Dental emergencies have terrible timing. It is almost never during a Tuesday afternoon when the office is open and you are free. It is usually a weekend, an evening, or right before a big event. Someone gets elbowed at a basketball game. A child falls off a swing. A filling cracks while you are eating dinner.
I want Ellensburg and Kittitas County residents to know what to do when something goes wrong, because what you do in the first hour can make a real difference. Sometimes the difference between saving a tooth and losing it.
What counts as a dental emergency
True dental emergencies include:
A knocked-out permanent tooth.
A cracked or fractured tooth, especially if there is pain or visible damage.
Severe tooth pain that does not respond to over-the-counter pain medication.
Significant swelling in the gums, jaw, or face, which can indicate infection.
Uncontrolled bleeding from the mouth.
A lost crown or filling, especially if there is pain.
An object stuck between teeth that you cannot remove with floss.
What is not an emergency: a chip on a back tooth that does not hurt, mild sensitivity to cold, a slow toothache that comes and goes. These should be addressed soon, but they can usually wait until normal business hours.
Knocked-out tooth: the most time-sensitive situation
If a permanent tooth gets completely knocked out, you have a window of about an hour to give it the best chance of being saved. Here is what to do:
Pick the tooth up by the crown, which is the white part you normally see in your mouth. Do not touch the root. Touching the root damages the tissue cells that need to reattach to your jaw.
If the tooth is dirty, rinse it gently with cold water for 10 seconds. Do not scrub it. Do not use soap or chemicals. Do not dry it.
If you can, place the tooth back in the socket immediately, with the right side facing forward. Bite gently on a clean cloth to hold it in place. The body's own environment is the best transport medium.
If you cannot reposition it, put the tooth in a container of milk. Cold milk if possible. Milk is the next-best thing to your own mouth because the proteins help preserve the root cells.
If you have no milk, put it in your own saliva. Spit into a small container with the tooth.
Do not put it in water. Do not put it in a tissue or napkin. Both will damage the root cells.
Call us immediately at (509) 933-3300. Even if it is after hours, leave a message. We do our best to see emergency cases as quickly as possible.
Cracked or broken tooth
Rinse your mouth with warm water to clean the area. If there is bleeding, apply gentle pressure with clean gauze.
Apply a cold compress to the outside of your cheek over the affected area to reduce swelling.
Avoid chewing on that side. If a piece of the tooth has broken off, save it if you can. Sometimes we can bond it back on.
Call us right away. Cracks can be small or extensive. A small crack might be treated with a filling or a crown. A more serious crack that extends below the gumline might require a root canal or, in worst cases, an extraction. The sooner we look at it, the more likely we can save the tooth.
Severe toothache
A toothache that wakes you up or will not go away with over-the-counter pain relief is telling you something. Do not wait it out. That level of pain usually means infection or significant decay, and both get more complicated the longer they go untreated.
Things to try while you wait for an appointment:
Rinse with warm salt water. About a teaspoon of salt in a glass of warm water, swished around the affected area for 30 seconds.
Floss carefully around the painful tooth to make sure nothing is trapped between teeth. Sometimes a piece of food stuck against the gum is the source of the pain.
Take ibuprofen if you can. It reduces inflammation, which is often what is causing the pain. Acetaminophen helps with pain but not inflammation. For severe pain, alternating ibuprofen and acetaminophen every three hours is more effective than either alone.
Apply a cold compress to the outside of the cheek.
Do not put aspirin directly on the tooth or gum tissue. Aspirin is acidic and can burn the soft tissues.
If the pain is accompanied by a fever, swelling that is spreading, or you are having trouble swallowing or breathing, this is a medical emergency. Go to the ER or call 911. Severe dental infections can spread to other parts of the body and become life-threatening.
Lost crown or filling
If a crown or filling falls out, save it and call us. In the meantime, you can use over-the-counter dental cement, available at most pharmacies, as a temporary fix to protect the exposed tooth. Avoid chewing on that side.
Most lost crowns can be re-cemented if the underlying tooth is healthy. If the crown fell off because of decay underneath, we may need to do additional work before placing a new crown.
How we handle emergencies at Central Washington Dental Care
We do our best to see emergency patients the same day. If you call during business hours with a true emergency, we will work you into the schedule. If it is after hours, leave a clear message with your name, phone number, and a description of what happened, and we will get back to you as soon as possible.
For traumatic injuries that involve broken bones, severe bleeding, head trauma, or loss of consciousness, go to the emergency room first. The ER can stabilize you and address the immediate medical needs. We will follow up with the dental work as soon as you are cleared.
Preventing future emergencies
The single best way to prevent dental emergencies is regular care. (We cover the right schedule for cleanings in our post on how often you should actually get your teeth cleaned.) Early detection of decay, cracks, and gum disease prevents the situations where teeth break or get infected unexpectedly.
For athletes, especially in contact sports, custom mouth guards prevent a huge percentage of dental injuries. Store-bought mouth guards offer some protection. Custom-fit ones, which we can make in our office, offer significantly better protection and are far more comfortable.
For people who grind their teeth at night, a night guard prevents tooth fractures and the kind of structural damage that leads to emergency situations.
If you are in pain or you have had an injury, call (509) 933-3300. We are here to help.
Related reading: How often should you actually get your teeth cleaned, Gum disease in Kittitas County, A dentist who grew up here.