Dental Emergencies

 
What is a Dental Emergency?
 
Basically, any dental problem requires immediate treatment in order to save a tooth, like an injury to the teeth or gums can be potentially serious.  To stop ongoing tissue bleeding or alleviate severe pain is considered a dental emergency and should not be ignored. Even if you have good oral health habits, dental accidents can happen like toothaches. Ignoring a dental problem can increase the risk of permanent damage as well as the need for more extensive and expensive treatment later on.  As small problems in the mouth can causes much bigger problems if they are not treated as soon as possible. This is because even injuries that seem small can affect the living tissues inside the teeth. Quick response to a dental problem improves the odds of saving injured or damaged teeth.
 
There are a couple of simple ways you can judge whether or not your situation constitutes an emergency. First, purely cosmetic issues are not a cause for a trip to the emergency room. Some patients consider some incidents, such as a chipped tooth, to be emergencies, too, due to the cosmetic effects on the smile’s appearance. However, there are some emergencies that could damage the appearance of your teeth, and the faster you get them treated the more likely you’ll keep your teeth and keep them looking good. While these issues may not necessarily be threatening to a person’s health and well-being, quick action is often desired for aesthetic reasons.
 
Second, you can safely assume it’s a real emergency if you’re bleeding from the mouth, have swelling/ bulges on your gums, are in severe pain, have loose teeth, or are experiencing swelling the facial area.
 
Dental emergencies are a common occurrence, but having the knowledge to handle the crisis can help reduce the stress of an emergency. Proper maintenance can minimize the chances of experiencing a dental emergency. This is why regular visits to the dentist can help you identify and avoid these situations.
 
Be prepared for a dental emergency. Carry contact info for your dental professionals with you at all times and seek treatment as soon as possible to maximize your chances of positive treatment outcomes in the long term. Immediately getting to a dentist within 30 minutes or less can make the difference between saving or losing a tooth.
 
Take any dental emergency very seriously. Do what you can to preserve your teeth and contact your dentist as soon as you can after the injury. Immediate management of the situation can help reduce the chances of long-term damage.
 
Most common dental emergencies may include teeth that are –
 
Knocked out tooth, forced out of position and loosened tooth or chipped, broken or fractured tooth.  In addition, lips, gums or cheeks are often cut or bitten. Oral injuries are often painful and should be treated by a dentist as soon as possible. Severe toothaches, signs of infection that may indicate an abscess (such as fever and dental or facial pain) or facial trauma that results in damaged or lost teeth or fractured facial bones. If you are experiencing severe pain or continued bleeding or any dental emergency call your dentist immediately. The interventions performed following a dental emergency will vary depending on the complexity of the situation. Some issues may be addressed with a simple restoration. For severe cases, like fractured jaws and certain types of tooth loss, oral surgery may be required.
 
What should I do when a tooth is knocked out?
 
A knocked-out tooth is a dental emergency that requires urgent attention. If your tooth has been knocked out due to an impact or severe facial injury. Try first to find the lost tooth. If the appropriate emergency steps are followed immediately after the tooth has been knocked out, the chances are very good that the tooth can be reinserted and preserved by a dentist.
 

