Dental Emergencies: Introduction

Pain is one of the reasons people go to the dentist. A painful tooth can be triggered by hot or cold food and drinks. Heavy biting or grinding may fracture a tooth and cause the tooth to hurt when you chew. Sometimes, when a filling falls out, you may have a throbbing ache.

Any injury to teeth or gums can be serious and should not be ignored. Injury can damage nerves or blood vessels. There is also a risk of getting an infection, which can become life threatening. If you ignore dental pain or dental injury, you're taking a chance. You should not delay getting treatment. Delays in treatment can be dangerous to your health. Getting injured teeth repaired and treated quickly is the best thing to do.

Today, dentists have many options for dealing with dental emergencies. Now you can benefit from advances in pain management and techniques to restore teeth. Teeth can be repaired with synthetic materials that are strong and look as good as your natural teeth. Your dentist has the training and skills to identify how serious the problem is, and he or she almost always can reduce or eliminate pain within a few minutes.

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Dental Emergency Procedures Can Help Save a Tooth

Handling a dental emergency can be tricky when you or a loved one is in pain, but a quick and appropriate reaction can help save a tooth in danger. The American Dental Association recommends that you become familiar with these dental emergency procedures just in case you ever have a dental emergency.

If a tooth is knocked out, hold the tooth by the crown and rinse the root in water if it's dirty. Do NOT scrub it or remove any attached tissue fragments. If you can, gently place the tooth back in its socket or store it in a cup of milk and head for the dentist (with the tooth) immediately.

If you break a tooth, rinse your mouth with warm water to keep the area clean and apply cold compresses on your face to reduce swelling. Go to the dentist immediately.
Treat a bitten tongue or lip by cleaning gently with a cloth and applying cold compresses to reduce swelling. If bleeding is heavy or doesn't stop after a short time, seek immediate treatment from your dentist or emergency room.

If a toothache is getting you down, rinse your mouth with warm water, gently floss to remove food that may be trapped around it and see your dentist as soon as possible. Do NOT apply aspirin to the tooth or gum tissues.

A jaw injury or possible fracture needs immediate attention at your dentist's office or the emergency room. Apply cold compresses on the way to reduce swelling.
If a loose or broken wire from your braces is irritating your mouth, cover the wire end with a small cotton ball, beeswax or a piece of gauze until you can get to the dentist. Seek immediate treatment if a wire gets stuck in the cheek, tongue or gum tissue, but don't try to pull it out yourself.

If you have a dental emergency while you are traveling, check the yellow pages under "dentist" for the number of the state or local dental society; the society will be able to refer you to a nearby dentist. Or, visit the local emergency room and ask for a dentist referral.

 

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Knocked-Out Tooth (Avulsed Tooth)

Dentists refer to a knocked-out tooth as an "avulsed" tooth. This is one of the most serious dental emergencies, but the damage isn't necessarily permanent. If you act quickly, there's a good chance the tooth can be saved.

 

What You Can Do

When a tooth has been knocked out, the nerves, blood vessels and supporting tissues are damaged, too. The nerves and blood vessels can't be repaired, but if your dentist can put the tooth back in place within an hour after it was knocked out, there's a good chance that the supporting tissues will reattach and hold the tooth in place.

 

It's essential to get to a dentist right away. In the meantime, here's what you should do:

Pick the tooth up by the upper portion (the crown). Avoid touching the root end.

If the tooth is dirty, rinse it under running water for a few seconds. Don't scrub it because the tooth can be damaged easily. When the tooth is clean, tuck it between the cheek and gum or, preferably, place it back into its own socket. Make sure it's facing the right way. The tooth has a better chance of surviving if it's kept in its natural environment. Another option is to put the tooth in a container of milk, or spit into a cup and place the tooth in the cup with the saliva. The most important thing is to keep the tooth moist. Use a cup of water if nothing else is available. You can also purchase a kit at some pharmacies. The kit contains a solution similar to natural saliva.


Remember, if you act quickly and get to your dentist as soon as possible, there's a good chance the tooth can be saved.

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Lost Filling or Crown

 

Fillings, which are materials used to fill cavities in the teeth, and crowns, which slip over and cover the tops of damaged teeth, sometimes loosen and fall out. This is rarely an emergency, but it can be painful because the exposed tooth tissue is often sensitive to pressure, air or hot and cold temperatures. In some cases, a filling or crown may come loose because decay has developed underneath it. The decay can cause the tooth to change shape and as a result, the crown of filling no longer fits the tooth properly.

