Life is short and should be enjoyed, but one of the consequences of life is accidents. Whether you like it or not and as much as you try to avoid them, they happen.
Many know what to do if an accident becomes a medical emergency; if we have an open wound, break a bone or have some form of life threatening condition, but what to do if you have a dental emergency?
Unlike a medical emergency, dental emergencies rarely require the assistance of staff at the emergency department.
When you have a dental emergency, often, the best place to visit is your dentist’s office.
This article is a guide as to what you should do in the event of a dental emergency. We explain:
- What to do if you need an emergency dentist.
- What to do if you need a dentist out of hours.
- How to help manage dental pain.
- And much more….
This guide goes into detail with explanations about dental emergencies, but if you are short of time, here are the key things to know.
- You probably don’t need to call 911.
- Providing there is no serious illness, or life threatening injury, do not call 911.
- Unless the issues are more serious like a broken or dislocated jaw, issues related to dental health would rarely be considered necessary for a 911 response.
- Only call as a last choice option.
- Don’t panic.
- Damage and injury to the tooth can be painful and upsetting, but try and stay as calm as possible, it will be ok. Working yourself up or being overly worried can lead to other complications.
- Consider how bad the situation really is.
- Take a few moments to stop, calm yourself or others and really assess how bad the dental problem is.
- Is the tooth chipped? Has a piece physically broken off? Is there lots of bleeding?
- Where there is extensive damage to the tooth, severe bleeding, severe pain as well as tooth loss, this will need emergency treatment.
- If the tooth is chipped or there is mild discomfort, this is unlikely to require emergency treatment.
- Control bleeding and pain.
- If there is lots of bleeding, the first step is to apply a piece of clean gauze, cloth or a handkerchief to the area and bite down to apply pressure. This should stem the bleeding.
- If appropriate, over the counter painkillers such as paracetamol and ibuprofen can normally be taken, and are excellent pain relievers.
- Call your dental office.
- Call your dental office for information and advice what to do, even if out-of-hours.
- Within office hours there is normally allowance for emergency appointments.
- If out-of-hours, some will leave a message with advice on what to do and who to contact in an emergency situation.
- Search for an emergency dentist.
- If out of hours or your regular dentists office is closed, search online for ‘emergency dentist’ or ‘24 hour dentist’ followed by your location.
- Go to the emergency room.
- Accessible day or night, they are the best option if you are in severe pain or bleeding and are unable to make contact with a dentist.
- Most emergency departments will have a dentist they can call on to aid you.
To better understand how and why these are the steps to take, if you can spare a few minutes, it is well worth reading the whole article.
What is a dental emergency?
Depending on who you ask will depend on what opinion you get in return on what actually is a dental emergency.
You may well believe that a chip to a tooth of your otherwise perfectly aligned smile is a dental emergency, whereas someone else will think that a dental emergency is only when a tooth has been physically knocked out from the mouth.
The reality is that the majority of so called dental emergencies, are not emergencies. Most can wait and only a very small number really are need immediate attention in the eyes of dental and medical professionals.
In 2014, 61,000 Canadians within Ontario visited the emergency room for dental emergencies, according to the Alliance for Healthier Communities.
In Scotland, Europe, their health service found that just 1% of the calls they received about dental health issues were considered dental emergencies.
But, with this said, the options are there for you to get some form of assistance any time of the day or night.
Dental professionals tend to group emergencies under 2 categories, those emergencies that include visible damage to the teeth and those that cause pain in the teeth.
To help you try and decide whether the condition is a dental emergency, we have grouped the common dental complaints into 3 groups, high, low and medium priority.
High priority – require emergency dentistry
- Where an accident or trauma has caused 1 or more teeth to be knocked out or lost.
- Where an accident or trauma has caused 1 or more teeth to become extremely loose and likely to fall out very soon.
- Significant bleeding that won’t stop.
- Severe pain that isn’t helped by painkillers.
- Wounds to the lips, tongue or cheeks.
- Swelling that affects the eye, or that affects the throat so that you are struggling to swallow or breathe.
Medium priority – treatment within 24 hours
- A physically damaged tooth where a large chunk has broken off, exposing the internal structures of the tooth.
- An infection or abscess (may be a large lump that bleeds or excretes pus).
- Severe toothache, swelling or bleeding that occurs soon after a recent dental treatment, such as a filling, tooth extraction, root canal, or dental implant.