• Immediately call your dentist for an emergency appointment. Your dentist may be able to put it back.
• Handle the tooth by the crown (the part that is usually exposed in the mouth, not the root. Do not touch the root of the tooth. Touching the root (the part of the tooth below the gum) can damage the fragile cells necessary for its reattachment back into the jaw bone.
• Very gently rinse the tooth in water if it is dirty to ensure that it’s clean. Do not scrub the tooth or remove any attached tissue fragments attached to it. Be sure to place a towel or wash cloth in the sink so that the tooth does not go down the drain.
• If you can, try placing the clean tooth gently in the socket back in place without touching the root to keep it moist. Make sure it is facing the right way. Never force it into the socket. If it is not possible to reinsert the tooth in the mouth of the injured person, or if there’s a chance that the tooth might be swallowed, wrap the tooth in a clean cloth or gauze and soak it in a container of cold milk or cup of water that contains a pinch of table salt, if milk is not available. It is important not to let the tooth dry out.
• You must act quickly. See your dentist as quickly as possible for the best chances of retaining the tooth.
• Use acetaminophen, for pain, do not take aspirin because aspirin can cause excessive bleeding.
• When a tooth exits the mouth, tissues, nerves and blood vessels become damaged.  If you get help and the tooth is put back in place within 1 hour of being knocked out, it has a fair chance that the tissues will grow to support the tooth once again surviving the trauma. After 2 hours, the chances are poor. The longer you wait to re-implant the tooth in its socket, the less chance you have of the tooth “taking” and remaining viable.

 
What do I do if my child knocks out a tooth?
 
If the tooth is a baby tooth, the best thing to do is find the tooth, keep it moist in a container of milk or place the tooth in the cup with the saliva and get to a dentist. Use a cup of water if nothing else is available.
 
Your dentist can see whether the entire tooth, or just part of it, came out. Your dentist can also determine whether to replant it again.  Dentists in Delhi are adopting a conservative approach in trying to save natural teeth as much as possible.
 
What should I do when a tooth is pushed out of position or its loose or partway out of its socket?
 
This is caused by impact or an injury. It may be pushed inward or outward but the tooth has not actually come out and it might be possible to save it if the tooth is not broken, and the nerve and blood vessels are still attached. It might have been knocked away from its usual position, or it might be hanging in by thin threads of tissue. It is important to call the dentist immediately to make an appointment.
 

• Attempt to reposition the tooth back to its original position if you can, use very light finger pressure, but do not force the tooth into the socket.
• Leave the tooth in your mouth even though it is partially out of the socket.
• Bite down to keep the tooth from moving.
• See your dentist right away and particularly if you are in a ‘hanging by the thread’ situation.
• Until you reach your dentist’s office, in the meantime use a cold compress to the outside of the mouth or cheek in the affected area to relieve pain. On the way stabilize the tooth and hold it in place with a moist tissue or gauze. Take an over-the-counter pain reliever if needed like acetaminophen. Do not take aspirin, for pain because aspirin can cause excessive bleeding.

 
What should I do when a tooth is fractured or cracked?
 
A cracked or fractured tooth is a serious issue. Fractured or cracked teeth usually suggest that damage has occurred to the inside of the tooth as well as to the outside. Call your dentist immediately for an emergency appointment and follow these steps:
 

• Rinse mouth immediately with warm water to clean the area.
• If the fracture is caused by facial trauma, apply an ice pack or cold compress on the face to minimize any swelling.
• Use acetaminophen, for pain; do not take aspirin because aspirin can cause excessive bleeding.
• Never apply a painkiller to the gum because it can burn the gum tissue. This includes Orajel, which often is marketed for these types of procedures.
• Avoid chewing on the injured tooth and avoid extreme temperatures.
• Immediately get to your dentist, who will determine treatment based on how badly the tooth is broken. Only a dentist can tell how bad the break is. An X-ray will be needed in order for your dentist to properly diagnose the condition of your tooth.

 
There are different types of tooth fractures-
 
Minor fracture: chipped teeth are minor fractures. Minor fractures can be smoothed by your dentist or simply left alone. Another option is to restore the tooth with a composite restoration. In either case, treat the tooth with care for several days.
 
Moderate fracture: Moderate fractures include damage to the enamel, dentine and/or pulp (soft tissue inside of the tooth with nerve and other live tissues). If the pulp (innermost layer of the tooth) is not permanently damaged, the tooth may be restored with a full permanent crown. If damage to the pulp does occur, further dental treatment such as root canal may be required.
 
Severe fracture: Severe fractures often mean a traumatized tooth with slim chance of recovery. This means. In this case fracture is so extreme that the tooth cannot be saved. If the tooth cannot be saved, your dentist will inform you of the various alternatives for replacing missing teeth, such as implant-supported restorations and bridges.
 
