dental emergencies, they may sometimes require prompt treatment by an orthodontist. For example, braces that become dislodged or orthodontic bands that detach from a back tooth should be reattached by an orthodontist. Protruding or broken wires also require an orthodontist’s attention.
Problems with orthodontic devices (e.g., loose brackets or bands, protruding wires) typically can be temporarily fixed with orthodontic wax. The eraser end of a pencil may be used to push the wire into a position that is less aggravating to the cheeks or gums until an orthodontist can be seen. Patients should never attempt to cut their orthodontic wire due to a risk of accidental inhalation or swallowing of the cut piece of metal. Pain due to mouth sores caused by protruding wires may be alleviated with periodic warm saltwater rinses or over-the-counter topical anesthetic to temporarily numb the area.
- Extruded tooth. A tooth that is loose or partially dislodged from its socket. When this occurs, it is crucial to see a dentist promptly if the tooth is to be saved. Waiting a day or two may make it difficult to reposition the tooth into place. To treat an extruded tooth, a dentist cleans the area around the tooth and eases it back into place. In some cases, a splint made of resin and wire may be used temporarily to stabilize the tooth. It may remain splinted for several weeks. When nerves or blood vessels are damaged, a root canal treatment may be necessary to prevent tooth discoloration or development of an abscess.
- Fractured tooth. A partial break in the tooth that can range from minor to severe. Trauma, cavities and other factors (e.g., teeth grinding) can cause teeth to fracture. In some cases (such as a minor chip) this may not cause pain. However, pain may occur if a large piece of the tooth breaks off or the nerve inside the tooth is exposed or damaged.
A prompt visit to the dentist can determine the extent of injury to the tooth. The type of procedure used to repair the tooth will depend upon the nature and extent of the damage that has occurred. See the Types of Fractures section for more information.
- Lost crown or filling. Tooth restorations such as fillings and crowns sometimes can crack, loosen and fall out. This often is the result of decay under the restoration, which causes the tooth to change shape in a way that no longer supports the restoration. Lost dental restorations are rarely an emergency, but may be painful, causing patients to seek immediate attention to alleviate the pain. Increased tooth sensitivity may also indicate that a crown or filling has been lost. Patients may feel the loose bit of restoration in the mouth while chewing.
Patients who experience a lost crown or filling should consult a dentist right away. In some cases, over-the-counter dental cement may be used to temporarily fill the void and relieve pain. If the remaining tooth has not been significantly damaged, a dentist can replace a crown or filling rather easily. If underlying decay is discovered, the dentist will need to remove the decay before replacing the restoration.
- Pericoronitis. Involves wisdom teeth that do not fully erupt, leaving part of a tooth covered by a flap of gum. Infection occurs when food particles or bacteria become trapped under the gum. Pericoronitis most often affects lower wisdom teeth. Symptoms include pain and swelling in the area of the wisdom teeth, a bad taste in the mouth and halitosis. A patient with pericoronitis may also have difficulty fully opening the mouth.
Pericoronitis is sometimes initially treated by cleaning and lavaging the area and removing damaged tissue or pus. Antibiotics may be used to kill any infection that sets in, and patients will be instructed on methods of keeping the area clean to help prevent the return of pericoronitis. In acute or recurring cases of pericoronitis, the patient should see an oral and maxillofacial surgeon to determine if the wisdom tooth should be extracted. In other cases, the wisdom tooth may eventually emerge on its own, ending the risk of further episodes of pericoronitis.
- Soft-tissue injuries. These are injuries to the tongue, cheeks, gums or lips. These may be cuts, punctures, burns or sores. They are usually painful and may bleed quite a lot. Minor soft tissue injuries often heal by themselves while more severe injuries may require stitching, which is usually performed by an oral and maxillofacial surgeon.
- Jaw fractures. These are usually the result of a traumatic episode such as a motor vehicle accident, a fall or assault. They should be treated by an oral and maxillofacial surgeon and may require admission to a hospital for treatment. Jaw fractures are often treated by wiring the jaws together for about 6 weeks or sometimes may require complex surgery to insert metal bone plates to hold the bones together.
- Stuck foreign debris. Food particles such as popcorn hulls can lodge underneath the gums and irritate tissue, which can eventually lead to infection. When this occurs, patients generally can feel the sensation of an object stuck under their gums, which may escalate to a throbbing pain and swelling of the area. Patients who cannot remove food particles with floss or a toothpick are urged to see a dentist, who can use specialized instruments to reach and remove the object.
Types of tooth fractures
There are various types of fractures that may occur as part of a dental emergency. Fractures may involve the tooth’s crown, root or both. In some cases, the pulp may be damaged. This type of damage is most likely to cause pain.
Each type of fracture requires a slightly different form of treatment. Patients who experience a fracture can rinse their mouths with warm water and apply an ice pack to the outside of the mouth in the area of damage to reduce any swelling.