- A tooth has been knocked out of alignment.
- Where multiple brackets or parts of a dental appliance have become loose and are impeding opening and closing of the mouth, or that are physically cutting into or damaging other parts of the mouth.
- Cracked or fractured teeth.
Low priority – treatment within 24-72 hours
- If the teeth have sustained a significant impact, even if there is no pain.
- A chipped tooth, where a small piece of the tooth is missing.
- Loose or lost dental filling.
- Detached restoration such as a crown or bridge.
- Loose or detached brace/orthodontic appliance.
These groupings are to be used as a guide only and if you are unsure or have concerns on whether you should seek medical assistance sooner, please do seek a professional opinion in your particular circumstances.
None-the-less hopefully this at least helps set some expectations on around how urgently a dentist is likely to need to see and treat you.
One of the messages to takeaway from this is that mild toothache a loose filling is not really an emergency. Dentists and doctors generally want to help those most in need in emergency situations. Of course they will help you, but if you go weeks with pain and finally decide enough is enough and want out of hours assistance, when in reality you could have booked a more routine appointment, it is not the best use of that professionals time.
The following images shows a flow diagram of how care professionals in Scotland’s NHS 24 help decide how urgently dental care is required.
Perhaps you can use it to help determine how seriously you need dental care.
What to do if you have a dental emergency?
The first thing to do in a dental emergency is to check and assess whether there is any risk to the affected persons life.
Are they conscious, breathing, bleeding? Just what injuries exist?
If there is risk and damage beyond the teeth call 911 and provide what support you can.
Even if their teeth and mouth has been damaged in an accident, the priority is their life, so a bleed from a head wound needs more urgent treatment than the missing teeth.
Broken and dislocated jaws would require hospital treatment, rather than that of a dentist.
Therefore, where it is clear that the injury is limited to the mouth and teeth it is still necessary to check for bleeding.
It is important to stop this bleeding if possible. Biting down on a clean piece of gauze or a handkerchief are ideal, to help absorb the blood, but also stop the flow and encourage clotting.
Should 1 or more teeth have been knocked out of the mouth, refer to our ‘knocked out teeth‘ section of this guide for more information on what to do, there are some very important steps you need to take.
With the bleeding under control if there is pain and discomfort, painkillers such as paracetamol or ibuprofen are available and appropriate, these should be taken to take to help ease any initial pain.
This information is not to be considered medical advice, so please exercise caution, refer to any instructions with medication and seek professional medical assistance if required.
It is necessary to make an assessment of whether this is really a dental emergency. Unless a tooth has been lost or severe pain or bleeding is being experienced, the likelihood of needing immediate attention is low. You can use the information in the last section of this guide to help you figure it out.
If you think it requires quick intervention and treatment, then the next step is to consider the time of day.
In almost all instances, it is best to contact your normal dental office, particularly if it is within normal office hours. Even outside these times, try giving them a call, to see if the lines are manned or there is a message with directions as to what to do in emergencies.
The best procedures, practice and advice can differ from one location in Canada to another, based on available facilities. Major cities like Toronto have dental practices that open late into the night and are closed for just a few hours where remote locations tend not to.
If you speak to an agent, describe the symptoms and they can advise and book you in for an emergency or routine appointment, whichever they feel is more suitable.
If they do not have availability, they will help make appropriate arrangements.
When the emergency is outside of dental office hours and your local dentist is not available or is unable to provide support, the next best option is to search for 24 hour or emergency dental care in your area.
Using a search engine like Google for this. Follow these terms with your location to help get relevant results that you can take a look at and follow up with, if appropriate.
If none of these options are successful then a trip to the emergency room is the best option.
Many hospitals will have a dentist they can call on. Not all do, but they are trained to help deal with situations that arise. If nothing else they can offer stronger painkillers, medication and treatment to ease pain and help manage the problem, until a dentist can be seen.
Find an emergency dentist
If you make regular visits for checkups with a dentist, that dentist and their office should be the first people you contact.
Most of the time they can help. Generally they will tell you to come straight in and then a dentist will see you as soon as is possible to help relieve your pain and deal with the problem you have.
If the emergency is out of hours or at a weekend, when you know your dental practice is closed, do still ring. They may have an out of hours message that gives advice on what to do.
In some areas there are out of hours clinics you can walk into, but most of these close by about 9/10PM. This covers a few hours past when most dental offices are closed.
