dental emergency 3

8/3/2019 Dental Emergency 3

1/21

%(/,9$1' 0(+5,

'0' ,

Dental Emergencies: Introduction

Pain is one of the reasons people go to the dentist. A painful tooth can be triggered by hot or cold foods and drinks. Heavy biting or grinding may break a tooth and

cause it to hurt when you chew. Sometimes, when a filling falls out, you may havea throbbing ache.

Any injury to teeth or gums should not be ignored. Nerves or blood vessels could be damaged. There is also a risk of getting an infection. If an infection is nottreated it can spread to other parts of the head and neck and cause serious health

problems. In rare cases it can even become life threatening. It is very important toalways seek treatment for a dental injury. Getting injured teeth repaired and treatedas soon as possible after an injury is the best thing to do.

Today, dentists have many options for dealing with dental emergencies. There areadvances in pain management and ways to restore teeth. Teeth can be repaired withsynthetic materials that are strong and look as good as your natural teeth. Your dentist has the training and skills to identify what the problem is and how serious itis. He or she almost always can reduce or get rid of your pain within a fewminutes.

If you're not sure if a dental problem is an emergency, dentists offer this advice: If

hurts, it's an emergency. This is because even injuries that seem small can affectthe living tissues inside the teeth. Quick treatment improves the odds of savinginjured or damaged teeth.

Any obvious damage to a tooth should be treated as soon as possible. Chips or fractures can affect the living tissue inside the tooth, causing more problems in thefuture. Your dentist can prevent the damage from getting worse.


2/21

The same is true of a lost filling or crown. Even if you don't have any symptoms,the tooth has lost its support and it could easily become damaged. Pieces could

break off or crumble, and you would need more extensive treatment. If you seeyour dentist right away, there's a good chance he or she will be able to repair thedamage more easily.

Tooth abscess

A tooth abscess is a collection of pus that's caused by a bacterial infection in theroot of a tooth or in the gum tissue surrounding the tooth. The primary symptom of a tooth abscess is a severe, persistent, throbbing toothache. Initially, the tooth may

be sensitive to heat and the pressure of chewing or biting. Later, you may developa fever, swelling in your face or cheek, and tender, swollen lymph nodes under your jaw or in your neck. If the abscess ruptures, you'll have a sudden rush of foul-smelling and foul-tasting fluid in your mouth.

A tooth abscess won't go away without treatment. If the abscess ruptures, the painmay decrease significantly but dental treatment is still needed. If the abscessdoesn't drain, the infection may spread to other areas of your head and neck. It mayeven become life-threatening.

To treat a tooth abscess, the dentist will likely drain the abscess and prescribeantibiotics to eliminate the infection. While the area is healing, the dentist mayrecommend rinsing your mouth with warm salt water and taking over-the-counter

pain relievers as needed. In some cases, a root canal may be necessary. In other cases, the affected tooth must be pulled.


3/21

Traumatic Injuries of the Lips and Tongue

Trauma to the lips, tongue and the inside of the mouth is quite common. The softflesh of the lips and their exposed location make them vulnerable to injury. A blowto the face can crush your lips against your teeth, causing bruising or cuts. Your teeth can cut the inside of your lip or puncture your skin. A fall or blow may causeyou to bite your tongue.

Any cut inside the mouth usually bleeds heavily because of the rich supply of blood to the area.

Symptoms

Symptoms include bruising, swelling or cuts on the lips or tongue.

Diagnosis

Your health care professional will ask about your recent trauma and do a thorough physical exam of the area. If the lips are injured, he or she will check the teeth and bone for damage, and look for pieces of chipped tooth.

Expected Duration


4/21

The healing time for a lip or tongue injury will depend on how badly it is cut.However, the mouth has many blood vessels, which promotes quick healing.

P revention

Many lip and tongue injuries occur during sports or other active pastimes. Theyoften could be prevented through the use of a safety mouth guard. Mouth guardsare made of soft plastic that is adapted to fit the shape of the upper teeth. Guardsmade for heavier contact sports may cover both the upper and lower teeth. Mouthguards protect both the lips and teeth by providing a shield in front of the teeth anda softer biting surface for the back teeth. Preformed guards are available insporting goods stores. A dentist can create a custom-fit guard.

