Dental Emergencies & Injuries
There are a number of simple precautions you can take to avoid accident and injury to your teeth. One way to reduce the chances of damage to your teeth, lips, cheek and tongue is to wear a mouthguard when participating in sports or recreational activities that may pose a risk. Avoid chewing ice, popcorn kernels and hard candy, all of which can crack a tooth. Cut tape using scissors rather than your teeth.
Accidents do happen, and knowing what to do when one occurs can mean the difference between saving and losing a tooth.
What can you do if a tooth falls out or fractures? Learn what to do in a dental emergency.
Dental Emergencies – Abscesses
A tooth abscess or root abscess is pus enclosed in the tissues of the jaw bone at the tip of an infected tooth. Usually the abscess originates from a bacterial infection that has accumulated in the soft pulp of the tooth.
Abscesses typically originate from dead pulp tissue, usually caused by untreated tooth decay, cracked teeth or extensive periodontal disease. A failed root canal treatment may also create a similar abscess.
There are three types of dental abscess. A gingival abscess that involves only the gum tissue, without affecting either the tooth or the periodontal ligament. A periapical abscess starts in the dental pulp. A periodontal abscess begins in the supporting bone and tissue structures of the teeth.
Presentation and symptoms
“The main symptom is a severe toothache. The pain is continuous and may be described as gnawing, sharp, shooting, or throbbing.” Putting pressure or warmth on the tooth may induce extreme pain. There may be a swelling present at the base of the tooth on the gum.
A chronic abscess may be painless but still have a swelling present on the gum. It is important to get anything that presents like this checked by a dental professional as it may become acute later.
In some cases, a tooth abscess may perforate bone and start draining into the surrounding tissues creating local facial swelling. In some cases, the lymph glands in the neck will become swollen and tender in response to the infection. It may even feel like a migraine as the pain can transfer from the infected area. The pain does not normally transfer across the face, only upwards or downwards as the nerves that serve each side of the face are separate.
In the short term, the topical application of oil of cloves to the infected area is well-documented as an effective remedy.
Successful treatment of a dental abscess centers on the reduction and elimination of the offending organisms. If the tooth can be restored, root canal therapy can be performed. Nonrestorable teeth must be extracted, followed by curettage of all apical soft tissue.
Unless they are symptomatic, teeth treated with root canal therapy should be evaluated at 1- and 2-years intervals to rule out possible lesional enlargement and to ensure appropriate healing.
Abscesses may fail to heal for several reasons:
- Cyst formation
- Inadequate root canal therapy
- Vertical root fractures
- Foreign material in the lesion
- Associated periodontal disease
- Penetration of the maxillary sinus
Following conventional, adequate root canal therapy, abscesses that do not heal or enlarge are often treated with surgery and filling the root tips; and will require a biopsy to evaluate the diagnosis.
An untreated severe tooth abscess may become large enough to perforate bone and extend into the soft tissue. From there it follows the path of least resistance and may spread either internally or externally. The path of the infection is influenced by such things as the location of the infected tooth and the thickness of the bone, muscle and fascia attachments.
External drainage may begin as a boil which bursts allowing pus drainage from the abscess, intraorally (usually through the gum) or extra orally. Chronic drainage will allow an epithelial lining to form in this communication to form a pus draining canal (fistula). Sometimes this type of drainage will immediately relieve some of the painful symptoms associated with the pressure.
Internal drainage is of more concern as growing infection makes space within the tissues surrounding the infection. Severe complications requiring immediate hospitalisation include Ludwig’s angina, which is a combination of growing infection and cellulitis which closes the airway space causing suffocation in extreme cases. Also infection can spread down the tissue spaces to the mediastinum which has significant consequences on the vital organs such as the heart. Another complication, usually from upper teeth, is a risk of septicaemia (infection of the blood), from connecting into blood vessels. Brain abscess, while extremely rare, is also a possibility.
Depending on the severity of the infection, the sufferer may feel only mildly ill, or may in extreme cases require hospital care.
