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Dental Emergencies

Common problems

Acute toothache

A toothache is an aching pain in or around a tooth. In most cases toothaches are caused by problems in the tooth or jaw, do not ignore the pain. Seek an appointment with your dentist. The steps outlined below can provide temporary relief:

  • Rinse your mouth with warm salt water and gently use dental floss to remove any food or debris that may be lodged. Do not use a sharp or pointed instrument to remove any debris as this may damage teeth or cause injury.
  • A painkiller may be taken for relief till you consult the dentist.
  • Try massage your aching tooth by hand, this can ease the pain by 50 percent. Place a cold compress on the outside of your cheek to minimise the swelling.
  • A few doctors also recommend the use of cloves and clove oil to soothe the pain.

Lost filling

  • Immediately report to your dentist.
  • As a temporary measure, fill a sugarless gum in the cavity or over the counter dental cements.

Dislodged Crown

Crowns sometimes fall out. This can be caused by a lack of cement or an improper fit. If this happens, place the crown in a secure, zip- top plastic bag. Then bring it to your dentist to have it cemented back in place. If you are in no discomfort and your appearance is not affected, don't try to put the crown back in place yourself.

If you do need to put it back in your mouth, clean it well on the inside. Use a toothpick to loosen and remove any cement or debris that is stuck to the crown. A wet cotton swab can finish the cleaning. You can replace the crown temporarily using denture adhesive or temporary cement. This is sold in many pharmacies. Contact your dental office immediately and try to schedule a visit for the next day.

Lost crown

  • If the crown falls off, make an appointment to see your dentist as soon as possible and bring the crown with you.
  • If you can't get to the dentist right away and the tooth is causing pain, use a cotton swab to apply a little clove oil to the sensitive area.
  • If possible, slip the crown back over the tooth. Before doing so, coat the inner surface with toothpaste or denture adhesive, to help hold the crown in place. Do not use super glue.

Dental Abscess

  • Place a dry black tea-bag or a piece of potato against the sore tooth in for a couple of hours or overnight. This reduces the infection and drains the pus. The result is diminished pain and swelling.
  • Swish your mouth with Hydrogen Peroxide 1.5% as a mouthwash in order to disinfect the inflamed area.
  • In case of abscess discharge brush your teeth (with a baking soda/peroxide toothpaste) and repeat the disinfectant per- oxide gargle.
  • You can assist the drainage by lightly pushing against your cheek near the abscess. BUT, only lightly! If you press strongly you may push pus into the bloodstream or nearby tissues which can cause a more serious infection.
  • Consult a dentist for starting appropriate antibiotics.
  • An oral infection, like tooth abscess is a serious condition and can cause problems in other areas of the body, like inflammation of the heart or facial bones. Seeking medical help is essential.

Gum Abscess and Periodontal Abscess

A gum abscess is the result of irritation caused by toothpicks or other objects or aggressive brushing. Due to a break in the gum surface, bacteria invades the area, causing a local infection. Initially, the area appears red,later the area becomes pointed and filled with pus.

  • You can use salt water and clove oil to temporarily reduce the pain before you seek dental help.
  • Sometimes using mouthwashes and peroxide flushes also bring temporary relief.
  • Antibiotic therapy also causes relief but you should visit the dentist within 24-48 hrs.

Broken Dentures or Lost Dentures

  • Accidents do happen and because dentures are a vital component to daily life, people should have a denture repairs service in mind before they are faced with a denture emergency.
  • Safeguard the pieces of your broken denture and report to your dentist. He is the only person who can fix it.
  • Do not try to use any adhesive or try to repair it yourself.

Jaw fracture

The term “jaw fracture” usually refers to fracture of the lower jaw (mandible). A fractured jaw causes pain and usually changes the way the teeth fit together. Often, the mouth cannot be opened wide, or it shifts to one side when opening or closing.

Fractures of the upper jaw (maxilla) are usually considered facial fractures. These may cause double vision (because the muscles of the eye attach nearby), numbness in the skin below the eye (because of injuries to nerves) or an irregularity in the cheekbone that can be felt when running a finger along it.