 

What You Can Do

You may be eating, or biting on something hard when you discover that a filling or a crown has become lose or fallen out. You may feel the lost filling or crown in your mouth.

If it's a crown, put it in a safe place and make an appointment to see your dentist as soon as you can. You don't want to wait too long because the tooth will be weak and could be damaged more if it is not protected by the crown. Also, when a crown is missing for a long time, your teeth may move. If this happens your crown may no longer fit.

If the tooth is sensitive and you can't get to your dentist right away, here's what you can do:

- If you can reach the sensitive area, apply a little clove oil with a cotton swab. It works well to dull tooth pain. You can buy clove oil in pharmacies and also in the spice aisle of many supermarkets.

- If you have the crown, you may be able to slip it back over the tooth. Before you do that, it's important to clean the inside of the crown as best you can. To hold it in place temporarily, coat the inner surface of the crown with tooth "cement," which you can buy in the dental section of your pharmacy. There are several temporary cements available. Some need to be mixed; others come ready to use. You also can use denture adhesive or even petroleum jelly if nothing else is available. These aren't permanent solutions, but they will help to hold the crown in place until you can see your dentist. You should not use any household glues to hold the crown in place. These products are not safe to put in your mouth and can damage the tooth and crown.

- If you've lost the filling or crown, you can use over-the-counter dental cement to cover the tooth surface. This will help to protect and seal the area until you're able to see your dentist, and can make you more comfortable.


What Your Dentist Will Do

If the tooth is structurally sound and the crown still fits properly, your dentist will clean the area and then replace the crown.

If the tooth has been affected by decay, your dentist will need to prepare the tooth again by removing the decay and then making a new filling or crown to replace the old one.

 

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Traumatic Injuries of the Lips and Tongue

What Is It?

Trauma to the lips, tongue and the inside of the mouth is quite common. The soft flesh of the lips and their exposed location make them particularly vulnerable to injury. With a blow to the face, the lips can be crushed against the teeth, causing bruising or lacerations. A person's own teeth can cut the inside of the lip or cause a puncture wound that penetrates the skin.

A tongue laceration often happens when a fall or blow causes someone to bite down on his or her tongue.

Any laceration inside of the mouth usually bleeds heavily because of the rich supply of blood to the area.

Symptoms

Symptoms include bruising, swelling, or cuts on the lips or tongue.

Diagnosis

Your health care professional will ask about your recent trauma and do a thorough physical exam of the area. If the lips are injured, he or she will check the teeth and bone for damage, and will check whether any pieces of chipped tooth are in the cut.

Expected Duration

The healing time for a lip or tongue laceration will depend on the severity of the cut. However, the extensive network of blood vessels in the mouth area promotes quick healing.

Prevention

Many lip and tongue injuries occur while participating in athletic or recreational activities and could be prevented through the use of a safety mouth guard. Mouth guards are made of soft plastic that is adapted to fit the shape of the upper teeth, protecting both the lips and teeth. Preformed guards are available in sporting goods stores or a dentist can create a custom-fit guard.

Routinely using seat belts and car seats can reduce the risk of trauma as a result of car accidents.

Treatment

At home, you can clean injured skin surfaces with mild soapy water and a soft clean cloth. To clean cuts inside the mouth, rinse with salt water or a hydrogen peroxide solution (one part hydrogen peroxide and one part water). Be sure not to swallow this peroxide rinse. However, do not be concerned if it foams. The peroxide is reacting to the bacteria normally found in the mouth.

If your lip is swollen or bruised, apply a cold compress. If there is bleeding, apply pressure with a clean cloth for at least five minutes. To help limit swelling, bleeding and discomfort, wrap crushed ice in clean gauze or a clean piece of cloth, and hold it inside the cheek.

Certain injuries will require medical attention from an oral or maxillofacial surgeon. It is particularly important to have an experienced surgeon stitch cuts that cross the vermilion border — the line that forms the junction between the skin and the fleshy part of the lip. Experience is required to make sure this boundary looks right as it heals because even a small irregularity will be permanently noticeable.

The doctor will first thoroughly clean the wound with lots of salt water or a hydrogen peroxide rinse to remove bacteria. Puncture wounds to the lip will then be closed from the inside out. Suturing all layers reduces the chance of scarring and helps make sure that the muscles around the lip maintain their ability to move.

Small puncture wounds in the tongue usually heal without the need for any treatment other than cleansing with antiseptic or hydrogen peroxide rinses. Although large cuts may require stitches, they tend to be hard to keep in place for any length of time because the tongue is so mobile during talking and chewing.

