If you are experiencing a true medical emergency, you should not be reading this. you should call 911 now and follow their instructions.
If you are currently a patient of record with our office and you have a dental emergency, you should contact either the office during regular hours or my answering service after hours by calling 203-598-7920 and they will contact me.
Assuming, that your emergency does not require a referral to an Emergency Room, the initial management typically involves arranging for medication to control your pain and possibly for an antibiotic to minimize the risk of infection if indicated . You will be seen and evaluated for your emergency as soon as possible.
Emergencies by there very nature tend to occur at the most inconvenient of times for all concerned, often after hours, at night, on weekends or holidays.
Dental emergencies can been divided into two groups; Those caused by trauma and those that are not.
Trauma Related Emergencies
Injuries involving teeth typically involve broken off teeth. The immediate management or first aid for these depends on the age of the patient as usually children age seven years and older have their permanent two front teeth whereas children younger than this often still have their primary or "baby" two front teeth. Most often it is one of the front four and usually one of the front two teeth that are most easily injured.
You should be aware that the advise that follows relates to isolated dental injuries. If teeth are injured as a result of a fall, a car accident or other significant mechanism, where there is a possibility of associated injuries to the brain, cervical spine or other vital structures, the injured person should be evaluated in the nearest Emergency Room where the injury to the teeth will be managed appropriately in the context of your trauma evaluation by the Emergency Medicine Physician.
If a "Baby Tooth" Is knocked Out
If a primary or "baby" tooth has been knocked out and is an isolated injury, there is no need to re-insert the tooth back into the empty socket. These are primary teeth and although a stressful event for the child and parent alike, remember that there is, a "backup permanent tooth" waiting to take it's place, although this permanent tooth may come in earlier or later than expected.
Ice is always appropriate in the event of swelling and should be applied every 2-3 hours for 30 minutes at a time over the first 24 hours. A soft diet maybe appropriate for a day or two and either Ibuprophen or Tylenol may help with any discomfort if the child is not allergic to these medications.
If a permanent Tooth Is Knocked Out
If a permanent tooth is "knocked out" and it is one of the front four teeth mentioned earlier, the object should be to re-implant or replace the tooth back into the socket within one hour to maximize the chances of the tooth "re-ankylosing" or re-attaching itself.
If the tooth is otherwise intact and relatively clean, it can re-inserted back into the socket where it had been and you should call me. If the tooth is grossly dirty, it can be rinsed off in clear water, but should not be scrubbed as this will loosen the ligamentous attachments necessary to hold it in place.
If you are unable to re-insert the tooth you should place the tooth in a glass of milk and either call me at the office during office hours or go to the nearest emergency room after hours as the re-implantation really needs to occur within 60 minutes of the injury to maximize it's chances for survival. Don't forget to take the tooth with you.
If in the ER, the emergency physican is unable to re-implant the tooth, he may contact either the dental resident or Oral Surgeon on call as the tooth may well require "splinting" to help hold it in place.
Cracked or Chipped Teeth
If you either chip or crack a tooth and it is not painful, you should call the office as early as possible during regular business hours to schedule an appointment to have it repaired. If the tooth is painful, you should call me as outlined above and we will get you comfortable and make arrangements to repair your tooth.
Non Traumatic Dental Emergencies
This group of problems can typically be subdivided into two groups; those which are painful and those that are not.
Odontalgia or "Toothache"
If you get a toothache in the absence of injury to the tooth, you should try to get comfortable by taking appropriate doses of either Ibuprophen or Tylenol as mentioned above, if you are not allergic to them. Hot water is a valuable diagnostic tool. If you take a mouthful of hot water and isolate it to the side of your mouth where the toothache is and you get pain while doing so, in all likelihood you will require a "root canal". Remember, the water should be hot, but not so hot as to scald yourself.
You should call me and arrangements will be made for a referral to a dentist specialist called an "endodontist", they are a specialist who only performs this procedure. These arrangements can usually be made for the same day or for the next day if your problem began after hours.
When you contact me, arrangements will be made for pain medication and we will get you comfortable again as soon as possible depending upon your proximity to a 24 hour pharmacy.
If you have associated swelling to the same side of your face as a toothache, ice is again appropriate as mentioned above. This can be accomplish by placing ice in a zip-lock bag and wrapping it in a face cloth or towel and holding it against the swollen cheek.
If swelling to your face is present in the absence of pain and trauma, the list of possible etiologies or "causes" is longer and may include a problem involving either your sinuses or even a salivary gland and you may need a referral to a specialist for specific tests or x-rays and we can help you with this.
What to Do If a Crown or cap Falls Off
Permanently seated crowns almost never will fall off, but this is not the case with a temporary crown. They are called temporary for a reason. They are designed to be removed and replaced with a permanent crown as part of your restorative procedure. The temporay cement will hold the temporary crown in place for a variable period of time depending on many factors, but it will not hold it in place forever.
Should your temporay crown fall off, gently clean out the inside of the crown and fill the space with fixed that can be bought in any pharmacy and place it back onto the tooth where it had been. This works almost without exception, but you should still contact the office to make arrangements to have it re-attached with "real temporay cement" until your permanent crown is ready.
One last piece of advise with regard to temporay crowns. If your planning a trip away from home and have a temporary crown in place, buy some fixadent and take it with you. Meals on a cruise for example are much more enjoyable if you have a crown to chew on and you'll be much happier with any photos taken of you on your vacation.
We hope almost as much as you do that who will never need any of the advise given above. We will continually evaluate any advise given here and make appropriate alterations as recommendations change.
This was never intended to be an exhaustive list of dental emergencies and we will add items of interest to you when we feel it is appropriate. This section on dental emergencies also was never intended to replace evaluation by a licensed dentist or a medical doctor.
Thank you for visiting my Web-site.
Joy Kathleen Lunan DDS