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Dental Emergencies

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For more information on oral health care needs, please visit the website for the American Academy of Pediatric Dentistry.

Toothache or Severe PainBack To Top

Any injury to the teeth or gums can cause pain. However, sometimes the origin of the pain may not be that obvious. The pain may be the result of many causes, including, but not limited to:

  • Deep cavities
  • Broken or lost fillings or crowns
  • Food stuck in the gums (i.e. popcorn wedged in the gums or between teeth)
  • Ulcer
  • Abscess (dental infection)
What you can do:

Rinse your child’s mouth with warm water every hour as needed to relieve the pain. Clean the area around the affected tooth thoroughly. This includes brushing well in the area and using floss. An ice pack placed on the affected site may also help relieve pain.

Do not place aspirin on your child’s gum or on the aching tooth as this can cause severe aspirin burn.

Give your child Children’s Tylenol (Acetaminophen) or Motrin (Ibuprofen) for pain.

If his/her face is swollen around his/her eye, apply an ice pack and take immediately to an emergency room.

Schedule an appointment with us ASAP so we can diagnose the problem and determine if anything needs to be done.

Facial SwellingBack To Top

Facial swelling usually develops after an injury, cut, bite, sting, or a dental abscess. However, it may also occur without any known cause. There is usually a localized area of redness, swelling, sometimes heat, and pain. There can sometimes be throbbing pain and a fever.

An infected tooth with an abscess (collection of pus) is the most common reason for facial swelling (cellulitis) seen in our office. This happens when the bacterial infection causing deep cavities penetrates through the tooth, out through the root, into the bone, and then into the surrounding facial tissues. Facial swelling or cellulitis is a very serious situation. Most often, we can not do any dental treatment until the cellulitis is resolved because the local anesthetic used to numb the teeth will not work due to the change in body chemistry. Therefore, we recommend that you see your pediatrician or emergency room physician first in order to receive the proper type of and dosage of antibiotics. Sometimes in order for the antibiotics to be effective, an I.V. antibiotic has to be administered by the medical doctor because oral administration of the antibiotic is not effective and the cellulitis will continue to get worse.

Call your physician or go immediately to the Emergency Department of the nearest hospital if any of the following occurs:

  • Chills, fever, or vomiting
  • Increased swelling or increased pain, especially around the eye
  • Increased redness or increased red streaking from the infected area
  • Elevation of the floor of the mouth, difficulty swallowing, or difficulty breathing

Swelling that is caused by infection that occurs around the eye, in the throat area that causes difficulty swallowing, or is associated with a fever can be life threatening.

Go see your pediatrician or emergency room immediately!

Disclaimer:

Dr. Lewis and Dr. Longoria and the other Doctors of Houston Pediatric Dental Specialists make no warranties, expressed or implied, as to any results to be obtained from use of the information “What should I do in a Dental Emergency.” We cannot diagnose or treat patients over the Internet. Information on this site is for educational purposes only. You should not rely on this information as a substitute for personal, medical, and/or dental attention or diagnosis. Without all available information about a patient, it is impossible to make a diagnosis. Help and answers are in the form of general ideas. Only you, your dentist, and other necessary and qualified health care providers can make an appropriate treatment decision in an emergency or for everyday care and dental treatment.

Loose ToothBack To Top

In children, a loose tooth is usually the result of a baby (primary) tooth becoming loose to make room for the adult tooth or the result of trauma.

In some cases, the new adult (permanent) tooth is starting to grow (erupt) into the oral cavity. However, the primary tooth has not fallen out. If you see this in your child’s mouth, please call us for an appointment. We may have to help your child by taking out the baby tooth to allow the new tooth to come into the mouth correctly.

What to do for a loose baby tooth:

Have your child “wiggle” the tooth themselves, pushing it a little at a time everyday. As more of the root of the tooth goes away, the baby tooth will usually come out by itself. This may happen spontaneously, or during eating. If you can see the new tooth coming in through the gums and the baby tooth is slightly loose but not enough for your child to remove it, call our office for an appointment. It is important to remove over-retained primary teeth so that the new permanent tooth can come in straight.

