A dental emergency, right now

Minutes matter

A knocked-out adult tooth

Do this in the order it is written. If someone else is with you, send them to ring us while you do it.

1. Find the tooth and pick it up by the crown — the white chewing part. Do not touch the root, and do not scrub it. The root surface carries the cells the tooth needs to reattach.
2. If it is dirty, rinse it for about ten seconds in cold milk, saline, or briefly under cold running water. Do not use soap, do not scrub, do not dry it, do not wrap it in tissue.
3. Put it back into the socket if you can. Line it up the same way round as the teeth beside it and press it gently but firmly home. Then have your child bite on a clean handkerchief or a piece of gauze to hold it there.
4. If you cannot put it back, store it wet. Cold milk is best. Saline is next. Your child’s own saliva works — into a small cup, or held inside the cheek only if they are old enough not to swallow it. Never plain water. Never dry.
5. Ring us and set off. Under thirty minutes is the target; under an hour is still worth hurrying for. Tell us on the phone what you have done so the room is ready.
6. Bring the tooth even if it is broken, and bring any fragments you can find.

We will not tell you what the outcome will be. What we can tell you is that a replanted adult tooth needs splinting, follow-up radiographs and review over months, and sometimes root canal treatment later. We will explain each step as we reach it.

Do not reimplant

A knocked-out baby tooth

Do not put a baby tooth back in. Not for a moment, not to "see if it fits". The adult tooth is forming directly above the socket and pushing a baby tooth back can damage it permanently.

1. Sit your child up and lean them forward so blood runs out rather than back.
2. Press a clean, damp gauze or flannel onto the socket and hold it there for ten minutes without lifting it to look. Lifting it restarts the clock.
3. Cold on the outside of the lip or cheek — a wrapped ice pack or a cold flannel — for ten minutes at a time.
4. Painkillers if needed, at the weight-based dose on the packet. Nothing against the gum.
5. Soft, cool food. No straws, no hard foods, no fingers in the socket.
6. Ring us the same day. We check that the whole tooth came out, look at the teeth either side, and check whether the injury has affected the developing adult tooth.

Bring the tooth if you have it, so we can be sure nothing is left in the socket. A baby tooth lost early sometimes needs a space maintainer so the adult tooth has room to come through.

Same day where the nerve is exposed

A broken, chipped or cracked tooth

1. Find the broken piece and keep it in cold milk or saline. Some fragments can be bonded straight back on.
2. Rinse the mouth gently with warm water to see what you are dealing with.
3. Look at the broken surface. A pink or red spot in the middle, or a spot of blood coming from the tooth itself, means the nerve is exposed. That needs treating today, not tomorrow.
4. Cover a sharp edge with a piece of sugar-free chewing gum or orthodontic wax so it does not cut the tongue or lip.
5. Cold compress on the outside for swelling. Painkillers at the packet dose if needed.
6. Ring us. Tell us whether you can see pink in the middle — it changes how quickly we need to see you.

A tooth that has been knocked but has not moved or broken still needs checking. Bruising to the nerve can show up weeks later as a tooth that darkens, and that is much easier to manage if we already have a baseline radiograph.

Facial swelling is urgent

Toothache, swelling or an abscess

Swelling that is closing an eye, spreading under the jaw or down the neck, or making swallowing or breathing difficult is an emergency room problem, tonight. Do not wait for a dental appointment.

1. Painkillers at the weight-based dose on the packet. Ibuprofen tends to work better for dental pain than paracetamol, unless your child has been told to avoid it.
2. Never hold aspirin or a painkiller against the gum. It burns the tissue and does nothing for the tooth.
3. Warm salt water rinses — half a teaspoon in a cup — if your child is old enough to spit reliably.
4. Cold on the outside of the cheek, not heat.
5. Do not try to lance or squeeze a gum boil.
6. Ring us for a same-day appointment. An abscess needs the cause treated; painkillers only buy time, and a swelling that goes down on its own has not gone away.

Take a photograph of the swelling when you first see it. If it changes overnight, that photograph tells us more than a description can.

Ten minutes of pressure

A bitten or cut lip, tongue or cheek

Mouths bleed dramatically and heal fast. The blood in the sink is almost always worse than the injury.

1. Clean the area gently with cool water and have a look at it in good light.
2. Firm, continuous pressure with clean damp gauze for ten minutes. Set a timer. Do not lift it to check.
3. Cold afterwards — an ice pop is both a cold compress and a distraction.
4. Watch for the things that need stitches: a cut that gapes open, a cut that crosses the border of the lip, a wound that goes all the way through, or bleeding that has not stopped after fifteen minutes of pressure. Those go to urgent care or an emergency room, and sooner is better for a good repair.
5. If your child bit their lip while numb after treatment, ring us — a chewed numb lip looks alarming the next day and is usually managed with keeping it clean and soft food.

Check the bite

A blow to the jaw or face

1. Ask your child to close their teeth together gently. If the bite feels wrong to them, or the teeth no longer meet the way they did, treat it as a possible fracture and go to an emergency room.
2. Go to an emergency room for any of: a jaw that will not open or close, a visible step or dent along the jawline, numbness of the lower lip or chin, bleeding from an ear, or an eye that is not moving normally.
3. Support the jaw on the way — a hand or a folded scarf under the chin. Do not force it open or closed.
4. Watch for concussion: loss of consciousness at any point, repeated vomiting, drowsiness, confusion or worsening headache. Those need medical assessment, not a dentist.
5. Once medical assessment is done, ring us. Teeth take the impact even when the jaw is fine, and we will want to check and photograph them.

Three others worth knowing

A tooth pushed sideways, backwards or up into the gum

Do not try to pull or push it back into place. Give soft food, cold on the outside, and ring us today. A displaced adult tooth usually needs repositioning and splinting. A baby tooth pushed up into the gum often comes back down on its own over weeks, but still needs looking at.

Something wedged between two teeth

Try floss, gently, once. Never a pin, a knife, a cocktail stick or anything metal. If it will not come out, leave it and ring us.

A lost filling or a crown that has come off

Keep the crown, do not glue it. Keep the area clean and give soft food on the other side. This is urgent-ish rather than urgent: ring us in the morning.