What should I do when tissue is injured?
 
Trauma to the lips, tongue and inside of the mouth is quite common. The soft flesh of the lips and their exposed location make them vulnerable to injury. Any cut inside the mouth usually bleeds heavily because of the rich supply of blood to the area. Injuries to the inside of the mouth include tears, puncture wounds and lacerations or tears to the cheek, gums, lips or tongue. Contact your dentist as soon as possible.
 
If you experience any type of tissue injury-
 

• If there is no bleeding, the wound or the affected area should be cleaned gently right away with a soft clean cloth by soaking it in warm water.
• If there is bleeding, rinse your mouth with a mild salt-water solution.
• Press down on the part of the mouth that is bleeding using a moistened clean cloth or piece of gauze or tea bag. Hold in place for 15 to 20 minutes
• If the bleeding is coming from the tongue, it can be reduced by gently pulling the tongue forward and place pressure on the wound using gauze
• If the lip is swollen, Using ice can help limit swelling. Use an ice pack or wrap crushed ice in clean gauze or a clean piece of cloth or cold compress in the affected area for 5-10 minutes to keep the swelling down.  If the bleeding does not stop after 15 minutes, take the injured person to your dentist or to a hospital emergency room for the necessary care right away.
• To alleviate any type of facial pain associated with tissue injury, you can take acetaminophen.
• Never take aspirin or ibuprofen for a dental emergency because they are anticoagulants, which can cause excessive bleeding.

 
Toothache
 
When you experience toothache, this is your body trying to tell you something. It usually an indication that something is wrong.
 
First, thoroughly rinse your mouth with warm water. Gently use dental floss to remove any lodged food to ensure the pain is not being caused by food particles or other debris trapped or caught between your teeth or between your tooth and gum. Sudden pain may be caused by pieces of food that come in contact with a decayed area of the tooth. Food, heat or cold may create pressure near the nerve and cause pain. If you don’t brush and floss well, the bits of food remain. Bacteria multiply in this area, and an infection of the tooth and gum may develop. This type of infection is called an abscess. It can be at the root end of the tooth (in bone) or in the gums. An abscess can be a serious health problem if it is not treated.
 
Call your dentist as soon as possible. Explain your symptoms and ask to be seen as soon as possible. The pain could be a result of any number of reasons, all with varying degrees of severity: infected gums, tooth decay, tooth abscess (pus), exposed root surfaces and more. If you are unsure of the severity of the situation (although the amount of pain should be an indication) take an over the counter pain medicine that works for you. If the area is swollen, apply an icepack or cold compress to the outside of your mouth or cheek at the spot of the sore throat for a good 20 minutes and head to the dentist right away. Do not put a heating pad, a hot water bottle, or any other source of heat on your jaw. Heat will make things worse instead of better.
 
Many people assume that applying medication like aspirin or any other painkiller straight on the gum below the tooth that is in pain might help. However, this doesn’t actually help.  In fact, it could do the exact opposite. It might burn or inflame the gum causing more problems for the already infected teeth.
 
Chipped or broken tooth
 
The teeth are strong, but they are still prone to fractures, cracks and breaks . Chips or fractures can affect the living tissue inside the tooth, causing more problems in the future. We can prevent the damage from getting worse with early treatment.
 
Broken teeth can almost always be saved.
 
Call your dentist and explain what happened. Try to find and retain the chipped particle or any pieces and place it in a moist cloth with a few drops of water or saliva (If kept in good condition, it may be possible to reattach it).
 
Sometimes fractures are fairly painless, but if the crack extends down into the root, it is likely that the pain will be extreme.
 
Teeth can fracture for any number of reasons, from biting down too hard, by trauma or from developing cavities that weaken your teeth. Rinse the mouth using warm water; rinse any broken pieces. If the broken edge is sharp, it is important to be careful while chewing because of the danger of your tongue or lips being damaged by the rough edge or as not to chip it more and see your dentist immediately.
 
