Dental Emergency First-Aid Guide - What to Do Before You Reach the Office

Knocked-out adult tooth (avulsion)

This is the most time-sensitive dental emergency. The tooth's ligament cells start dying within 30-60 minutes outside the socket. Steps:

1. Pick the tooth up by the crown (the white part), never the root.
2. If dirty, rinse briefly with saline or milk - do NOT scrub or use soap.
3. Try to gently re-insert the tooth into its socket. Bite on a clean cloth to hold it.
4. If you cannot re-insert, store the tooth in milk or in your saliva (between cheek and gum). Plain water damages the root cells.
5. Call our office immediately. We reserve same-day emergency slots.

Baby teeth that are knocked out are NOT re-implanted - risk to the developing adult tooth above. Bring the tooth to the office anyway so we can confirm it is fully out and check for damage.

Severe toothache or suspected abscess

A throbbing toothache, especially one that wakes you at night, often signals an infected nerve. Action steps:

1. Rinse with warm salt water (1 teaspoon salt in 8 oz water).
2. Floss carefully around the tooth - sometimes a piece of food is the entire cause.
3. Take ibuprofen (Advil) 400-600 mg every 6 hours and acetaminophen (Tylenol) 1000 mg every 6 hours staggered, IF you have no contraindications. This combination outperforms most prescription painkillers for dental pain.
4. Do NOT place an aspirin against the gum - this causes chemical burns.
5. Call us. An abscess often needs a root canal or extraction, and antibiotics if facial swelling is present.

Go to the ER immediately if: swelling spreads to the eye, throat, or floor of the mouth; you have difficulty swallowing or breathing; or you develop a high fever.

Broken or chipped tooth

Small chip with no pain: Save the chip if you can find it (wrap in tissue), schedule a non-urgent appointment within a week. The fix is usually composite bonding.

Larger break with sharp edge: Cover the edge with dental wax, sugarless gum, or a piece of wax paper to protect your tongue. Avoid chewing on that side. Call to schedule within 1-2 days.

Tooth fractured deep with pain or visible pink/red exposure: This is a pulp exposure - call our emergency line. Treatment usually requires a crown and possibly a root canal.

Lost crown, filling, or veneer

If a crown comes off, retrieve it if possible - most can be re-cemented if intact. Temporarily, you can use over-the-counter dental cement (Dentemp, available at most pharmacies) or sugar-free gum to protect the exposed tooth. Do not use super glue. Avoid chewing on that side. Schedule an appointment within 1-3 days; the tooth without its crown is vulnerable to fracture.

Lost filling: Same playbook. Cover with dental wax or temp cement until you can be seen, ideally within a week.

Bleeding gums or after-extraction bleeding

Some bleeding after a tooth extraction is normal for 12-24 hours. To control it:

1. Bite firmly on a folded gauze pad for 30 minutes. Replace as needed.
2. If still bleeding, bite on a moistened black tea bag - tannins help clotting.
3. Sit upright; do not lie flat (raises pressure to the head).
4. Avoid spitting, rinsing, smoking, or using a straw for 24 hours - dislodging the clot causes dry socket.

Gums that bleed when brushing or flossing are usually a sign of gum disease, not an emergency - schedule a non-urgent visit.

Soft-tissue injury (lip, tongue, cheek)

For cuts to the lip, tongue, or cheek: rinse gently with warm salt water, apply firm pressure with clean gauze for 10-15 minutes, and use ice on the lip. Most oral cuts heal quickly because of strong blood supply. Call if bleeding does not slow within 15 minutes of pressure, if the cut is deeper than ¼ inch, or if you cannot clean debris out of the wound.