Because the mouth is rich with bacteria, an antibiotic often is prescribed following a lip or tongue laceration to ward off infection.

When To Call A Professional

Seek medical care if:

Bleeding cannot be controlled with pressure and a cold compress.
A laceration crosses the border between the lip and facial skin.
The lip is punctured.
An infection develops after an injury — Signs of any infection — redness, tenderness, fever and drainage of pus — usually will be evident approximately four days after the injury.

 

Prognosis

The outlook is excellent. The rich blood supply in the oral cavity promotes rapid healing, often with minimal scarring.

 

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Fractured and Broken Teeth

 

Teeth are remarkably strong, but they can chip, fracture or break. Teeth usually break as a result of trauma — from biting down on something hard, for example, or from a blow to the face. A child may fracture a tooth falling off a bike or curb during play. Cavities that have weakened the tooth also can cause chipping or fractures.

If a large piece of the tooth breaks off, it can hurt because the nerve inside the tooth may be damaged. If the nerve inside the tooth is exposed to air, saliva, or hot or cold foods or drinks, it can be extremely uncomfortable.

When a tooth cracks or fractures, it may or may not hurt. You may not notice the damage immediately. Minor tooth fractures are unlikely to cause symptoms. Deeper fractures can be painful because the damage may extend to the nerve inside the tooth. Pain from fractures may be constant or may come and go. Many people feel pain when they chew because as they chew they apply pressure to the tooth. As the fractured tooth bites down on the food, the crack in the tooth gets wider, but once the pressure is released, the crack closes again.

Larger fractures may cause a portion of the tooth to break off.

 

What You Can Do

Fractured Teeth
There is no way to treat fractured teeth at home. You need to see your dentist whenever a tooth is sensitive to changes in temperature or if it hurts while you're eating. Pain that's constant is a serious warning sign because it may mean that a fracture has damaged the nerve and live tissues inside the tooth.

Broken Teeth
You'll want to see your dentist as soon as possible. Your dentist will need to determine if the break was caused by decay and if the nerve is in danger. Adults with a damaged nerve usually will require root canal treatment, but in children, there's a possibility the nerve can be saved if the dentist is able to treat the problem immediately.

In the meantime:

- Save the pieces. If the break was relatively clean, your dentist may be able to cement the tooth back together as a temporary measure.

- Rinse your mouth well with warm water. If you were able to save the tooth fragment(s), rinse them under running water.

- If an area is bleeding, apply a piece of gauze to the area for about 10 minutes or until the bleeding stops.
Apply a cold compress to the cheek or lips over the broken tooth. This will help reduce swelling and relieve pain.

- If you can't get to your dentist right away, cover the broken surface of the tooth that is in your mouth with temporary dental cement, available in pharmacies.
Take an over-the-counter pain reliever.

What Your Dentist Will Do

 

Fractured Teeth
There are several types of tooth fractures, each of which requires different treatments. These include:

Minor cracks — Also called "craze lines," these are superficial fractures that affect only the tooth's enamel, the outer white part of the tooth. Minor cracks rarely need treatment. However, your dentist may lightly polish the area to smooth out any rough spots.

Chips — Minor chips don't always need treatment, although your dentist may recommend repairing the damage with filling material to prevent it from getting worse or to make the tooth look better. If the chip is in the front of the mouth, your dentist probably will use a tooth-colored filling. Often, if the chip is very small, your dentist may lightly sand the area to smooth out any rough spots.

Cusp fractures — These affect the pointed chewing surfaces (the cusps) of the teeth. They usually do not affect the pulp and are unlikely to cause significant pain. They may interfere with normal chewing, however, so your dentist may need to repair the damage. Minor cusp fractures sometimes are repaired by filing the surfaces of the tooth to restore the shape of the tooth. Frequently, these fractures will require an onlay or crown, in which the tooth is covered with a metal or porcelain material.

Serious fractures — These are fractures of the teeth that are deep enough to expose the nerve tissue. Usually, the broken part of the tooth will bleed. They almost always cause the tooth to hurt and be sensitive. This type of fracture will require root canal treatment to remove the exposed nerve. A crown likely will be needed to restore the tooth.

Cracked tooth — This type of fracture involves the whole tooth, from the chewing surface all the way down toward the nerve. However, in this type of fracture the two pieces have not come apart. This type of crack is similar to a crack that may form in an automobile windshield; the pieces remain in place, but the crack gradually spreads. Cracks can sometimes be repaired with filling material, although the tooth often will need a crown to prevent the crack from getting worse. If the pulp (nerve and other live tissues) is damaged, you may need a root canal as well.