If there’s bleeding, apply a piece of gauze to the area for about 10 minutes or until the bleeding stops. Apply a cold compress to the outside of the mouth, cheek, or lip near the broken/chipped tooth to keep any swelling down and relieve pain.
 
Pain is a sign that you have broken through the enamel layer to the dentine, which is sensitive because it contains nerve endings, or even deeper into the pulp, which is pink and may bleed a bit. Pain can also warn that the tooth is fractured, sometimes below the gum line where you cannot see the break.
 
Treatment will vary depending on the severity of the damage – from smoothing out a chipped out area or bonding with a white tooth-colored filling to repair the tooth if it’s a small break. If the break is serious and there has been damage to the tooth’s nerve, root canal therapy may be necessary as well. Your tooth may also need a crown (also called a cap). Keep in mind that cracks are not always visible. Symptoms may involve pain while chewing and sensitivity to cold and possibly hot foods and liquids as well as air, which may over time, become more pronounced.
 
See your dentist as soon as possible. Not receiving the proper treatment can result in infection or further decay or damage.
 
Something stuck or caught between teeth
 
For objects stuck in the mouth, first try using dental floss, very gently and carefully, to remove the object but avoid cutting your gums. But do not try to remove or dislodge the stuck object with a sharp or pointed object, it can cut your gums or scratch the tooth surface. The item might be painful or cause an infection, so see your dentist if you cannot get the object out.
 
Lost filling
 
In some cases, your filling could fall out due to the beginning of a new cavity or from the normal wear and tear over time. Either way, without a protective cover, your tooth is prone to temperature sensitivity and deterioration.
 
As a temporary measure, stick a piece of softened sugarless chewing gum into the spot where filling was lost.  Be sure the gum you use is truly sugarless, as gum with sugar can cause pain when introduced into the tooth and can potentially lead to bacterial infections in the area.
This will protect the area for a short period of time. See your dentist as soon as possible.
 
Lost crown
 
Usually, a crown comes loose while eating. Once it is out of the mouth, the affected tooth may be incredibly sensitive to temperature changes, pressure or air. Crowns generally become loose because the tooth beneath is decaying. This could be a sign that there is another cavity that has formed in your tooth. The decay destroys part of the tooth and causes shape changes in the teeth, meaning that the crown no longer fits.
 
If a crown has dropped out of the mouth, make a dental appointment as soon as possible. Don’t wait too long. What is left of the tooth will not be as strong as your crown. The tooth has lost its support and it could easily become damaged. Pieces could break off or crumble, and you would need more extensive treatment. Make sure to rinse your mouth out with warm water if ever this happens to you.  Keep the crown in a cool, safe place because there is a possibility that the dentist can reinsert it. If the crown is out of the mouth for a long period of time, the teeth may shift or sustain further damage.
 
Broken or loose brackets, wires or bands
 
If a wire breaks or sticks out of a bracket or band and is causing discomfort by poking your cheek, tongue, or gum, try using the eraser end of a pencil to push the wire gently into a more comfortable position. If this isn’t possible, cover the end with something soft to provide a cushion like orthodontic wax, a small cotton ball, or piece of gauze until you are able to get to your orthodontist’s office. Never try to cut the wire, as you could end up swallowing it or breathing it into your lungs.
 
Abscess
 
Abscesses are infections that occur around the root of a tooth or in the space between the teeth and gums. Abscesses are a serious condition that can damage tissue and surrounding teeth, with the infection possibly spreading to other parts of the body if left untreated.
 
Because of the serious oral health and general health problems that can result from an abscess, see your dentist as soon as possible if you discover a pimple-like swelling on your gum that usually is painful. In the meantime, to ease the pain and draw the pus toward the surface, try rinsing your mouth with a mild salt water solution (1/2 teaspoon of table salt in 8 ounces of water) several times a day.
 