Treatment by a dentist will vary depending on the type of fracture that occurs. Minor cracks (or craze lines) and chips, for instance, are not usually considered emergencies. The following can be considered dental emergencies:
- Serious fracture. This damage typically exposes nerve tissue, causing bleeding and pain. A root canal treatment is usually necessary to remove the nerve in the tooth. Once this procedure is complete, a crown will be used to cover the tooth.
- Cracked tooth. Damage that begins on the chewing surface which sometimes extends all the way down to the nerve. The tooth does not break in two, but a craze line remains which can spread or open. Filling material can be used to repair some cracks. However, in many cases a crown or root canal treatment is required.
- Split tooth. Occurs when a cracked tooth actually splits into two separate parts. In most cases, the tooth must be extracted. Sometimes, a split tooth may be treated with a root canal treatment (if the pulp is damaged) and a crown used to cover and protect the tooth.
- Vertical tooth fractures. Damage that begins in the tooth root and spreads upward to the chewing surface, frequently a type of split tooth. This type of fracture is often very painful due to inflammation or infection of the tissues surrounding the root. In most cases, the tooth must be extracted.
- Decay-induced fracture. Fracture of the tooth resulting from a cavity that weakens the tooth from the inside out. Treatment for a decay-induced fracture varies on a case-by-case basis and can best be determined by a dentist who examines the damage.
Signs and symptoms of dental emergencies
Patients who suffer injuries to their teeth or gums often can immediately identify them as dental emergencies because of the significant pain that accompanies the injury. Sometimes, it can be difficult to determine the source of this pain. In other situations – such as a tooth that is knocked out (avulsed) – the source of the pain may be more obvious.
Dental emergencies typically cause pain or discomfort that ranges from mild to severe. The nature of the pain differs depending on the type of injury suffered. For example, damage to a filling or crown may cause sudden pain, while debris that becomes trapped under the gum is more likely to cause pain that becomes gradually more severe over time. Most abscesses are painful, although sometimes there may be little or no pain associated with these infections. In addition, soft-tissue injuries may also cause bleeding, which can make the injury appear worse than it actually is.
Some injuries to the tooth may not cause pain but instead cause structural damage that is visible, such as some tooth chips or fractures.
Patients who experience any type of dental pain or apparent structural damage to their teeth should consult their dentist immediately. Even minor aches or superficial chips on teeth may indicate problems with the living center of a tooth (pulp). Early diagnosis and treatment is important because it can help prevent larger, more serious problems. While it is best to consult a dentist for dental emergencies, hospital emergency departments can often provide assistance if a dentist is unavailable in the off hours.
Risk factors and causes of dental emergencies
Dental emergencies can result from many different factors. A person may damage a tooth during an accident or athletic activity. Tooth decay can cause damage to teeth or dental restorations that can lead to fractures and result in a dental emergency.
Accidents can also damage soft tissue and result in a dental emergency. Other examples of causes of soft-tissue dental emergencies include accidentally biting oneself, burning oral tissue with hot food and chewing on hard objects that injure the soft tissue of the mouth.
Diagnosis methods for dental emergencies
People who visit a dentist as a result of a dental emergency will undergo a dental examination. The dentist will visually scan the site of the injury or area where pain is occurring. The teeth, lips, tongue and gums may be inspected. A dental and medical history will be obtained. X-rays will likely be taken.
Nondental causes of a patient’s dental pain may be considered and ruled out. This may include checking for signs of the following:
- Myofascial inflammation. Swelling of facial muscle tissue. When this occurs around the mouth and jaw area, dental pain may result. TMJ disorder can sometimes cause myofascial pain.
- Migraine headaches. A severe type of headache. Migraines can sometimes cause dental pain (e.g., a toothache) that may be mistaken for a dental emergency.
- Sinus, nasal or ear infections. Inflammation and infection of the sinus cavities (sinusitis), nasal tissues or ears may include symptoms of dental pain.
- Nerve damage. Injury along certain nerve pathways may cause dental pain.
A dentist often can determine the severity of the dental emergency based on examination of the painful area – for instance, whether or not the tooth is loose or is tender to the touch. In most cases, x-rays may be helpful in determining the extent of a tooth injury. Injuries to the soft tissues – such as the tongue, cheeks, lips or gums – also will be diagnosed primarily through a physical examination of the oral cavity.
Biting tests may be performed to identify possible tooth fractures or cracks. These tests can identify specific areas of a tooth that may be sensitive when biting on a wooden stick. Another diagnostic technique involves shining an intense beam of light on the surface of a tooth and examining it from the opposite side (transillumination). Fractures may be detected as the light passes through the tooth. However, this can be difficult to determine in teeth with dental restorations.
In some cases, a patient may be referred to a specialist. For example, an orthodontist may need to be consulted for broken braces, a periodontist may need to be consulted for gum infections, and an oral surgeon may be needed to treat severe soft-tissue injuries, drain abscesses or perform extraction of wisdom teeth due to pericoronitis.