Signs and Symptoms of Jaw Fracture

Following the trauma and the fracture, you'll have pain, some swelling, and possibly bruising. Even after emergency medical care and after the healing process, you may still have symptoms, including:

  • Jaw pain
  • Jaw fatigue
  • Difficulty opening your mouth to eat or talk
  • Ringing in your ears
  • Dizziness
  • Headache
  • Popping sounds in your jaw
  • Neck pain
  • Locking jaw

First aid

Temporarily bandaging the jaw (around the top of the head) to prevent it from moving may help reduce pain. The specific treatment for a fractured jaw depends on how badly the bone is broken. If you have a minor fracture, you may only need pain medicines and to follow a soft or liquid diet for a while.

Surgery is often needed for moderate to severe fractures. The jaw may be wired to the teeth of the opposite jaw to improve stability. Jaw wires are usually left in place for 6 to 8 weeks. Small rubber bands (elastics) are used to hold the teeth together. After a few weeks, some of the elastics are removed to allow motion and reduce joint stiffness.

If the jaw is wired, you can only drink liquids or eat very soft foods. Have blunt scissors readily available to cut the elastics in the event of vomiting or choking. If the wires must be cut, consult a health care provider promptly so they can be replaced.

Do not attempt to correct the position of the jaw.

Prevention

Safe practices in work, sports, and recreation, such as wearing a proper helmet when playing football, may prevent some accidental injuries to the face or jaw.

Dislocated Jaw

Dislocated jaw is where the bones of the jaw are knocked out of place. This is often caused by a trauma or blow to the face but may also be occasionally caused by yawning or yelling. The condition is usually very painful.

First aid

Your doctor should be able to manually reset your jaw using thumbs and push it back into position. He may or may not need to do this under anesthesia. The jaw may need to be stabilised.

This usually involves bandaging the jaw to keep the mouth from opening widely. In some cases, surgery may be needed particularly if repeated jaw dislocations occur.

After dislocating your jaw, you should not open your mouth widely for at least 6 weeks. Support your jaw with one or both hands when yawning and sneezing.

Dental Trauma

Dental trauma may occur as a result of a sports mishap, an altercation, a fall inside the home, or other causes and needs prompt attention.

Orthodontic emergencies with braces or retainers

Diagnosis:

If a protruding wire is causing irritation, cover the end with a small cotton ball, beeswax, piece of gauze or a chewing gum until you are seen by a dentist. If a wire gets stuck in the cheek, do not attempt to remove it. Go to the dentist immediately. If an appliance is loose or a piece breaks off, do not wear it again until it has been repaired or adjusted by your orthodontist. Place the appliance and the piece in a clean container and go to the dentist.

Treatment

Maintain good oral hygiene throughout the treatment.

Do not participate in any activity where there is any chance of injury to the face or the teeth.

You should not bite anything with your front teeth to prevent the brackets from coming off. Only the posterior (back) teeth can be used for chewing and eating.

The success of the treatment is in your hands

Cut or Bitten Tongue, Lip or Cheek

Treatment

To control bleeding for any injuries apply pressure directly to the area with a clean cloth or gauze pack.

However, if bleeding does not stop within 15 minutes, go to the emergency or your dental surgeon. It may require stitches.

To minimise swelling, apply ice or cold compresses to face at the site of the injury.

Chipped or Broken Tooth

Treatment

Gently clean dirt from the injured area with warm water.

Protect the tooth from exposure to air or cold liquid (cover with sterile gauze).

Place a cold compress over the face, in the area of the injured tooth, to decrease the swelling.

If a nerve is exposed go to a dentist immediately.

Take broken pieces to the dentist who will evaluate the damage and treat the break or fracture accordingly

Avulsed Tooth or Knocked- out tooth (dental avulsion)

Diagnosis:

This occurs when a tooth is completely displaced or knocked out of the dental socket. Dental avulsion injuries occur most frequently in children between the ages of 7 and 9, an age when the alveolar bone surrounding the tooth is relatively resilient. Adult teeth that are avulsed (knocked- out) should be considered for immediate replantation in order to enhance the tooth’s long- term prognosis.