Dental Emergencies – Pain
Any injury to the gums or teeth can be very painful. In some cases, however, the cause of severe dental pain is not obvious. For example, pain that comes on suddenly may be caused by particles of food that got lodged in a cavity and have started to irritate the nerve inside the tooth. If you lose a filling or a crown, the nerve inside the tooth may be exposed, and you may feel severe pain when air or hot or cold substances touch the uncovered part of the tooth.
Pain that becomes more severe over a period of time is commonly caused by debris lodged under the gum. Popcorn is a common offender. Because the hard cellulose fibers of the popcorn kernel don’t break down, it can remain stuck between your gum and your tooth. The longer a food particle stays trapped between the gum and tooth, the greater the chance the gum will become irritated and infected and the pain will get worse. If you develop an infection, called an abscess, it can become a serious health problem if left untreated.
Pain when you bite or chew, especially if it is accompanied by a foul odor and a bad taste, can be a sign of an abscess that needs immediate treatment.
What You Can Do
First, call your dentist and make an appointment.
In the meantime, here are a few steps you can take at home to try to relieve some of the pain:
- Take an over-the-counter pain reliever, such as ibuprofen (Advil, Motrin) or acetaminophen (Tylenol). However, be aware that you need to see your dentist. If you mask the pain with a painkiller and ignore it, the infection can spread and could become life threatening.
- Rinse your mouth with warm water every hour or as needed to ease the pain.
- If the pain is caused by debris lodged in a cavity, washing the area may relieve the problem.
- Floss your teeth, then run a toothpick around the gum line. This may remove debris that’s lodged under the gum.
- If you’ve lost a filling or crown, dip a cotton swab in clove oil and apply it to the exposed part of the tooth. Clove oil, available in pharmacies and supermarkets, works well to relieve tooth pain. You also can use a topical anesthetic, such as Anbesol, also available in pharmacies and supermarkets.
- Putting an ice pack on your face over the area that hurts also may relieve the pain. Apply the ice for 10 to 20 minutes of every hour, as necessary.
- If you will be traveling in an airplane, the change in pressure when the plane takes off or lands may make you feel more uncomfortable. You should get dental treatment before traveling by air.
What Your Dentist Will Do
Even when dental problems cause a lot of pain, the problems — and the treatments — often are relatively simple if you seek help right away.
If you have a cavity, your dentist will clean out any debris, remove the decayed part of the tooth, and place a filling. Once the inner part of the tooth is protected, the pain will usually disappear immediately.
If your problem is related to debris under your gums, your dentist will use special instruments to remove the debris. If you have an infection, you may be given a prescription for antibiotics and pain medicine. If an antibiotic is prescribed, it is important that you take it as directed until you have finished all the medication.
An abscess in the tooth or gum may require more extensive treatment, such as drainage of the abscess, root canal treatment or tooth extraction.
Dental Emergencies – Avulsed Tooth 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.
What Your Dentist Will Do
Putting the tooth back in place is a simple procedure. Your dentist will use water to flush debris from the tooth socket. Then he or she will slip the tooth back into place. The tooth may be splinted to adjacent teeth with plastic resin and orthodontic wire. This keeps the tooth stable so it can heal and reattach.
The tooth does not always reattach in the right way. If it doesn’t reattach properly, the tooth may eventually fuse to the jawbone. If this happens, the root of the tooth can erode or be reabsorbed into the body. This occurs slowly. Your dentist will monitor this condition and may suggest further treatment such as a root canal.
The nerves and blood vessels that were severed when the tooth was knocked out often don’t heal. If this happens, the tooth may begin to darken. This is usually a sign that you will probably need to have root canal treatment. If you do not get treatment, the tooth will weaken and be more likely to break and crack. If this happens, you are more likely to develop an abscess, which is an infection. Sometimes, you will not know that you have an infection, but if you see something near the damaged tooth that looks like a pimple that comes and goes, you should see your dentist.