When immediate treatment is needed to save a tooth, relieve severe pain, or stop oral bleeding, it is a dental emergency. A 2009 survey discovered that as many as one in six Americans find themselves in this unhappy situation each year, and noted that a great many people are unprepared to respond appropriately and effectively. This discussion focuses on the steps we can take before, during, and after a dental emergency so as to minimize stress and achieve the best possible outcome. A more detailed review of the various types of dental emergency and the response issues particular to each can be found here.
The events most commonly driving a dental emergency are knocked-out teeth, loose teeth, a tooth out of alignment, chipped, cracked or fractured teeth, soft tissue injury and facial pain, and severe infection or abscess in the mouth. About a quarter of dental emergencies involve restorations such as fillings, caps, or crowns.
Pain is not always a reliable indicator of the urgency of a dental emergency, as some situations requiring urgent care are not immediately painful. When there is severe pain, no one’s going to procrastinate about getting treatment, but painless emergency conditions should be taken no less seriously. Getting immediate treatment, in some cases within 30 minutes, can make the difference between saving a tooth and losing it. Unless you’re a dentist yourself, you shouldn’t try to judge the urgency of a dental emergency. You should seek care as soon as possible.
WHERE FOR CARE?
A dental emergency requires treatment by an emergency dentist. This may seem obvious, but in fact, many people head for hospital emergency rooms. About 2 million each year. This is less than ideal, to put it mildly. Most hospital emergency facilities don’t have a dentist on staff, and the physicians are very limited in what they can do to help. In fact, in most states, it is illegal for anyone but a licensed dentist to fill a cavity, pull a tooth, restore a crown, or perform any other dental procedure. In most cases, the ER doctor can prescribe a pain reliever and/or an antibiotic, and that’s about it.
A visit to the ER for a dental emergency is also expensive. A 2010 analysis of the 115,000 ER visits involving dental issues in Florida found the average cost per visit was $765. The chief benefit received by these patients was a referral… to a dentist. As for insurance, there do exist dental policies that might cover a hospital ER visit under certain narrow conditions, and some health insurance may provide benefits. But as a rule, it’s going to be entirely out-of-pocket.
The only times the ER is the correct destination for a person with a dental emergency are when there’s been an oral infection persisting untreated for weeks, or, when the dental issue is secondary to a bigger problem like facial trauma with swelling or a broken jaw. Persistent oral infections can become quite serious, even life-threatening, and the antibiotics provided in the ER can halt their progress until a dentist treats the underlying cause.
Most households have some kind of plan in place for medical emergencies. We have first aid kits, and lists of emergency phone numbers (magnets for refrigerator doors). Preparedness for dental emergencies isn’t very complicated or burdensome and will be deeply appreciated in time of need.
A dental first aid kit should have a few essential “hardware” items: a small container for any crown or filling that’s come out, an over-the-counter topical painkiller gel, a wooden applicator, sugar-free gum, gauze, salt, a handkerchief, and acetaminophen for any pain. Other NSAIDS like aspirin and ibuprofen are not right for this application, as they are blood thinners and can make it more difficult to control any bleeding. Acetaminophen is the best choice.
The purpose of a dental first aid kit is to provide comfort and to “set the table” for successful treatment during the (hopefully short) period of time before the dentist gets to work. The short story is that there are no home cures for dental emergencies. The uses to which these first aid kit resources are put is beyond the scope of this discussion, but a review can be found here. Basic familiarity with self-care procedures is one of the “software” items in an emergency plan, but it’s not a bad idea to print them out and stow the “crib sheet” in the kit for reference.
The other software items in a dental emergency preparedness plan are telephone numbers for the family dentist and for any local or regional dental emergency facilities that are open when the dentist is not.
Time is of the essence.
A CASE STUDY
A 34-year-old woman, Rita, set to the yardwork one Saturday morning. Her two young boys followed their mother’s example, one raking while the other pulled weeds. Rita, absorbed in pruning her roses, became aware they’d begun to argue and turned to see what the matter was. The rake flung by her irate older son caught her full in the face, knocking out her left maxillary central incisor. Her left front tooth.
In dental terminology, Rita had suffered an avulsion. She realized almost immediately she’d been injured, and quickly discovered she was missing a tooth. She knew what to do. She set her two sons to searching for the missing tooth in the grass, while she phoned the family dentist. Her younger son found the tooth, whole and apparently intact, in just a few minutes.
Rita picked up her tooth and took it inside, being careful not to touch the root. She rinsed it for 10 seconds in a gentle stream of lukewarm tap water while wiping the blood from her chin and explaining to the boys that they’d be driving to the dentist and that they’d soon find her “talking funny”. Rita then carefully and delicately inserted her tooth back into its socket.
It immediately became clear that Rita wouldn’t be able to keep her tooth in its socket during the trip to the dentist’s office. She went to Plan B. She retrieved her dental first aid kit, took out the small covered container therein, filled it halfway with milk, and plopped her tooth into it. With her tooth submerged in milk, she and the boys drove to the dentist’s office. As she settled into the dentist’s chair, about 30 minutes had elapsed since her accident.
The dentist performed a replantation with Rita under anesthesia. He splinted the tooth to its neighbors with composite resin and stitched a cut in her gums caused by the trauma. He sent her home with a prescription for antibiotics and advised her to consult with her primary care physician about a tetanus booster shot.
The dentist removed the gum sutures a week later, and the splinting three days after that. A root canal procedure was scheduled and performed. Follow-up care included x-rays to monitor the replanted tooth’s accommodation. Rita regained full functional utility with no cosmetic downgrade.
Rita achieved the best possible outcome after having her tooth knocked out because she was prepared. She knew what to do, and had the critical item on hand and ready when she needed it. She was one of about 5 million Americans who had a tooth knocked out that year. Some of the others were not as fortunate as Rita, and while in some cases the extent of damage to the tooth puts her kind of outcome out of reach, many could have done better by being as well prepared as she was. Be like Rita. Be prepared for dental emergencies.