Dental Emergency?

There are times when a dentist is needed right away. Dentistry does not have set rules on how to prioritize patients' needs. Sometimes the priority is obvious. A life threatening infection is more serious than a broken denture. When adult teeth are knocked out, they must be put back as quickly as possible. Baby teeth that are knocked are not replaced, so often children who have had such a tooth knocked out can wait. What is an emergency? What should you do if you have one?

Swellings are potentially the most serious dental emergencies. Swellings within the mouth (intraorally) are usually due to infection. Cancer, cysts, injuries, and blocked salivary ducts can cause swellings. Treatment of intraoral swellings can wait for a day or two unless the patient has a fever, trouble swallowing or trouble breathing. If any of these conditions exists, and you cannot see your dentist immediately, go to a hospital emergency room as soon as possible.

The accidental loss of an adult tooth (avulsion) requires immediate treatment. That tooth must be put back into its socket as quickly as possible. Teeth that are reimplanted within 30 minutes have a high rate of recovery. After 30 minutes, the success of reimplantation falls off dramatically. Many dentists recommend that lay people on the scene of the accident attempt to reimplant the tooth to save time. Rinse the tooth gently with milk, the patient's saliva, saline solution (the medical term for salt water) or water. Do not rub the tooth to clean it. Press the tooth firmly into the socket. Ask the patient to hold the tooth in place. Don't worry about lining it up perfectly. Even a front tooth that is reimplanted backwards can be fixed later with a crown.

Teeth that are forced out of position, but not knocked out also need to be attended to quickly. Dentists will try to numb the area and press the tooth back into its original position. The repositioned tooth may become discolored or develop a root canal infection, but repositioned teeth usually have a good prognosis.

Fillings, crowns and bridges fall out for various reasons. Cement can wash out. Part of the tooth might break. There may be tooth decay. These problems may be a nuisance, unaesthetic, uncomfortable, bad tasting, and even odiferous. However, loose crowns, bridges and fillings do not require immediate treatment. Call your dentist, explain the problem and make an appointment for a time that is convenient for you both. If there is an uncomfortable hole or sharp area, you can fill or cover it temporarily with sugar free chewing gum.

A broken adult or baby tooth usually does not require emergency treatment. Teeth are formed in three layers. The inside of the tooth is the pulp. The pulp is composed of nerves, blood vessels. If this layer is penetrated when the tooth breaks, then the tooth will need root canal treatment. The middle layer is the dentin. Dentin can be sensitive, but a break through dentin need not be treated right away. Chips and broken pieces of enamel, the outermost tooth layer, are sometimes left untreated. For a broken tooth, call the dentist for a convenient appointment. Cover the tooth with soft, sugar free gum if it is uncomfortable.

While a broken denture is not an emergency, it can be a serious cosmetic and functional problem. Sometimes, broken dentures can be repaired while you wait. That depends on what broke, what caused the break and what the denture is made of. The wearer must take the denture to a dentist. The dentist will examine the condition of the patient's denture, teeth and gums to try to determine why the denture broke. Then, the fit of the denture is checked. If the denture no longer fits well, the denture could break again or cause other problems. Keep in mind that this is not a do it yourself job. Most lay people who try to fix a cracked denture or replace a tooth that fell out cause increased damage to their prosthesis.

Most of the emergency calls a general dentist receives are not emergencies at all. Usually, they are treated with a phone call. A good rule of thumb with a newly noticed condition that is not painful or swollen is that the patient can wait for a convenient time to see the dentist.
Last month, the mother of one of a patient called. She sounded frantic. She had just discovered that her young son had a tooth growing in out of place. To make matters worse, the baby tooth had not fallen out. She considered this a dental emergency. She wanted to know what to do right away. A few calming words eased this mother's mind.

She was told that this is normal. Sometimes, baby teeth may fall out (exfoliate) and adult teeth come in (erupt) on different schedules. If the adult tooth erupts and the baby tooth has not exfoliated six months later, call your child's dentist to schedule an appointment for an examination. The dentist may decide that it is necessary to remove the tooth or may still recommend waiting for the deciduous tooth to exfoliate naturally.

A similar emergency call came from a woman who noticed a black spot on her gums that she had not seen before. Her dentist identified that spot as an amalgam tattoo, a spot where silver amalgam filling stains the gum. Amalgam tattoo usually occurs when a tooth is extracted and a piece of filling falls under the gum, or when a tooth is filled and some of the old or new filling enters a cut in the gum. Dentists note discolorations during examinations. This woman's dentist pointed to the place in her chart where he had noted the color, size, shape and consistency of her spot along with his diagnosis several years before.

You may want to ask your dentist or his staff what their emergency policy is. How soon are emergency appointments made? How is the office covered outside of office hours? Who covers the office when the doctor is away? Does your dentist's policy match your own?