Treatment
Primary Tooth

A primary tooth that has been avulsed is usually not reimplanted. The risk of injury to the developing permanent tooth bud is high.

Permanent Tooth

Do not touch the root of the tooth. Handle the tooth by the crown only.

Rinse the tooth off only if covered by debris. Do not scrub or scrape the tooth.

Attempt to reimplant the tooth into the socket with gentle pressure, and hold it in position. Hold the tooth in place. Aluminium foil may be used to help stabilise the tooth, or the patient can bite gently on gauze or a soft cloth. Time is critical and immediate replacement is best, and ideally should not be delayed more than 30 minutes.

If unable to reimplant the tooth, place it in a protective transport solution, such as Hank's solution, milk, saline, or placing it in the patient’s mouth next to the cheek, if the patient is able to do so.

This will hydrate and nourish the periodontal ligament cells which are still attached to the root. A small container of Hank's Balanced Salt Solution can be purchased.

The tooth should not be wrapped in tissue or cloth. The tooth should never be allowed to dry.

Go to a dentist or hospital emergency room for evaluation and treatment.

Radiographs may need to be taken of the airway, stomach, and mouth if the tooth cannot be found.

Tetanus prophylaxis should be considered if the dental socket is contaminated with debris.

Points to remember:
  • Do not hold the tooth by the root surface
  • Do not scrape or rub the root surface
  • Do not let the tooth dry out
  • Do not put the tooth in ice
  • Avoid rinsing or storing the tooth in water for more than one or two seconds
  • Do not remove any tissue or gum fragments from the tooth

To help prevent against a broken or knocked out tooth always ensure your child is fitted with a custom made mouth-guard when participating or training in contact sports.

Traumatised Tooth

Diagnosis:

When a permanent tooth has been knocked out, it may be saved with prompt action. The tooth must be found immediately after it has been lost. It should be picked up by the natural crown (the top part covered by hard enamel). It must not be handled by the root. If the tooth is dirty, it may be gently rinsed under running water. It should never be scrubbed, and it should never be washed with soap, toothpaste, mouthwash, or other chemicals. The tooth should not be dried or wrapped in a tissue or cloth. It must be kept moist at all times.

The tooth may be placed in a clean container of milk, cool water with or without a pinch of salt, or in saliva, the last being the best option. If possible, the patient and the tooth should be brought to the dentist within 30 minutes of the tooth loss. Rapid action improves the chances of successful re- implantation; however, it is possible to save a tooth after 30 minutes, if the tooth has been kept moist and handled properly.

Treatment

Treatment of a broken tooth will vary depending on the severity of the fracture. For immediate first aid, the injured tooth and surrounding area should be rinsed gently with warm water to remove dirt, then covered with a cold compress to reduce swelling and ease pain. A dentist should examine the injury as soon as possible. Any pieces from the broken tooth should be saved and brought along.

If a piece of the outer tooth has chipped off, but the inner core (pulp) is undisturbed, the dentist may simply smooth the rough edges or replace the missing section with a small composite filling. In some cases, a fragment of broken tooth may be bonded back into place. If enough tooth is missing to compromise the entire tooth structure, but the pulp is not permanently damaged, the tooth will require a protective coverage with a gold or porcelain crown. If the pulp has been seriously damaged, the tooth will require root canal treatment before it receives a crown. A tooth, that is vertically fractured or fractured below the gumline will require root canal treatment and protective restoration. A tooth that no longer has enough remaining structure to retain a crown may have to be extracted (surgically removed).

Luxated Tooth (luxation, lateral displacement, extrusion)

Diagnosis:

Luxation involves displacement of a tooth in a labial, lingual, or lateral direction. If the displacement is less than 5 mm, the dental pulp will remain vital in about 50% of the cases. Lateral luxation is an angular displacement of the tooth while it remains within the socket. There is usually an associated fracture of the supporting alveolar bone, especially with labial and palatal luxations. An extrusion occurs when a tooth is only partially removed from the socket. In the primary dentition, the alveolar bone surrounding the tooth is relatively elastic, so the most common injury in toddlers is a dental luxation (displacement injury) with gingival haemorrhage. The primary upper incisors are often pushed toward the palate during a fall.