When the emergency occurs from about 9pm through to 9am then you are often going to need to go to the emergency room, if you need treatment.
Ways to ease dental pain
Whilst the best cure is dealing with the issue at hand, depending on the severity, it might be a few hours or even a couple of days before you get the treatment you need.
You have a few options to try and ease the pain and discomfort. Most find that painkillers are the most effective option.
Paracetamol and ibuprofen can be very effective, very quickly. Always read the labels and be aware asprin can thin the blood and make any bleeding worse.
If there is swelling, a cold compress, ice pack or similar can help reduce this. Some people may get more relief from a heat pack.
Keep yourself sat upright to help drain any swelling away from your face.
Another simple, but often overlooked choice is to to something else to distract you from the pain.
You might feel like lying in bed or on the couch, but as you lay there you normally have time to think about the problem.
Do what you can to distract you and take your mind away from any discomfort.
Got a hobby you love doing, go do it, meet up with friends, get out the house and find ways of occupying your mind with something other than the tooth pain.
If you are hungry and want food, you might want to think carefully about what you eat, depending on what’s wrong with your teeth.
A small chipped tooth you need not worry too much, but if a tooth has broken or cracked you might want to avoid alcohol, smoking and eating or drinking particularly hot or cold foods.
Nerves inside the tooth may be exposed and can be very sensitive to these changes in temperature and cause a lot of discomfort.
Sticking to luke warm food and drink can be a good choice in these situations.
Some find that rinsing the mouth out with a warm salt water solution can also help ease discomfort.
There are many ‘at home’ remedies, but we have not seen much evidence to suggest these remedies are that effective. Most provide very limited, if any relief.
The emergency dental appointment – what to expect
Because the appointments and visits to the dental office are unplanned, it is not possible in all cases to ‘fix’ the problem right there and then.
The dentist will try, particularly if the fix is simpler, but more complex problems may require additional visits to the dentist office.
You can be assured that they will do all they can to ease any discomfort and pain and provide a fix, even if it is temporary.
This temporary fix is going to be more common when the emergency visit is to ER and outside of normal office hours.
To give an example, you may go in with severe tooth pain, and it is determined that the cause is decay.
That decay may have made its way to the centre of the tooth and the treatment needed is root canal therapy and a crown.
A skilled procedure, you often need to be referred to an endodontist and then have a crown made. This cannot all be done in an emergency appointment.
The emergency dentist may place a temporary filling to protect the tooth as best as possible and maybe some medication to ease the pain.
Appointments can then be arranged to get the right treatment as soon as possible during normal operating hours.
Emergency dental treatment costs
Each province within Canda have their own guide to the dental fees that should be charged for particular services, therefore you should have a good idea as to the cost of the treatment prior to it being undertaken.
However, there may be additional charges that apply, particularly out of hours, but you should be advised of this ahead actually seeing a dentist.
Where you can get an emergency appointment during normal opening hours there may not be much in a way of a premium to pay compared to treatment in the middle of the night.
If you have dental insurance, your policy may cover emergencies, but every policy and what it covers is different.
Some policies may have limits on what they pay out or a % that they cover. An emergency visit may limit how much you can claim for that year for regular dental checkups.
Refer to your own policy and what it does and does not cover.
That emergency appointment is not always going to solve the problem entirely.
As per the earlier example, if the tooth needs root canal therapy and a dental crown these charges will need to be covered at some point, assuming you have the cause of the problem treated.
If you have dental insurance, this may cover some of the cost.
No dental insurance? Expect to pay for it out of your own pocket, or need to take out some sort of finance to do so.
The costs of course depend on the treatment, but a root canal and crown can easily cost several thousand dollars.
Kids & emergency dentists
Just like an adult, kids can damage and injure their teeth. It is quite common, a trip, fall, or collision with something as they play.
As a parent or guardian, you are right to be worried, it can seem 10 times worse when it is a young person that is suffering rather than yourself.
However, you need to stay calm, collected and rational to assess the situation and make an informed judgement on what to do. Panicking can make the situation worse for all.
For the most part the steps and actions taken when dealing with an emergency dental situation is the same with a child as it is an adult.
Depending on the age of the child will depend on how accurately they can explain any pain and symptoms they may well be suffering.
