Emergency Management

Dental emergencies happen, and sometimes it's hard to know how urgently you need to see a dentist. Different types of dental emergencies can include tooth infection, tooth trauma/fracture, restoration loss, and gum infection.

You should immediately seek medical attention if you develop sudden swelling not localized to a specific tooth, have a fever related to a tooth infection, have trouble breathing, or if you are bleeding uncontrollably.

Tooth infection

Most dental emergencies are endodontic in nature, meaning bacteria have accessed the pulp of the tooth, which contains the nerve and blood vessels. The bacteria destroy the pulp and work their way out the base of the roots into the surrounding bone. An abscess develops when pus becomes trapped around the tip of the root. Symptoms can include, but are not limited to, severe pain described as shooting, aching, or throbbing; swelling at the base of the tooth, the gum, or the cheek; and/or a very strong odor or taste.

Treatment usually involves root canal therapy or extraction. If the tooth is restorable, a root canal can be performed. In this procedure, either a general dentist or a specialist cleans the bacteria and diseased tissue from the root canal system, and fills the space with an inert material that keeps bacteria out. If the tooth has been too badly damaged or fractured, an extraction must be done to remove the diseased tooth.

Patients with an endodontic emergency often experience some relief from NSAID's such as ibuprofen, and a course of antibiotics is sometimes necessary to control infection. If you think you may be experiencing an endodontic emergency, you should see a dentist as soon as you can. Even if the symptoms diminish, this is usually a temporary phenomenon, and the chronic infection will become acute again if a root canal or extraction is not performed.

Tooth trauma

Tooth trauma is a common dental emergency. The more traumatized your tooth, the more urgently you need to see a dentist. If a small part of your tooth breaks off, or if you lose all or part of a filling, you do not need to see the dentist as urgently, unless you can see bleeding from the tooth itself or you are in pain. If a large portion of the tooth breaks off, if you see bleeding from the tooth, or if you are in pain, you should see the dentist right away. It is important to follow-up even a small tooth fracture within several weeks to make sure the tooth is protected long term.

If a crown or bridge comes off, depending on how visible and how sensitive the area is, you should see a dentist within a few weeks. If you are in pain, you should see the dentist right away. Without the protection of a crown or bridge, your tooth/teeth are more susceptible to temperature sensitivity and decay. You should bring in the prostheses, if possible, because sometimes they can be re-used.

If a tooth is forced out (avulsed) or displaced it is necessary to see a dentist right away. Depending on how much, and in what direction, a tooth is moved, often it can be saved by repositioning then splinting to adjacent teeth. Sometimes performing root canal therapy is necessary on traumatized teeth due to a lack of blood supply as a result of the trauma.

If you have an avulsed tooth, a dentist can sometimes clean it, perform a root canal, then replant it in the mouth. To maximize chances for success, place an avulsed tooth in milk or Hanks Balanced Salt Solution (HBSS). Any other liquid, including water and saliva, could damage the tooth; however, if an ideal solution is not available, a tooth kept moist has a better chance for survival than a tooth that remains dry. If you place the tooth in an appropriate solution quickly after it is lost, and if you get to the dentist within a few hours, sometimes the tooth can be successfully replanted.

Gum infection

Sometimes irritants become wedged below the gumline or in-between teeth. If irritated long enough or substantially enough, the gums can swell, become red, and/or bleed. If you notice an isolated area become red and inflamed, you can thoroughly clean the area with a toothbrush, floss and a toothpick. Gently clean slightly underneath the gumline. Use hydrogen peroxide and baking soda to form a paste, then brush that paste gently onto the area. Let it sit for about two minutes, then rinse. Also use a warm salt-water rinse several times per day. Often a mild, isolated gum infection can be cleared with this protocol alone. If no improvements are noticed in 48 hours, you should see a dentist. Tarter buildup can cause generalized gum irritation, and a dental professional has to scrape off tartar with special instruments, so you need to see your dentist for generalized cases of gum irritation. If the irritated gums are associated with severe pain, you should see a dentist right away.

If you are not sure if you should see a dentist, call the office at (202)863-1600 to discuss the problem.