Treatment
Primary Tooth

Place a cold wet cloth over the mouth and bring the child to a dentist. Provide pain relief by giving children’s analgesics.

Permanent Tooth

Rinse with cold water and keep an ice pack over the lip and mouth to reduce swelling. Give analgesic for pain relief.

Try to reposition the luxated tooth back to its normal position using gentle to moderate finger pressure. The patient is then instructed to gently hold the tooth in position.

Obtain definitive dental care as soon as possible.

Tooth Fracture (infraction)

Diagnosis:

Crown fractures comprise about 33% of injuries to primary teeth, and about 75% of injuries to permanent teeth. A crown fracture is classified based on the location of the fracture in relation to the enamel, dentin, or pulp tissue of the tooth. If the fracture of the crown is incomplete or if it produces cracks in the enamel, it is referred to as an enamel craze, crack, or infraction. The craze lines begin at the enamel surface and end at the enamel- dentin junction.

Treatment

Have the child rinse with warm water

Use a cold cloth or ice pack to reduce swelling.

Use acetaminophen for pain, not aspirin.

Cover any severe fracture with a biocompatible cement or dressing until a dentist can treat the problem.

Intrusion Tooth pushed up (dental intrusion)

Diagnosis:

An intrusion injury is the most severe type of luxation injury. The intruded tooth is impacted into the alveolar bone and the alveolar socket is fractured. The forces that drive the tooth into the socket wall crush the periodontal ligament and rupture the blood and nerve supply to the teeth. The tooth may not be visible and can be mistaken for an avulsion. If a permanent tooth is involved, radiographs may show an alveolar fracture, or tooth displacement into the nasal cavity. Pulpal necrosis (death of the dental pulp) occurs in 96% of cases of intruded permanent teeth. If a primary incisor is involved in an intrusion injury, a lateral anterior radiograph (“mini- ceph”) should be taken of the traumatised region to determine the proximity of the intruded primary root tip to the developing adult tooth bud.

Treatment

Rinse with cold water, and keep an ice pack over the lip and mouth to reduce swelling.

Give analgesic for pain relief.

Subluxation & concussion Tooth was hit (subluxation, dental concussion)

Diagnosis:

Concussion results in mild injury to the periodontal ligament without tooth mobility or displacement. Subluxation causes significant injury to the periodontal ligament , resulting in some tooth mobility. There is usually bleeding at the marginal gingival, and the tooth is tender to percussion in subluxation

Treatment

Rinse with cold water, and keep an ice pack over the lip and mouth to reduce swelling.

Give analgesic for pain relief.

Root Fracture (apical, mid- root, cervical)

Diagnosis:

Root fractures occur in only 7% of dental injuries. Horizontal root fractures occur in anterior teeth and are caused by direct trauma. Vertical root fractures usually occur in molars, and may be caused by clenching or trauma to the mandible. Vertical root fractures are more difficult to detect, and may not be found until extensive tooth destruction has occurred. A horizontal root fracture is classified based on the location of the fracture in relation to the root tip (apex). Horizontal root fractures may occur in: the apical third, middle third, or cervical third of the root. The prognosis worsens the further cervically (towards the crown) the fracture has occurred. Tooth fractures are often not apparent during a clinical examination, and can usually only be diagnosed using appropriate radiographs. Radiographs with at least two views are required for making this diagnosis. Treatment

Rinse with cold water, and keep an ice pack over the lip and mouth to reduce swelling.

Give analgesic for pain relief.

Prevention

To avoid the traumatic experience of a toothache,

Visit your dentist regularly

Self examination is also an important. If you see any change in your oral cavity report toy our dentist as soon as possible.

Follow proper oral hygiene technique

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