Dental emergencies are quite frightening and often painful. Prompt treatment is almost always required to alleviate pain and to ensure the teeth have the best possible chance of survival.
Sometimes teeth become fractured by trauma, grinding or biting on hard objects. In other cases, fillings, crowns and other restorative devices can be damaged or fall out of the mouth completely. If there is severe pain, it is essential to make an appointment with the dentist as quickly as possible. The pain caused by dental emergencies almost always gets worse without treatment, and dental issues can seriously jeopardize physical health.
Types of dental emergency and how to deal with them
Avulsed tooth (tooth knocked out)
If a tooth has been knocked clean out of the mouth, it is essential to see a dentist immediately. When a tooth exits the mouth, tissues, nerves and blood vessels become damaged. If the tooth can be placed back into its socket within an hour, there is a chance the tissues will grow to support the tooth once again.
Here are some steps to take:
- Call the dentist.
- Pick up the tooth by the crown and rinse it under warm water. DO NOT touch the root.
- If possible, place it back into its socket – if not tuck it into the cheek pouch.
- If the tooth cannot be placed in the mouth, put the tooth into a cup of milk, saliva, or water as a last resort. It is important to keep the tooth from drying out.
- Get to the dentist, quickly and safely.
The dentist will try to replace the tooth in its natural socket. In some cases, the tooth will reattach, but if the inner mechanisms of the teeth are seriously damaged, root canal therapy may be necessary.
Lost filling or crown
Usually, a crown or filling comes loose while eating. Once it is out of the mouth, the affected tooth may be incredibly sensitive to temperature changes and pressure. Crowns generally become loose because the tooth beneath is decaying. The decay causes shape changes in the teeth – meaning that the crown no longer fits.
If a crown has dropped out of the mouth, make a dental appointment as soon as possible. Keep the crown in a cool, safe place because there is a possibility that the dentist can reinsert it. If the crown is out of the mouth for a long period of time, the teeth may shift or sustain further damage.
When the dentist is not immediately accessible, here are the steps to take:
- Apply clove oil to the tooth to alleviate pain.
- Clean the crown and affix it onto the tooth with dental cement. This can be purchased at the local pharmacy.
- If the crown is lost, smear the top of the tooth with dental cement to alleviate discomfort.
- DO NOT use any kind of glue to affix the crown.
The dentist will check the crown to see if it still fits. If it does, it will be reattached to the tooth. Where decay is noted, this will be treated and a new crown will be made.
Cracked or broken teeth
The teeth are strong, but they are still prone to fractures, cracks and breaks. Sometimes fractures are fairly painless, but if the crack extends down into the root, it is likely that the pain will be extreme. Fractures, cracks and breaks can take several different forms, but are generally caused by trauma, grinding and biting. If a tooth has been fractured or cracked, there is no alternative but to see the dentist as quickly as possible.
Where a segment of tooth has been broken off, here are some steps that can be taken at home:
- Call the dentist.
- Rinse the tooth fragment and the mouth with lukewarm water.
- Apply gauze to the area for ten minutes if there is bleeding.
- Place a cold, damp dishtowel on the cheek to minimize swelling and pain.
- Cover the affected area with over-the-counter dental cement if there is no way to see the dentist immediately.
- Take a topical pain reliever.
The nature of the break or fracture will limit what the dentist is able to do. If a fracture or crack extends into the root, root canal therapy may be the only effective way to retain the tooth. In the case of a complete break, the dentist will usually affix the fragment back onto the tooth as a temporary measure.
When a tooth has been dislodged or loosened from its socket by trauma or decay, it might be possible to save it. If the tooth remains in the mouth and attached to the blood vessels and nerves, there is a good chance root canal therapy will not be necessary.
It is important to call the dentist immediately to make an appointment. In the meantime, use a cold compress and over-the-counter medications to relieve pain. The dentist will reposition the tooth and add splints to stabilize it. If the tooth fails to heal, root canal therapy may be required.
If you have questions or concerns about dental emergencies, please contact your dentist.
Cracked and fractured teeth are common dental problems. As people retain their natural teeth longer (due to advances in dental technology), the likelihood of cracked teeth increases. There are many reasons why teeth may crack, for example, biting on hard objects, trauma, grinding and clenching of teeth. All of these behaviors place the teeth under extra strain and render them more susceptible to cracking.
When tooth enamel is cracked, pain can become momentarily debilitating. When no pressure is exerted on the crack there may be no discomfort. However, as the cracked tooth performs a biting action, the crack widens. The pulp and inner workings of the tooth then become exposed, and painful irritation occurs. As pressure is released again, the two parts of the crack fuse back together, and pain subsides. If left untreated, the pulp becomes irreversibly damaged and constantly painful. The resulting pulp infection can affect the bone and soft tissue surrounding the tooth.
Symptoms of a cracked tooth may include:
- Unexplained pain when eating.
- Sensitivity to warm and cold foods.
