Urgent care
Dental emergency: what to do in the first hour
Dental emergencies are mostly manageable, and the first hour matters more in some cases than others. Here is what to do, sorted by what has happened.
First: the hospital list
Stop reading and go to an emergency room if any of these apply:
- Swelling that is spreading fast, closing your eye, or extending under the jaw into the neck
- Any difficulty breathing or swallowing
- You cannot open your mouth
- Fever alongside facial swelling
- Major facial trauma, or a jaw that feels broken or misaligned
These are airway and systemic-infection risks. They need intravenous antibiotics and monitoring. Coming to a dental office first costs time you may not have.
Everything below is dental-office territory.
A knocked-out adult tooth
Time is the whole game here: the odds of successful reimplantation drop steeply after the first hour.
- Find the tooth. Pick it up by the crown, never the root.
- If it is dirty, rinse it briefly in milk or saline. Not water. Do not scrub it, and do not remove any tissue attached to the root.
- Put it back in the socket if you possibly can, and bite gently on a clean cloth.
- If you cannot, store it in milk, saline or your own saliva. Never dry, never in tap water.
- Get to a dentist immediately.
A knocked-out baby tooth should not be reimplanted: doing so can damage the developing permanent tooth underneath. Still call.
A broken or cracked tooth
Save any fragment in milk. Rinse your mouth with warm water. Cover a sharp edge with sugar-free gum or dental wax so it stops shredding your tongue. Avoid chewing on that side. Call the same day if there is pink or bleeding tissue visible. That means the pulp is exposed and the tooth needs treating promptly.
Severe toothache
Take an over-the-counter anti-inflammatory at the labeled dose, on schedule rather than only when it hurts. For dental pain this generally outperforms paracetamol alone. Cold on the outside of the face. Sleep propped up, because lying flat raises the pressure and the pain.
Do not place aspirin against the gum; it burns the tissue. And do not let the pain relief postpone the call: antibiotics and painkillers cannot reach dead pulp tissue, so a tooth that quiets down has not resolved.
Swelling or an abscess
Cold compress on the outside, twenty minutes on and twenty off. Never heat: it draws infection outward and makes it worse. Sleep with your head elevated. Call today, and reread the hospital list above, because this is the category that escalates.
Bleeding that will not stop after an extraction
Fold clean gauze into a firm pad, place it directly on the socket (not on the surrounding teeth) and bite hard for a solid thirty minutes without checking. Checking is what restarts it. Repeat once if needed. Do not rinse, spit or use a straw. If it is still heavy after an hour of proper pressure, call.
A lost crown, filling or bridge
Keep the crown. Temporary dental cement from a pharmacy will hold it for a day or two; household adhesives will not, and some of them make the tooth unrestorable. Avoid very hot and cold food. This is urgent-ish rather than urgent, but sooner is better, because neighboring teeth drift into the space within days and make refitting harder.
Something stuck under the gum
Try floss and a gentle rinse. If it will not come out, leave it and call. Poking at it with anything sharp turns a small problem into a laceration.
Preventing the next one
Most dental emergencies are not accidents. They are the visible stage of something that had been building: a cracked cusp under an old wide filling, decay under a crown margin, a tooth already noted as questionable at a check-up you did not go to. Regular exams and a night guard if you grind remove a large share of them.
Keep your dentist’s number in your phone. Not in a drawer.
Written for patients of Oak Hills Dentistry in Spring, Texas. General dental education, not a diagnosis or a treatment plan for any individual. Reviewed by Dr. Neal H. Patel before publishing.