Treatment options for dental emergencies
Treatment of a dental emergency will depend on the type of emergency and extent of damage. For example, chipped teeth may require little more than polishing while a severely fractured tooth may require extraction. Some soft-tissue injuries are able to heal on their own while others require stitching. For more information about treatments related to specific injuries, see Types and differences.
Until patients are able to reach a dentist, there are several steps they can take to treat their condition and to reduce their pain. Permanent teeth that become extruded or avulsed require prompt attention if they are to be saved.
Patients who experience an abscess can rinse their mouths several times daily with a saltwater solution that is one-half teaspoon of salt to 8 ounces of water. This draws pus to the surface and temporarily decreases pressure in the affected area.
To relieve dental pain before reaching the dentist, an over-the-counter pain reliever, such as ibuprofen, may be used, according to the Academy of General Dentistry (AGD). The AGD does not recommend using aspirin, which is an anticoagulant that may cause excessive bleeding during a dental emergency.
Patients also can rinse with warm water once an hour or as needed to reduce pain. Patients who have an item lodged in their teeth can floss their gums before gently running a toothpick along the gum line to try to dislodge the debris.
People who develop a toothache or lose a filling or crown and experience pain can obtain over-the-counter remedies such as “toothache kits,” toothache gels and liquids which ease the pain. These remedies often contain eugenol, a substance found in clove oil.
Clove oil has been a traditional remedy for toothaches, but there is insufficient clinical evidence to support its use. As a supplement, it is not regulated by the U.S. Food and Drug Administration and patients should be cautious with its use. Clove oil should not be applied to the gums because it may burn. Application should be made by a cotton swab dipped in a tiny amount of the oil. Too much oil in the mouth may be poisonous.
Over-the-counter topical anesthetics also are available to numb soft tissue pain. Use of heat or cold can often relieve symptoms associated with dental emergencies. For example, applying ice packs to the part of the mouth that is hurting can relieve pain and swelling in some cases (e.g., extruded tooth; biting the lip, cheek or tongue). Ice should be applied for between 10 and 20 minutes of every hour. In other cases, use of warmth may be more soothing to a patient’s symptoms. For example, rinsing with warm saltwater can relieve symptoms associated with an abscess. Patients who are in any doubt about whether to use heat or cold should consult their physician or dentist rather than trying to guess which technique is more effective.
In addition, pain and bleeding from soft-tissue injuries can be treated by rinsing the mouth with a saltwater solution, using gauze to apply pressure to the injured area for 10 to 15 minutes and placing ice on the affected area for five to 10 minutes.
Prevention methods for dental emergencies
Not all dental emergencies can be prevented. However, people can take steps to reduce the risk of injuries that may lead to dental emergencies.
Parents can help reduce their child’s risk of experiencing a dental emergency due to physical injury by childproofing their home. This includes removing items that can be tripped over (e.g., extension cords), pulled or tipped over (e.g., certain types of lamps, table cloths) or inserted into the child’s mouth (e.g., loose change, small parts of toys and other objects).
In addition, people of all ages should use caution when participating in athletics or other activities where they are at risk of falling or crashing into people or things. Wearing appropriate protective devices (e.g., headgear, mouth guards) during contact sports or when bicycling, rollerblading, skateboarding or riding a motorcycle can protect the teeth from injury. In addition, people are urged to wear seat belts or other age-appropriate safety restraints when traveling in a car.
Good dental hygiene can help prevent tooth decay that may contribute to fractures and lost restorations. Brushing and flossing after eating foods that may get stuck under the gums (e.g., popcorn) can help prevent infection. Allowing hot foods to cool slightly before eating may prevent burns on the tongue, cheeks or gums. Sharp or crunchy foods (e.g., pretzels) should be consumed carefully, so as not to injure the soft tissue of the mouth. Chewing ice or hard candies should be avoided because of an increased risk of tooth fracture. Treating tooth grinding (bruxism) can help prevent fractures or cracks in teeth.
Regular dental examinations allow a dentist to track potential weaknesses and other problems that could result in a tooth or soft-tissue injury down the line. Dentists also can provide preventive care and recommend methods to keep teeth and soft tissues strong, healthy and less susceptible to injury.
Questions for your doctor
Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions related to dental emergencies:
- Is my injury a dental emergency?
- How long can a tooth be out of the mouth and still be saved?
- Is there a chance my mouth may reject a reimplanted tooth?
- What are the options if a permanent tooth cannot be saved?
- What self-treatment can I perform until I see the dentist?
- What type of pain relief medications or remedies do you recommend?
- What type of treatment do you recommend?
- What symptoms may indicate I have developed complications?
- What long-term risks do I face as a result of my dental emergency?
- Will I need to make follow-up visits after my treatment?
- How can I lower my risk of future dental injury?