- Pain with no obvious cause.
- Difficulty pinpointing the location of the pain.
What kind of cracks can affect the teeth?
There are many ways in which a tooth can be cracked. The specific type of crack will determine what type of treatment is viable. In many cases, if the crack is not too deep, root canal therapy can be performed and the natural tooth can remain in the mouth. In other situations, the tooth is too badly damaged and requires extraction.
Here is a brief overview of some of the most common types of cracks:
Crazes – These are generally tiny vertical cracks that do not place the teeth in danger. These scratches on the surface of the teeth are considered by most dentists to be a normal part of the tooth anatomy. A craze rarely requires treatment for health reasons, but a wide variety of cosmetic treatments can be performed to reduce the negative aesthetic impact.
Oblique supragingival cracks – These cracks only affect the crown of the tooth and do not extend below the gum line. Usually, the affected part of the tooth will eventually break off. Little pain will result, because the tooth pulp (that contains the nerves and vessels) will remain unaffected.
Oblique subgingival cracks – These cracks extend beyond the gum line, and often beyond where the jawbone begins. When a piece breaks off, it will usually remain attached until the dentist removes it. Oblique subgingival cracks are painful and may require a combination of periodontal surgery (to expose the crown), and endodontic treatment to place a crown or other restorative device.
Vertical furcation cracks – These cracks occur when the roots of the tooth separate. This type of crack almost always affects the nerve of the tooth. Because the tooth will not generally separate completely, root canal therapy and a crown can usually save the tooth.
Oblique root cracks – These cracks tend not to affect the surface of the tooth at all. In fact, the damage is only apparent below the gum line and usually below the jawbone. Root canal therapy may be possible; depending on how close the fracture is to the tooth surface. However, extraction is almost always the only option after sustaining this classification of fracture.
Vertical apical root cracks – These cracks occur at the apex (tip of the root). Though the tooth does not require extraction from a dental perspective, many patients request an extraction because of the high degree of pain. Root canal therapy alleviates the discomfort for a while, but most often, teeth affected by such cracks are eventually extracted.
How are cracks in the teeth treated?
There are many different types of cracked teeth. Some can only be exposed using X-ray machines, while others are clearly visible to the naked eye. In cases where the tooth root is affected, root canal therapy is the most viable treatment option. The pulp, nerves and vessels of the tooth will be removed, and the resulting space will be filled with gutta-percha. A crown or filling will be added to stabilize the tooth and it will continue to function as normal.
When the crack is too severe for the tooth to be saved, the dentist will perform an extraction. There are a number of restorative options in this case, such as bridges, dental implants and partial dentures. All of these structures can restore biting, chewing and speaking functions.
If you have any questions or concerns about cracked teeth, please ask your dentist.
Root Canal Therapy
Root canal therapy is needed when the nerve of a tooth is affected by decay or infection. In order to save the tooth, the pulp (the living tissue inside the tooth), nerves, bacteria, and any decay are removed and the resulting space is filled with special, medicated, dental materials, which restore the tooth to its full function.
Having a root canal done on a tooth is the treatment of choice to save a tooth that otherwise would die and have to be removed. Many patients believe that removing a tooth that has problems is the solution, but what is not realized is that extracting (pulling) a tooth will ultimately be more costly and cause significant problems for adjacent teeth.
Root canal treatment is highly successful and usually lasts a lifetime, although on occasion, a tooth will have to be retreated due to new infections.
Signs and symptoms for possible root canal therapy:
- An abscess (or pimple) on the gums.
- Sensitivity to hot and cold.
- Severe toothache pain.
- Sometimes no symptoms are present.
- Swelling and/or tenderness.
Reasons for root canal therapy:
- Decay has reached the tooth pulp (the living tissue inside the tooth).
- Infection or abscess have developed inside the tooth or at the root tip.
- Injury or trauma to the tooth.
What does root canal therapy involve?
A root canal procedure requires one or more appointments and can be performed by a dentist or endodontist (a root canal specialist).
While the tooth is numb, a rubber dam (a sheet of rubber) will be placed around the tooth to keep it dry and free of saliva. An access opening is made on top of the tooth and a series of root canal files are placed into the opening, one at a time, removing the pulp, nerve tissue, and bacteria. If tooth decay is present, it will also be removed with special dental instruments.
Once the tooth is thoroughly cleaned, it will be sealed with either a permanent filling or, if additional appointments are needed, a temporary filling will be placed.
At the next appointment, usually a week later, the roots and the inside cavity of the tooth will be filled and sealed with special dental materials. A filling will be placed to cover the opening on top of the tooth. In addition, all teeth that have root canal treatment should have a crown (cap) placed. This will protect the tooth and prevent it from breaking, and restore it to its full function.
After treatment, your tooth may still be sensitive, but this will subside as the inflammation diminishes and the tooth has healed.
You will be given care instructions after each appointment. Good oral hygiene practices and regular dental visits will aid in the life of your root canal treatment.