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IS THIS A DENTAL EMERGENCY?

CONDITION RED?

Faced with troubling signs and symptoms in the general area where dentists do their work, a decision must be made. Is this a dental emergency? It’s an important decision, with consequences for the short term and the long term.

Some types of dental emergencies have much better outcomes if the emergency dentist starts treatment within 30 minutes. For nearly all types, the-sooner- the-better is the rule. That said, there are likely to be costs involved in making an emergency response to something that isn’t really an emergency, so it pays to learn the basic principles for drawing the line in the right place.

WHAT EXACTLY IS A DENTAL EMERGENCY?

First of all, let’s get on the same page about what a dental emergency is. There’s no universal golden definition, but by reviewing the professional and popular literature on the subject we can see two consistent themes.

One criterion is based on the consequences of delaying treatment or ignoring the problem altogether. By this standard, a dental emergency is any dental problem that requires immediate treatment in order to save a tooth, stop ongoing tissue bleeding, or alleviate severe pain. That certainly seems like a good definition, but it begs the question of how to know whether a given dental problem meets that standard.

The other criterion is more practical: if a person is fussy about availability for treatment, it is not an emergency. Helpful, but it misses the several types of true emergencies in which there is no pain, or only tolerable pain and distress.

A review of five common types of dental emergency, and what to do about each one, put these two principles together and pops out a useful rule of thumb that is easy to remember and to apply.

THREE EASY PIECES

Let’s start by looking at three issues which are obviously emergencies, and discuss the appropriate responses to each one.

There are about 5 million cases of avulsion each year. Teeth getting knocked out or otherwise displaced from their proper places. Nobody needs a dental or medical diploma to make this diagnosis! There’s a gap where there was a tooth. There’s a tooth out there somewhere, visible or not. There may well be blood and pain. Since an adult’s teeth don’t come out for no reason, there was almost certainly a traumatic or progressive condition that led to the avulsion.

Time is of the essence. Teeth can be replanted successfully. The odds of success are greatly improved by proper first aid and rapid intervention by a dentist.

The ideal first response to avulsion, while organizing an emergency dental appointment, is to replace the tooth in its socket after rinsing it gently in water, and rinsing the mouth. Never touch the root! This step may not be practical if the event that caused the avulsion also damaged the tooth or the gums, in which case the tooth should be stored either in the mouth, between gum and cheek, or completely covered by milk in a small covered container. Pain can be dealt with by taking acetaminophen, orally. Don’t take other NSAIDs like aspirin or ibuprofen, as these interfere with blood clotting and so promote continued bleeding. Never apply painkiller of any kind to the empty socket.

A broken tooth is also pretty easy to self-diagnose, visually and/or by probing with the tongue. A part of the tooth that was there, isn’t anymore. This is an emergency, and while getting to the dentist any tooth fragments found should be handled the same way as a whole tooth that came out. Sometimes fragments can be bonded back in place with good functional outcomes. It’s the dentist’s job to determine whether this is possible in each case, not the patient’s.

Where there’s no obvious physical displacement or deformation of one or more teeth, but the pain is severe, there isn’t much to think about. Anyone who has experienced it can tell you that severe dental pain is very severe indeed. Likely suspects here are infections of various soft tissues such as the pulp inside the teeth, and abscesses.

The important thing here is to accept the fact that the problem is not going to go away, and can’t be resolved with home remedies. Since abscesses can progress to serious or even life-threatening illness, and since telling the difference between an infected root and an abscess is not a matter for non-professionals, this is an emergency and should be handled as one. Infected roots are treated with root canal therapy. Dentists drain abscesses and then do root canal therapy to try to save the tooth. The sooner there’s treatment, the better the chances for a good outcome.

UNDER THE RADAR?

Cracked teeth are a little more difficult to detect than the three types of emergency we’ve just reviewed. One reason is that it’s the molars and premolars that are the usual suspects, and they’re not easy to visually inspect without a dental mirror. The usual cause is found in the tremendous forces these grinding teeth are subjected to.

A cracked tooth is an emergency mainly because it has an unhappy future. It’s an incomplete fracture on the way to completion. Sharp pain on chewing hard and sensitivity to cold are the most common symptoms, but often the patient feels nothing out of the ordinary, until suddenly, without warning, he or she does feel something. Something not pleasant at all. First aid is acetaminophen for the pain- and dialing the dentist.

Adults should not have loose teeth and don’t unless something undesirable is the cause. Gum disease is one of these, a bacterial infection attacking the gums, surrounding tissues and bones. By the time a tooth is loose, this gum disease is quite advanced and from there can rapidly progress.

Another progressive cause is habitual tooth grinding, or clenching, usually unconsciously. Here, again, by the time a tooth has been loosened, serious complications like severe headaches and facial pain are not far behind.

The third common cause of loose teeth in adults is trauma. A blow strong enough to loosen a tooth is likely to have produced even more dramatic results elsewhere, but the loosened tooth is a dental emergency which needs care as soon as possible after more critical medical issues have been dealt with.

NONE OF THE ABOVE?

We’ve discussed five fairly specific types of dental emergency, three obvious and two less obvious. There are others, common ones involving restorations like crowns and fillings falling out, and less common ones brought on by the infinite range of ailment and injury the world has in store for us.

Luckily, we don’t need to study and remember all the types of dental emergency in order to identify one when it happens, and so to respond effectively.

TAKEAWAY

A few common themes distinguish dental nearly all dental emergencies: displacement, deformation, or intolerable distress in teeth or supporting tissues. If a tooth is not where it used to be, if its shape has changed, or if there’s bleeding, severe pain, or any other intolerable distress, it’s a dental emergency. Anything that’s fallen out of the mouth should be preserved, kept moist, and brought along to the dentist. Pain can be treated with acetaminophen. Not aspirin or other NSAIDs.

Errors will be made. The important thing is that it’s better to have rushed to the dentist only to be told it’s not really an emergency than it is to put off going to the dentist and making a true emergency worse.