Some dental problems need prompt treatment to relieve pain, control infection or save a tooth. This article explains common dental emergencies, warning signs, what to do before you are seen, what treatment may involve, recovery and risks.

When it is a dental emergency

Severe toothache that is not controlled by usual pain relief.
Swelling of the gum, face or jaw, especially with fever.
A knocked-out adult tooth.
A broken tooth with pain, or a tooth that has been pushed out of position.
Bleeding from the mouth that does not stop with firm pressure.

Go to a hospital emergency department or call 000 if swelling affects breathing or swallowing, spreads towards the eye or down the neck, or there is a high fever, a serious facial injury or uncontrolled bleeding.

Common causes

Dental injury

Falls, sport and accidents can chip, crack, loosen or knock out teeth. A knocked-out adult tooth has the best chance of surviving if it is put back within an hour.

Pick the tooth up by the crown (the white part), not the root.
If it is dirty, rinse it briefly in milk or saline. Do not scrub it.
Push it gently back into the socket and bite on a clean cloth to hold it, then see a dentist straight away.
If you cannot put it back, keep it in milk or in the person’s saliva (for example inside their cheek, if they are old enough not to swallow it) and get to a dentist quickly.
Do not put a baby tooth back in, as this can damage the adult tooth underneath. Still see a dentist. See children’s dentistry.

Infection and abscess

Deep decay, cracks or gum disease can lead to an abscess, a collection of pus at the root of a tooth or in the gum. It can cause throbbing pain, swelling and a bad taste. Infection can spread if not treated.

Before you are seen

Phone a dentist as early in the day as you can and describe the problem.
Take pain relief such as paracetamol or ibuprofen if suitable for you, following the packet instructions. Do not put aspirin on the gum.
Use a cold pack on the outside of the face for swelling.
For bleeding, bite firmly on clean gauze or a damp tea bag for 20–30 minutes.
Bring a list of your medications, allergies and medical conditions.
If sedation may be used, arrange for someone to take you home.

What treatment may involve

The dentist examines the area and usually takes X-rays. Local anaesthetic is used, and sedation may be offered for longer or more complex procedures. Depending on the problem, treatment may include:

draining an abscess and starting root canal treatment to remove the infected pulp;
removing a tooth that cannot be saved;
repositioning and splinting a loosened or knocked-out tooth;
repairing a broken tooth, or placing a temporary filling or dressing until a later visit;
stitching cuts to the gums or lips.

Antibiotics are not needed for most dental pain, and do not replace treatment of the tooth. They may be prescribed when infection is spreading or you are unwell.

Recovery and aftercare

Take pain relief as advised and use cold packs for swelling on the first day.
Eat soft foods and avoid very hot or spicy food until numbness wears off and the area settles.
Avoid vigorous rinsing, smoking and straws for the first day or two after an extraction.
Keep your mouth clean, brushing gently around the area.
Attend follow-up appointments, as emergency treatment is often the first stage of care.

Risks

Risks depend on the procedure and include infection, bleeding, dry socket after an extraction, numbness from nerve irritation, and damage to nearby teeth or fillings. People with bleeding disorders or on blood thinners need extra care. Contact the dentist if pain or swelling increases after a few days, bleeding returns or you develop a fever.

Preventing dental emergencies

Wear a mouthguard for contact sports.
Do not use your teeth to open packets or bottles.
Have regular check-ups so decay and cracks are treated before they become painful.
Keep your dentist’s phone number handy, and check what your health fund extras cover for emergency treatment.

Common questions

Should I go to a dentist or hospital?

Most toothaches, broken teeth and knocked-out teeth are best seen by a dentist. Go to hospital for swelling that affects breathing or swallowing, spreading facial swelling with fever, serious facial injuries or bleeding you cannot stop.