Emergency

If you face a dental emergency, you may need to seek dental or medical care immediately, depending on the severity of the emergency.  If you are an established patient, call Dr. Victor’s Springfield Smiles office at (937) 390-3077. If necessary, you can call our emergency number, which is listed on the answering message.  If you or your loved ones feel that an emergency is life threatening, such as in ludwig’s angina  (when an infection begins to restrict a person’s ability to breathe), do not hesitate to call 911 or visit an emergency room. Your health is the most important thing.

Once the source of pain is identified, Dr. Victor will present to you the best course of treatment to get your pain under control as quickly and easily as possible. If your emergency cannot be resolved over the phone, Dr. Victor may ask that you come in for an evaluation and/or treatment.

Below are tips on dealing with urgent dental situations; you may want to display this list on your refrigerator or store it near your emergency phone numbers for easy reference.

  • Broken, chipped, or fractured tooth
  • Infected tooth
  • Knocked-out tooth (dental avulsion)
  • Lateral displacement of a tooth
  • Tooth pushed up (dental intrusion)
  • Tooth was hit but appears fine
  • Object caught in teeth
  • Avoiding Injury

Broken, chipped, or fractured tooth

A broken or chipped tooth can occur for a variety of reasons.  Some fractures occur from trauma, others from grinding you teeth, and others may be the result of chewing something.  A crown fracture is classified based on the location of the fracture in relation to the enamel, dentin, or pulp tissue of the tooth:

  • Fracture of enamel only (outer portion of the tooth).  It is rarely painful, and is not a true emergency.  Often this can be resolved with a filling or just smoothing the roughened surface.
  • Fracture of enamel as well as dentin.  They are recognized by the yellow to pink color of the dentin.  Depending on the amount of pain or trauma the patient has, this may or may not require emergent treatment.
  • Fracture exposing the nerve, requires immediate care. The fracture site will have a reddish tinge or will show bleeding. In an Ellis class III dental fracture, exposure of the pulp’s nerve endings can cause extreme pain – even if exposed only to air. Exposure of the pulp in this type of fracture will eventually lead to pulpal necrosis from bacterial infection, if left untreated.

 Infected Tooth

An infected tooth can be a severe source of pain and discomfort, and should be addressed as soon as possible.  In order to rule out other potential issues, you may want to rinse with warm water and inspect the teeth to be sure there is nothing caught between them. If pain continues, use a cold compress to ease the pain. Do not apply heat or any kind of aspirin or topical pain reliever directly to the affected area, as this can cause damage to the gums. Consider taking oral pain relievers, and contact our office immediately by calling (937) 390-3077.

If left untreated, the infection can spread throughout the body.  Typically the first place infected is the bone around the tooth. The localized infection can cause an abscess, which is an area of pus that forms as part of the body’s effort to fight a bacterial infection. If the abscess does not find a path of drainage, it can cause severe swelling, and may even block off the patient’s airway in a process called Ludwig’s angina.  If such swelling occurs, do not hesitate to call 911 or visit an emergency room.

An untreated infection of the pulp can also allow the bacteria to spread systemically, allowing it to lodge in other areas of the body, including the brain.    In general, any infection, including dental infections, should not be left untreated.

Knocked-out tooth (dental avulsion)

A dental avulsion occurs when a tooth is completely displaced or knocked out of its socket.  Emergency care for avulsed teeth depends on whether or not the tooth is a permanent tooth or a baby tooth.

Baby teeth should not be re-implanted.  This is due to a high probability of infection that can impact the development of the permanent adult tooth.

Adult teeth should be considered for immediate re-implantation in order to enhance the tooth’s long-term prognosis.  Follow this emergency response procedure for best results.  Note that time is of the essence, as teeth left out for longer than15 minutes begin to have a much poorer prognosis.

  • Do not touch the root of the tooth. Handle the tooth by the crown only.
  • Rinse the tooth off only if there is dirt covering it. Do not scrub or scrape the tooth.
  • Attempt to reimplant the tooth into the socket with gentle pressure, and hold it in position.

If unable to reimplant the tooth, place it in a protective transport solution, such as Hank’s Balanced Salt Solution, milk, or saline. This will hydrate and nourish the periodontal ligament cells which are still attached to the root. You may want to consider getting a small container of Hank’s Balanced Salt Solution for your home, school, or sports team.  It can be purchased in dental emergency kit form at many drug stores and online. Contact lens solution is not an acceptable storage medium.  The tooth should not be wrapped in tissue or cloth. The tooth should never be allowed to dry.

Contact Dr. Victor or take the patient to the nearest 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.

Lateral displacement of a tooth

Lateral displacement of a tooth occurs when the tooth is dislocated in a side-to-side direction. If the displacement is less than 5 mm, the tooth will remain vital in about 50% of the cases.  There is usually an associated fracture of the supporting bone.

If a tooth is laterally displaced, have the patient rinse with cold water, and keep an ice pack over the lip and mouth to reduce swelling. Give Tylenol for pain relief, assuming no medical contraindications. 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.  Contact Dr. Victor for definitive dental care as soon as possible.

Tooth pushed up (dental intrusion)

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 dental intrusion injury occurs, rinse with cold water, and keep an ice pack over the lip and mouth to reduce swelling. Give Tylenol for pain relief, if not medically contraindicated.  Contact Dr. Victor for definitive dental care as soon as possible.

Tooth was hit but appears fine

Teeth that are hit but appear fine may have experienced what is termed a dental concussion.  This results in mild injury to the periodontal ligament without tooth mobility or displacement. In some cases, minor movement of the tooth may be noticeable.  In any situation, the tooth may be tender for a week or two.  In general, have the patient rinse with cold water, and keep an ice pack over the lip and mouth to reduce swelling. Give Tylenol for pain relief, if not medically contraindicated.

In some instances, an impacted tooth may change color after being subjected to trauma.   Dental trauma affects the blood supply to the tooth, and therefore its health and color.  It should be noted that color changes may take months to occur.

Different color changes suggest specific problems with traumatized teeth:

  • Yellow or yellow-brown discoloration indicates calcification and obliteration of the dental pulp (nerve canal). No treatment is usually needed with this type of discoloration.
  • Grey or black discoloration indicates necrosis (death) of the dental pulp in 98% of cases. Such teeth will usually require root canal treatment or extraction.
  • Pink indicates either internal resorption, or the presence of blood pigments in the dentinal tubules of the tooth. The pink tooth needs to be monitored closely.

Object caught in teeth

If something is caught between your teeth, use dental floss to gently remove it. Never use a metal, plastic, or sharp tool to remove a stuck object. If you are unable to remove the item with dental floss, give Dr. Victor a call.

Avoiding injury

There are a number of things you can do to help you and your child avoid dental emergencies. Child-poof your house to avoid falls. Don’t chew on ice, popcorn kernels, or other hard foods. Always use car seats for young children and require seat belts for older children. A mouthguard should be worn for all contact sports. Finally, prevent toothaches with regular brushing, flossing, and exams.