A severe infection or abscess in the mouth can be life-threatening and should be dealt with immediately.
 
Possible Broken Jaw
 
Broken jaw requires specialized attention. Go to your dentist or a hospital emergency department immediately.
 
They are generally caused by a strong force to the jaw, from sports injuries, vehicle accidents, or work accidents.
 
If you think your jaw is broken, you will usually feel pain in the face or jaw and have swelling and bruising. You may not be able to close your jaw or get your upper and lower teeth to align properly.
 
To control swelling, apply a cold compress. Stabilize the jaw using a bandage wrapped beneath the jaw and tied on top of the head.
 
A broken or dislocated jaw may cause breathing problems or significant bleeding. If not treated properly, a broken jaw can have devastating effects on a person’s ability to eat and breathe.
 
Most reputed dental clinics in Delhi like Smile Delhi,  have an oral surgeon on their panel so that any emergency situations caused by trauma can be sorted in the clinic itself. In our clinic i.e. ‘Smile Delhi-The Dental Clinic‘, fractures are routinely treated by our oral surgeon.
 
If you are not sure whether or not you are having a true dental emergency, answer the following questions:
 

• Are you bleeding from the mouth?
• Are you in severe pain?
• Do you have any loose teeth?
• Have you been hit in the face or mouth?
• Do you have any swelling in the mouth or facial area?
• Do you have any bulges, swelling or knots on your gums?

 
If you answered yes to any of these questions, you might be having a dental emergency and should call your dentist immediately. It’s important to describe to your dentist exactly what has happened and what you are feeling.
 
If you experience extreme pain caused by hot or warm foods or beverages, try drinking ice water. It might relieve the pain. Sip on ice water and hold some in your mouth until you see the dentist.
 
If you are having sensitivity to cold or if it causes pain to breathe in air, avoid cold foods and beverages. Breathe through your nose and call your dentist’s office.
 
If you experience pain in a tooth when biting down, it might indicate an abscess. This is an emergency and you should call your dentist’s office.
 
How to Avoid a Dental Emergency
 
Many dental emergencies can be easily avoided by having routine check-ups with your dentist to ensure that your mouth and teeth are healthy, strong and free from decay. Dentist in Delhi are routinely counselling patients during their check-ups to avoid such emergencies.
 
There are a number of simple precautions you can take to avoid accident and injury to the teeth:
 

• Wearing a mouth guard during sports activities or recreational activities will help to prevent teeth from being chipped, knocked out or broken.
• Avoid chewing on ice, popcorn kernels and hard foods that may crack your tooth.
• Chew hard foods, such as nuts and peanut brittle, slowly.
• Never use your teeth to open or cut anything especially any type of hard shells and avoid using your teeth as scissors on tape, packaging or ribbon.

 
If you are planning to travel out of the country or leaving for an extended vacation, during which you may not have ready access to dental care, it is important to see your dentist for a routine check up before you leave. Your dentist can make sure that you don’t have any loose crowns or teeth, decay close to the nerve of a tooth that could cause you pain or develop into an abscess or other problems that could be easily fixed before becoming a dental emergency later.
 
Accidents happen, and knowing what to do when one occurs and being prepared can mean the difference between saving and losing a tooth.
 
Dentists in Dental clinics in Delhi  usually provide an emergency telephone number where they can be reached at any time of the day or night in case of a dental emergency.
 
Being Prepared for a Dental Emergency
 
Because a dental emergency can happen at any time and place, the best thing to do is be prepared and don’t panic. Pack and keep with you a small emergency dental care kit containing the following:
 

• Name and phone number of your dentist
• Acetaminophen (not aspirin or ibuprofen because they can act as a blood thinner and cause excessive bleeding during a dental emergency).
• Handkerchief
• Gauze or cotton
• Small container with a lid

 
 

Posted By – Dr. Shriya