What to do after an accident:

If your child’s tooth is loose due to an accident, rinse and cleanse the injured area with warm water and then check for broken tooth fragments. If all the teeth are intact, gently touch the traumatized teeth to check for looseness. If you notice slight bleeding around a damaged tooth and the tooth is not very loose, you can monitor your child at home. Keep your child on a soft diet for a few days to prevent further damage to the teeth and soft tissues. The bleeding should stop shortly, and the tooth should tighten over time.

If the tooth is loose and in a different position (pushed into the bone, pulled out, or pushed to one side or another), please call our office for an appointment. We will need to take x-rays to check for possible root damage and determine what treatment is necessary.

Any tooth that has been traumatized may darken over time. This usually means that the nerve in the tooth is dying. The traumatized baby teeth may change into an array of colors, from pink to dark gray. This color change does not necessarily mean that the tooth needs to be removed. It only means that the tooth has suffered some type of trauma and needs to be watched closely. Sometimes, a traumatized tooth or teeth will need subsequent removal weeks or months after the trauma. Signs to watch for include complaints of dental pain, seeing an abscess or bubble on the gums above or below the traumatized teeth, constant fidgeting with, touching, or avoiding the tooth in very young children. In any of these cases, please call our office to schedule an appointment.

Place cold compresses over the area of the injury on your child’s face. You can use a towel or gauze to hold pressure on any bleeding areas. You may give your child Children’s Tylenol (Acetaminophen) or Children’s Motrin/Advil (Ibuprofen) to relieve pain and use ice compresses over swollen areas. Keep your child on a soft diet for 2 weeks to prevent further damage. Call our office to have the tooth/teeth examined.

Call your local emergency room if the following occurs:

  • Chills, fever, or vomiting
  • Difficulty walking or change in gait
  • Severe increase in swelling or pain
  • Inability to swallow or keep liquids down
  • Bleeding that does not stop even after continued pressure for 20 minutes

 

Tooth Pushed Out of PlaceBack To Top

If your child’s adult (permanent) tooth is moved inward, outward, and/or upward, try to reposition it back to its normal position with very light finger pressure. Do not force the tooth back into position. Hold the tooth in place with a tissue or gauze if it is very loose. Call our office for an appointment so that we can check the area with diagnostic x-rays and decide on a treatment plan. If the damage is very extensive, future root canal treatment may be needed to save the tooth.

For a baby tooth that has been moved out of its normal position, please call our office for an appointment. We will need to take x-rays to check for possible root damage and determine what treatment is necessary. Do not try and reposition the baby tooth. You could cause damage to the developing permanent tooth.

You may give your child Children’s Tylenol (Acetaminophen) or Children’s Motrin (Ibuprofen) to relieve pain and use ice compresses over swollen areas. Keep your child on a soft diet for 2 weeks to prevent further damage.

Call your local emergency room if the following occurs:

  • Chills, fever, or vomiting
  • Difficulty walking or change in gait
  • Severe increase in swelling or pain
  • Inability to swallow or keep liquids down
  • Bleeding that does not stop even after continued pressure for 20 minutes

Broken ToothBack To Top

Instructions for a baby (primary) tooth:

If a tooth is chipped or cracked and your baby seems to be in pain, you should schedule an appointment right away, as part of the nerve may be exposed. You should also take your baby to the dentist if the tooth is very loose. The dentist may decide to pull it so that your baby won’t choke on it if it falls out on its own.

If the tooth is chipped but it doesn’t seem to be bothering your baby, schedule an appointment for the dentist to evaluate whether there are underlying cracks or other damage you can’t see.

Instructions for a permanent tooth:

When a permanent tooth is chipped it can be very sensitive to air and pressure. Call to schedule an appointment ASAP so we can assess the extent of fracture.   Tylenol or Motrin to control pain are acceptable. You can place chapstick or Vaseline over the fractured area of the tooth to help desensitize the tooth until treatment can be done at the dentist. Teeth with very large fractures may need a nerve treatment (root canal) immediately and some may need one several years down the road.  

