Dental Emergency: What to Do First

Go to a hospital first if

Some situations are not for a dental clinic. Go to a hospital emergency department straight away if you have:

• swelling of the face, jaw or neck, especially with fever
• difficulty swallowing, opening your mouth or breathing
• swelling spreading towards the eye
• bleeding that does not stop after 20 to 30 minutes of firm pressure
• a heavy blow to the head or face with vomiting, drowsiness, confusion or a suspected broken jaw

Infection in the face can spread quickly. Do not wait to see how a swelling develops.

A knocked-out tooth

An adult tooth that has been knocked out can often be put back if it is dealt with quickly. Time matters most. The aim is to get it replanted within about 30 to 60 minutes.

1. Pick the tooth up by the crown (the white part), not the root.
2. If it is dirty, rinse it briefly with milk or clean water for a few seconds. Do not scrub it or use soap or antiseptic.
3. If you can, gently push it back into the socket the right way round, and bite lightly on a clean cloth to hold it.
4. If you cannot, keep it moist. Put it in a small container of cold milk, or hold it inside your cheek if the person is old enough not to swallow it. Do not store it dry or in plain tap water for long.
5. Go to a dentist at once.

Do not replant a baby tooth, since this can harm the adult tooth underneath. Still see a dentist the same day to check the injury.

A broken or chipped tooth

1. Rinse your mouth with warm water.
2. Save any fragment, in milk or saline if possible.
3. Press a cold pack on the cheek to reduce swelling.
4. Cover a sharp edge with sugar-free chewing gum or dental wax.
5. See a dentist the same day if the tooth is painful, bleeding inside, or a large piece has broken. A small chip with no pain can wait a day or two, but should be checked.

See the broken tooth page for more.

Severe toothache or swelling

• Rinse with warm salt water (half a teaspoon in a glass).
• Take your usual pain relief at the dose on the pack, if it is safe for you. Do not put aspirin or any medicine directly on the gum.
• A cold pack on the outside of the cheek can help swelling. Do not apply heat.
• See a dentist the same day. An abscess needs treatment of the cause, and antibiotics alone do not fix the tooth.

Bleeding after an extraction

Some oozing for the first 24 hours is normal.

1. Fold clean gauze or a clean cotton cloth, place it over the socket and bite firmly for 20 to 30 minutes. Do not keep checking.
2. Sit upright, and avoid rinsing, spitting hard, drinking through a straw, smoking and hot drinks for 24 hours.
3. If it still bleeds, repeat with fresh gauze. A moist tea bag held in place can also help.
4. If bleeding continues after a second 30 minutes, contact your dentist or go to a hospital.

Read the full tooth extraction aftercare. Severe pain returning a few days after an extraction may be a dry socket, which needs a visit.

A lost filling or crown

1. Keep the crown or filling safe.
2. Clean it and, if it fits easily and comfortably, a dentist may be able to put it back. Do not use superglue.
3. A temporary dental cement from a pharmacy can protect the tooth until you are seen.
4. Avoid chewing on that side, and keep the area clean.
5. See a dentist within a few days. An exposed tooth can break, decay or become infected.

A cut to the lip, tongue or cheek

Clean the area with water, apply firm pressure with clean gauze, and use a cold pack. A deep cut, one that gapes, or bleeding that does not stop after 15 minutes of pressure needs medical attention.

What to bring and tell the dentist

• The tooth or fragment, in milk
• A list of medicines, especially blood thinners
• Allergies, including to penicillin
• When and how the injury happened

Preventing emergencies

Wear a mouthguard for contact sports, do not use your teeth to open bottles or packets, and treat toothache early. Most dental emergencies are the end point of a problem that gave earlier warnings.