Tooth Pain and Dental Emergencies

When it is a hospital, not a dentist

Most dental problems are urgent rather than dangerous. A few are genuinely dangerous, and the difference is worth knowing before you are deciding at midnight.

• Swelling that is spreading toward the eye, or downward into the neck and floor of the mouth.
• Difficulty swallowing, difficulty breathing, or a voice that has changed.
• Fever alongside facial swelling.
• Inability to open the mouth more than a couple of centimetres.
• Facial injury involving loss of consciousness, or a suspected broken jaw.

Any of these means the emergency department, straight away. A spreading dental infection can compromise the airway, and that progresses faster than most people expect.

A tooth has been knocked out

For an adult permanent tooth, the first thirty minutes matter more than anything else that follows.

• Pick the tooth up by the crown, the part you normally see. Do not touch the root.
• If it is dirty, rinse it briefly in milk or saline. Never scrub it, and never use soap or disinfectant. The cells on the root surface are what allow it to reattach.
• If you can, put it straight back in the socket the right way round and bite gently on a clean cloth to hold it.
• If you cannot, put it in cold milk. Milk is far better than water, which damages the root cells. Saliva works too, held in the cheek if the person is old enough not to swallow it.
• Get to a dentist within the hour.

A baby tooth is different: do not put it back, because reimplanting it can damage the adult tooth developing above. Take the child to be seen, but the tooth itself stays out.

A broken or chipped tooth

Rinse with warm water and keep any fragment, ideally in milk, since a clean break can sometimes be bonded back on. Cover a sharp edge with sugar-free gum or dental wax if it is cutting the tongue.

A chip in enamel is not urgent. A break that exposes the pink or red centre of the tooth is, because the nerve is open. That one should be seen the same day.

A lost filling or crown

Uncomfortable but not an emergency. Keep the crown, keep the area clean, and avoid chewing on that side. A temporary dental cement from a pharmacy can hold a crown for a few days. Never use household glue: it makes the tooth impossible to restore properly and can damage the nerve.

Toothache and abscess

Pain that wakes you at night, or lingers for minutes after something hot or cold, usually means the nerve inside the tooth is inflamed or infected. That is what root canal treatment exists to fix, and treating it early is the difference between saving the tooth and removing it.

An abscess produces throbbing pain, a bad taste, and often swelling in the gum. If it bursts, the pain may vanish and the problem has not gone anywhere. Painkillers manage the symptom, they do not treat the cause, and antibiotics alone rarely resolve a dental abscess because they cannot reach the source inside the tooth.

Until you are seen, ordinary painkillers taken as directed and a cold compress on the outside of the cheek will help. Do not hold aspirin against the gum, which burns the tissue.

Wisdom tooth pain

Wisdom teeth usually arrive between seventeen and twenty-one, and cause trouble when there is not enough room. The gum over a partly erupted tooth traps food and becomes inflamed, which produces pain at the back of the jaw, sometimes with difficulty opening.

Warm salt water rinses help in the short term. Recurrent episodes are a reason to have the tooth assessed properly, because each one is more disruptive than the last.

Reaching us

The clinic is open Monday to Friday, nine to six. For urgent problems call rather than sending the form, since the phone is answered during opening hours and a form may not be seen until the next working day.

Outside those hours, use your judgement against the list at the top of this page. If it is on that list, go to hospital.