If a tooth has been chipped or broken off and can be found, it is worth saving to take to the dentist with you. Where the child still has their first set of teeth it is highly likely the tooth will not be replaced or repaired as the adult teeth will soon develop, but retaining it can be helpful, if nothing more than allowing the dentist to make a more informed assessment.
Just like an adult if the situation does not require emergency treatment, there is no need to seek out an emergency dentist. But, it is normally worth getting an appointment booked with your general dentist, so that they can take a look and make sure there is no hidden damage or risk.
If there is severe trauma or pain that needs immediate attention, then the child should be taken to an emergency dentist.
Although a paediatric dentist is a professional specialised in children’s teeth, you do not need to find a emergency dentist specifically for kids, all emergency dentists will be able to issue initial treatments required to child or adult of any age.
More specialised skills and experience might be called upon if the circumstances require it.
Baby teeth that are knocked out will not be replaced as doing so can damage the adult tooth growing underneath. Baby teeth that are damaged may not be repaired unless there is a lot of pain. That said, if the whole tooth is found then it is worth saving, just in case.
Tips to avoid dental emergencies
Life is full of unpredictabilities, so you cannot avoid all dental emergencies, but there are certainly some preventative steps you can take to avoid an unwanted trip to the dentist.
- Wear a mouthguard when playing sports.
- This might not apply if your sport is golf or swimming, but sports like football or baseball are 2 examples where the face and the teeth might take a hit. A mouthguard can help shield the teeth.
- A good oral hygiene routine.
- Brushing twice a day and flossing too can help keep your teeth in a good, healthy condition, reducing the likelihood of any issues.
- Regular dental checkups.
- This gives an opportunity for a trained professional to take a look at your oral health. They can spot and treat issues before they become to big an issue.
- Don’t bite into hard foods.
- Particularly hard food stuff like ice, nuts and those fruits with stones in can damage teeth and fillings, try to avoid biting down hard on these.
- Use your teeth appropriately.
- Don’t use your teeth to open beer bottles or packaging, doing so can put unnecessary force and pressure on the teeth.
- Don’t ignore pain and sensitivity.
- If you are getting regular pain, sensitivity or discomfort in the teeth, don’t ignore this. The longer they are left the more problematic they may become. Holes in teeth don’t repair themselves.
- Trust your gut instinct.
- If you think you might have something wrong with your dental health, but are perhaps not sure because there is no pain, then get it checked out to be sure.
How to be prepared for dental emergencies
Being prepared for a dental emergency doesn’t necessarily mean having to have your neighbourhood dentist on speed dial or becoming a trained dentist yourself.
But, there are a few simple steps you could take, as advised below, to help ease the situation should a dental emergency arise.
- Have a first aid kit/emergency dental kit.
- Buy or create a dental emergency kit or include the components as part of a first aid kit you might have.
- Include things such as paracetamol, gauze and an antiseptic mouthwash.
- Grocery stores and pharmacies sell over-the-counter emergency filling kits that could be used to stick crowns back in.
- Be aware of what to do should a tooth be knocked out.
- There are some do’s and don’ts with knocked out teeth, refer to the next section in the article to find out what they are.
- Make sure you are registered with a dentist.
- This can help speed up the process should you need their assistance.
- Know your dental practice operating hours.
- Become familiar with your dental practice opening hours and contact numbers. Perhaps store them in your phone or in a place you will remember to refer to..
- Emergency dentist numbers.
- Take a note of any 24 hour emergency dental practices or contacts in your area or that relate to your practice if needs be.
Knocked out teeth – top tips
One of the most serious dental emergencies is where a tooth is knocked out of the mouth entirely. This is technically known as an avulsed tooth.
Here are some key things you should and should not do with a tooth that has been knocked out.
- Call the dental office/emergency dentist for an appointment.
- Try to find the tooth if it has been knocked out.
- If the original tooth can be found, it can often be saved and reimplanted within a certain time frame.
- Pick it up by the crown (the wider top part of the tooth you can normally see), not by the root(s)(the bit that normally sits under the gum)
- This reduces the chance of further damage to the tooth.
- If dirty, gently rinse with water from the tap.
- Do not scrub the tooth clean.
- Do not use soap or chemicals.
- Leave any natural tissues attached to the tooth, on the tooth.
- Don’t dry the tooth or wrap it up.
- Do not wrap the tooth or cover it in a cloth or tissue this can do more harm than good.
- Place the tooth back in the socket, adults only.