Knocked Out ToothBack To Top

Instructions for an Adult (Permanent) Tooth:
  • Find the tooth. Handle the tooth by the crown, not the root portion.You may rinse the tooth with milk, but do not clean or scrub the root of the tooth. Without touching the root, try to reinsert the tooth back into the socket.
  • If you cannot reinsert the tooth, transport the tooth in a cup containing cold milk. Your child must see a dentist immediately!  Time is a critical factor in saving the tooth. If you cannot get in touch with a dentist, immediately proceed to the emergency room. In Houston, the best ER’s for this are Hermann Hospital and Texas Children’s in the Medical Center, however, any ER physician should be able to reimplant.
  • Remember to take the tooth with you.
  • After the dentist places your child’s permanent tooth back into his/her mouth and stabilizes it with a wire, the tooth will still require follow-up evaluations for 2-3 years to determine the success of the treatment.A successful outcome for the tooth cannot be guaranteed even if the tooth was replaced in a timely manner. Potential complications following an avulsion include changes near the root of the tooth, submergence of the tooth, or infection, which may all result in future loss of the tooth.
Instructions for a Baby (Primary) Tooth:
  • A knocked out baby tooth should NOT be reinserted (replanted).Damage to the permanent tooth could occur if reinserted. Tylenol or motrin is acceptable for pain and place an ice pack if any swelling occurs. Schedule an appointment with us so we can take an xray to confirm that the whole tooth is gone.

Broken JawBack To Top

If you suspect that your child has fractured his/her jaw, try to keep the jaw from moving by using a towel, necktie, or handkerchief to immobilize the jaw.

Signs of a fractured jaw include inability to open the mouth, sideways canting of the jaw upon opening, uneven teeth that appear different than before the accident, and inability to close the teeth together properly.

Take your child immediately to the nearest hospital emergency room!

Apply cold compresses to control swelling.

Broken AppliancesBack To Top

If a broken appliance can be removed easily, go ahead and take it out. If the appliance cannot be removed, cover the sharp or protruding portion with cotton balls, gauze, chewing gum, or the dental wax (can be purchased at a local pharmacy like Walgreens or CVS).

If a wire is stuck in the gums, cheek, or tongue, do not remove it. Call us immediately for further instruction. Loose or broken appliances which do not bother your child don’t usually require emergency attention.   Please call our office to schedule an appointment to evaluate the appliance.

Bitten or Chewed Lip after Dental TreatmentBack To Top

After any dental treatment where your child has been anesthetized (numbed), your child might want to scratch his/her face because there is a tingling sensation as the anesthetic is wearing off. Please watch that your child does not scratch or bite his/her cheeks, lip, or tongue. Your child feels his/her face and lips differently, and he/she may not be able to understand that the area is numbed. The numbness will last another 2-3 hours after we have finished working with your child. Please do not give your child any solid foods or snacks for a few hours as your child may bite or chew his/her cheeks, lip, or tongue and probably will not feel the injury. Give your child soft foods such as soup, Jell-O, ice cream, yogurt, juice, milk, milk shakes, or smoothies to maintain a soft diet.

What to do if this happens:

If your child has bitten his/her cheek, lip, or tongue, there may be swelling which may worsen over the next 2-3 days. A yellowish, white plaque (soft scab) will develop. This is part of the healing process. The lesion will heal over the next 10-14 days. If your child complains of pain, you may give him/her children’s Tylenol or Advil and apply Orabase (can be purchased at your local pharmacy) over the swollen areas.

Abscess (Dental Infection)Back To Top

An abscess may appear as a “pimple” or “bubble” on the gums. This may occur as the result of deep dental cavities or trauma. An abscess is a limited area of pus formed as a result of a bacterial infection. If you see this kind of pimple or bubble on the inside of your child’s mouth, call our office for an appointment ASAP. A dental x-ray will be required to correctly diagnose the infection.