Dental Emergencies

A knocked-out (avulsed) permanent tooth is a dental emergency with a 30-60 minute window for reimplantation success. Act immediately: pick the tooth up by the crown (the white part) — never touch the root. If dirty, rinse gently under cold running water for 10 seconds — do not scrub. If possible: reinsert the tooth into the socket immediately (push it firmly back in, bite on a clean cloth to hold it), then go to a dentist. If reinsertion is not possible: store the tooth in cold milk (best widely available medium), or between the cheek and gum in the patient's own saliva (if an adult — aspiration risk in children). Do not store in tap water (cells on the root die). Do not dry store it. Go to a dentist or emergency department immediately — every minute matters. Milk teeth are NOT reimplanted (they can damage the developing permanent tooth beneath). Success rates: near 90% if reimplanted within 5 minutes, dropping sharply after 60 minutes.

A dental abscess is a bacterial infection forming a pus collection — either at the root tip of a tooth (periapical abscess, usually from untreated decay reaching the pulp) or in the gum (periodontal abscess from gum disease). Symptoms: severe, constant, throbbing toothache; sensitivity to pressure; facial swelling; fever; and a bad taste from pus drainage. It is a dental emergency when: there is facial swelling beyond the immediate area of the tooth (spreading infection), difficulty opening the mouth (trismus), swallowing difficulty or throat swelling, breathing changes (airway compromise), or fever with the swelling. These signs indicate the infection is spreading into the jaw spaces — Ludwig's angina is a life-threatening complication. Go to an emergency department immediately. A localised abscess with pain but no spreading signs: see a dentist urgently (same day) for drainage and antibiotics. Antibiotics alone without drainage are inadequate treatment.

Immediate pain relief measures: take ibuprofen (400mg) and paracetamol (1g) alternately every 3 hours — they work through different mechanisms and together are more effective than either alone, safer than doubling the dose of either. Cold packs on the cheek reduce inflammation. Don't put aspirin directly on the gum or tooth — it burns the tissue. Oil of cloves (eugenol) from a pharmacy applied to a cotton pellet placed in a cavity provides temporary dental pain relief. A temporary filling material (Dentemp, available at pharmacies) can seal a broken tooth or exposed cavity providing short-term relief. These are temporary measures only. The only definitive treatment for dental pain from an abscess, pulpitis, or lost filling is dental treatment — pain relief allows you to get through the night and reach a dentist the next morning. If pain is accompanied by facial swelling, fever, or difficulty swallowing — go to emergency now, not morning.

It depends on the extent of the fracture. Minor chip (enamel only, no pain): not an emergency — see your dentist within a few days. The sharp edge can be smoothed; a small composite repair is quick and painless. Fracture into dentine (tooth is sensitive, mildly painful but manageable): urgent (within 24-48 hours) — dentine exposed to bacteria can allow rapid decay progression. Fracture exposing the pulp (severe pain, possibly bleeding from the tooth): emergency — the pulp is exposed to bacteria and will become infected without treatment. Root canal or extraction needed. Fractured tooth root: usually requires extraction — the dentist diagnoses this with an X-ray. Vertical crown-root fracture: often requires extraction as these are rarely restorable. A temporary measure for any fractured tooth: cover sharp edges with dental wax or sugar-free chewing gum to prevent cutting the tongue or cheek until you reach a dentist.

Not all wisdom teeth need removal — if they erupt fully, are properly positioned, can be cleaned effectively, and are not causing problems, they can be left in place. Removal is indicated when: the wisdom tooth is impacted (partially or fully stuck in the jaw) and repeatedly causing infections (pericoronitis — inflammation and infection of the gum flap over a partially erupted tooth), causing decay in the adjacent second molar due to inaccessibility for cleaning, causing pain or cysts around the impacted tooth, or causing crowding that the orthodontist has recommended addressing. Prophylactic removal of asymptomatic impacted wisdom teeth is controversial — major dental organisations no longer routinely recommend removal of asymptomatic wisdom teeth, as surgery carries its own risks (infection, dry socket, nerve injury causing lip numbness). The decision requires an X-ray assessment and discussion of the specific risk-benefit in each case.