- For adult teeth the best thing to do if possible is place it back in the socket it came out of. The sooner this is done the better.
- Bite down on a piece of gauze to help keep it in place.
- Do not do this with children’s first (deciduous) teeth.
- Keep the tooth moist.
- If the tooth won’t go back in the socket, place it in the mouth in between the gum and cheek.
- With children, assess the risk of the tooth being retained in the mouth and any risk to swallowing.
- If needed, the tooth can be stored in a clean cup in either milk or water.
- See a dentist within 60 minutes.
- The best chance of successful placement of the original tooth is if you can see a dentist in 30-60 minutes.
- Don’t put yourself or others at risk (rushing to the dentist) to achieve this, but avoid any unnecessary delays.
Unlike a medical emergency that might need a call to be placed to 911, there are few dental incidents that require such.
In almost all cases where the teeth have been damaged, it is the dentist who is best placed to help.
Emergency rooms do have dental professionals on call and can provide some immediate assistance, particularly pain medication, but this is generally just to help you get by until to can see a dentist.
It is quite possible to see a dentist within a very short space of time if you really need the care, most will give priority to real dental emergencies that include, teeth that have been knocked out, sever pain and broken teeth.
When the incident occurs out of hours, do try your local dental clinic first. They often can give a contact number or details for an emergency contact local to you.
Searching the web for emergency dentists in your area can be helpful too. Larger cities in particular will often have centres that offer extended opening hours.
Not all dental insurance plans will cover emergencies, so expect to have to pay relatively high fees, but you may find that a large proportion of the treatment is covered if it can wait or has to be done after that emergency appointment.
If possible prepare yourself and be aware of what you can do should a dental emergency arise.
Is the emergency dentist free?
No. Emergency dental fees can run into hundreds of dollars, depending on what work has to be completed.
Normally though treatment completed, particularly out of hours will be minimal, in the interest of getting you out of pain and in a more comfortable condition.
Fees are set by the different provinces within Canada, so there will be some variation and there may well be some ancillary costs associated.
Can an emergency dentist remove teeth?
A dentist will always try to save a tooth and only remove it if it is absolutely necessary.
If it is considered necessary then the tooth can and will be removed during that emergency appointment.
If there is a complexity in the removal, it may well be delayed, but this is considered on a case by case scenario.
For example, wisdom teeth are not normally extracted under ’emergency’ conditions.
Can an emergency dentist remove wisdom teeth?
Yes, they can if required, but rarely is this necessary.
Most wisdom teeth will be removed as part of a planned treatment to deal with any pain or complications suffered as a result of their presence.
If considered necessary, due to trauma, swelling or other complication a dentist can remove it under emergency conditions, but typically, it is impacted or partially erupted third molars that require extraction.
These tend to take a little longer to remove, requiring more involved surgery and time is usually allocated in the diary of the dentist to do this.
What can an emergency dentist do?
An emergency dentist can do all that your normal general dentist can and would do.
Depending on the dentist on call or actually available at the time of your dental emergency, they may have other dental skills such as orthodontics, periodontics or orthodontics which they could technically make use of during that appointment, but those advanced skills are usually reserved for use during normal office hours.
Emergency dentistry is most often about managing severe pain and trauma that is being suffered.
Where is the nearest emergency dentist?
The nearest emergency dentist is likely to be your normal dental office.
However, if you make special trips or travel further for your regular dental work, then there may well be a dentist that can deal with an emergency dental situation closer to you.
Depending on your location and the office hours of dentists within your area will depend on their availability.
Larger towns and cities usually have much better availability and choice than smaller rural areas.
Emergency dentist without insurance?
Most dental offices will accept patients requiring dental care, even if they do not have dental insurance, but you will have to pay for it.
Policies will differ, but you may need to pay an initial fee upfront before seeing a dentist to confirm you can afford the treatment.
Some offices will offer payment plans, but if you can source the money more affordably from elsewhere (family or friends) it might be more cost effective.
If you attend a dentist regularly there are often Dental Discount Plans that the office will offer, where you pay fees regularly but the benefit if discounted dental care as and when you need it.
Local dental schools may well be able to offer discounted treatment, but this will not normally be out of hours.
Some charities offer or support those most in need, but you may have to wait to benefit from such and can not generally get instance care.
For those with no money or enduring economic hardship government assistance such as Medicaid might be available for you.