Split tooth — This means that the tooth has split vertically into two separate parts. Some teeth, such as your back teeth (molars), have more than one root. It may be possible to keep one of the roots, which will then be covered with a crown. First, root canal treatment will be needed. Second, the root or roots that will not be kept are removed with a minor surgical procedure. Third, a crown will be made to cover the root and replace the tooth. Often, however, the tooth will have to be extracted.

Vertical tooth fractures or split root — These are cracks that start in the root of the tooth and extend upward toward the chewing surface. Vertical tooth fractures are often painful because the tissues surrounding the root may be inflamed or infected. In most cases, the tooth will have to be removed.

Decay-induced fracture — In this case, the tooth has fractured or crumbled because a cavity weakened the tooth from the inside out. Your dentist will evaluate the cavity and recommend the best way to restore the tooth.

Broken Teeth
There are many possible treatments for broken teeth, depending on the severity of the break.

If the break affected only the outer part of the tooth (the enamel), your dentist may be able to repair the damage with a filling. If the tooth is in the front of the mouth, your dentist probably will use a composite (tooth-colored) filling.

A more serious break will involve the enamel as well as the inner layer of the tooth (the dentin). In some cases, the damage can be repaired with a filling, but often the tooth will need a crown.

The most serious breaks are those that damage the nerve. In addition to making and placing a crown, your dentist probably will need to do root canal treatment to remove the damaged nerve and blood vessels.

Some fractures will require periodontal surgery before a crown can be placed. If the facture is below the gum line, close to or below the bone holding the tooth in the jaw, periodontal surgery will be needed to remove some bone to create enough room to place the crown over the root properly.

 

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Sports Safety: Avoiding Tooth and Mouth Injuries

A few years ago, a dental journal called ADA News published an article that described what seemed like an unusual case: A child had suffered serious dental injuries after snagging his teeth on a basketball net while doing a slam-dunk.

A freak accident? Not quite. After the article appeared, nearly 40 dentists wrote in with their own stories about would-be Michael Jordans who sacrificed their front teeth in pursuit of the perfect dunk.

In older children and adults, sports injuries are common. Dentists estimate that between 13% and 39% of dental injuries occur while playing sports.

The front teeth suffer the most. About 80% of all dental injuries affect one or more of the front teeth. Soft tissue damage — from biting the tongue or cheek, for example — also is common.

 

Basic Protection

Dental injuries aren't always permanent. Even if a tooth has been knocked out completely, it often can be saved if you get to a dentist quickly enough. In addition, minor chips and cracks can be repaired with "invisible" materials that are nearly as strong as the original tooth.

However, even "minor" mishaps can cause significant, and expensive, damage. If you enjoy sports or other high-risk activities, it's worth investing in some protection. The use of mouth guards among football players, for example, is believed to prevent about 200,000 oral injuries a year.

 

There are two types of protection to choose from:

 

Helmets — If you enjoy any type of activity that involves speed or impact — such as playing football, skating or riding a bike or a scooter — a helmet is a must. Forget hand-me-downs; if the helmet doesn't fit correctly or is not appropriate for a particular sports, it may be too uncomfortable to wear.

 

Mouth guards — As many male and female student and adult athletes have discovered, wearing a mouth guard is one of the best ways to prevent a sudden trip to the dentist.
Some ready-to-wear, U-shaped mouth guards, made from rubber or vinyl materials, are available to purchase over-the-counter in many sporting goods stores. However, they generally do not fit well and, as a result, do not evenly distribute the force of an impact. Dr. Sadowsky recommends that you avoid using these type of mouth guards and suggests going to a dentist to have a custom-fitted mouth guard made to fit comfortably in your mouth and offer better protection.

If having a mouth guard custom-fit by a dentist isn't an option, then an alternative could be a "boil-and-bite" mouth guard. These mouth guards are made from a type of plastic that softens in boiling water. You place the mouth guard in boiling water, and once the plastic is soft, you put it into your mouth, bite down on it, and mold the softened plastic around your teeth using your fingers, lips and tongue. Be careful not to scald yourself when removing the mouth guard from the boiling water, and make sure that it isn't too hot to put into your mouth. If the mouht guard doesn't fit comfortably the first time, you can reheat it and do it again. These "boil-and-bite" mouth guards are available in many sporting goods stores.