Common Tooth Emergencies
A painful tooth (acute pulpitis)
When left untreated, cavities will infect the nerve of a tooth and the tooth will turn painful. The infection may continue to spread into the bone under the teeth and result in a swelling in the face.
Pain relief for an infected nerve is can be had by beginning a root canal. The first step in a root canal is called a pulpotomy.
What to expect when receiving a pulpotomy
Root canals are done under local anesthesia (a routine shot) which is no different than the kind of shot you get when receiving a filling. The shot is followed by about two minutes of drilling to clean out some of the infection and to relieve pain due to inflammation in the tooth. Usually a good night’s sleep is the result. The tooth will be left either uncovered, or temporarily covered by a pain relieving, white cement, antibiotic filling.
Do not delay in getting pain relief
Dental pain is intolerable. A severely painful tooth must have a pulpotomy done at the first emergency visit. The exception to this is if you have a large swelling. This will need an incision (cut in the gum - see below). If the dentist prescribes an antibiotic and fails to do a pulpotomy or incision for a painful tooth, then it is the wrong treatment. On the first emergency visit the tooth should be drilled for a pulpotomy and medicated or a swelling should be drained of pus. If the dentist cannot do a pulpotomy or drain a swelling - then you should be referred to an endodontist (root canal specialist) who will do this treatment that same day.
A dead tooth with no pain
One final note - a tooth nerve can also ‘go bad’ from a sudden blow such as a fall. There is rarely pain in these teeth and usually no outward sign of the ‘dead’ nerve, however, sometimes after a few months these teeth might turn dark or infection may be found in the bone around the teeth by x-rays. A darkened tooth should have a root canal done before a porcelain laminate or a crown is placed. Also a root canal should be done if an infection is discovered by x-rays.
A sudden swelling:
Rapidly growing swellings must be treated immediately by an incision (a cut into the swelling) to remove pus. Giving antibiotics alone is not a proper treatment. Draining out pus is particularly important for swellings near the nose or in the jaw. If these are left untreated, you can end up in a hospital. If your dentist is unable to cut and drain the swelling, then an oral surgeon should be found to do it THAT DAY. A swelling should never go untreated overnight.
Broken teeth (tooth fracture):
If a tooth is broken and beyond saving the dentist may send you to an oral surgeon to do the extraction. In this case it is best for the dentist to remove loose, painful pieces of the tooth for your comfort until an oral surgeon can be seen. For patients with special conditions (immune issues, cancers) the dentist should also refer an extraction at an oral surgeon or hospital where proper care can be received.
If an entire tooth is loose due to gum disease, your dentist should remove the tooth at that visit. You should never be sent home in pain.
Sometimes a tooth cracks, but the pieces are still very firm in the bone. These teeth often have to be removed. Your dentist might refer you to an oral surgeon for removal of the tooth. In the meantime the tooth should be shaved down in height and smoothed so that you are comfortable while eating.
Note that the sudden breakage of a front tooth and the accompanying embarrassment is a dental emergency
Don’t be shy about asking the dentist to act immediately when you have a cosmetic problem such as a broken front tooth. If a white filling can be placed - it should be done within a day or two.
A knocked out adult tooth (avulsed tooth)
Gently pick up the tooth, but do not touch the root. Rinse with water and gently place it back in the socket. Then, go right to your dentist. The dentist will cleanse the area, tie the tooth in place with a wire and prescribe antibiotics. Once healed, a root canal is necessary. After a few years it is important to realize that the tooth will probably begin to loosen again and have to be removed, however, with a little luck you may yet get a number of years service from that tooth.
Click the link above to learn about fillings, crowns and root canals