Routinely using seat belts and car seats can reduce the risk of trauma as a result of

car accidents.Treatment

At home, you can clean injured skin surfaces with mild soapy water and a soft,clean cloth. To clean cuts inside the mouth, rinse with salt water or a hydrogen

peroxide solution (one part hydrogen peroxide and one part water). Be sure not toswallow this peroxide rinse. However, do not be concerned if it foams. This iswhat the rinse normally does when it contacts mouth tissue.

If your lip is swollen or bruised, apply a cold compress. If there is bleeding, apply pressure with a clean cloth for at least five minutes. Using ice can help limitswelling, bleeding and discomfort. Wrap crushed ice in clean gauze or a clean

piece of cloth and hold it on the area affected.

Certain injuries will require treatment by an oral surgeon or plastic surgeon. It is particularly important to have an experienced surgeon stitch cuts that cross thevermilion border. This is the line that forms the junction between the skin and thefleshy part of the lip. Experience is required to make sure this boundary healscorrectly. Even a small irregularity will remain noticeable.

The doctor will first thoroughly clean the wound with lots of saline or a hydrogen peroxide rinse. Cleaning removes bacteria as well as foreign matter such as dirtthat might have entered the wound. A betadine solution will then be applied to thearea to disinfect it. Puncture wounds to the lip will then be closed from the insideout. Stitching all layers reduces the chance of scarring..


5/21

Small puncture wounds in the tongue usually heal without any treatment other thancleansing with antiseptic or hydrogen peroxide rinses. Large cuts may requirestitches.

The mouth contains many bacteria. For this reason, an antibiotic often is prescribedafter a cut to the lip or tongue to prevent infection.

Seek medical care if:

y Bleeding cannot be controlled with pressure and a cold compressy You have a deep cuty A cut crosses the border between the lip and facial skiny The lip is puncturedy An infection develops after an injury Signs of any infection usually will

be evident about four days after the injury. Signs include:o Rednesso Tendernesso Fever o D rainage of pus

If a tooth is loose or broken, visit your dentist.

P rognosis

The outlook is excellent. The rich blood supply in the mouth promotes rapidhealing, often with little scarring.

Abscess

When the inside of your mouth gets hurt or irritated, bacteria may enter and causean infection. Sometimes you will see a painful swelling filled with pus (a thick,

yellowish fluid). If the pus can't drain out, the area will get more swollen and painful. This is known as an abscess. The abscess forms a barrier around theinfection. This is one way that your body tries to keep a bacterial infection from


6/21

Speariding.

Abscesses can form very quickly. Sometimes they form only one or two days after the infection starts. There are two types of abscesses:

y A gum abscess (also called a periodontal abscess) usually is caused by aninfection in the space between the tooth and gum. The infection may occur after food gets trapped between the gum and tooth. In people with severe

periodontal disease, bacteria can build up under the gum and in the bone.

y A tooth-related abscess (also called a periapical abscess) occurs inside thetooth. This happens when the tooth's nerve is dead or dying. This type of abscess shows up at the tip of the tooth's root. Then it spreads to thesurrounding bone.

Most abscesses are painful, so people usually seek treatment right away.Sometimes, the infection causes little or no pain. If an abscess is not treated, theinfection can last for months or even years. It will not go away on its own, so it'simportant not to ignore the symptoms.

If the infection is not treated, it can damage the surrounding bone and teeth. Ahollow tunnel sometimes forms through the bone and skin to allow pus to drain.

This tunnel is called a fistula or "sinus tract." You might see or feel this openinginside your mouth. It looks like a pimple. If you have pus draining through afistula, you might notice a strange taste in your mouth.

The buildup of pressure causes the pain of an abscess. D raining the abscessthrough a fistula reduces the pressure. The pain will disappear. However, the


7/21

infection still needs to be treated.

Sometimes, an abscess that isn't treated can form a fluid-filled bubble (cyst) in theaw bone. If the tooth is severely broken down and can't be saved, the cyst may

come out when the tooth is extracted. If the tooth can be saved, you will need aroot canal to remove the infected nerve. If this treatment does not heal the cyst, youmay need surgery to remove it.

In rare cases, the infection that causes an abscess may spread and lead to serioushealth problems.

Abscesses are always serious because the infection may spread to other parts of the body. Call your dentist for an appointment.

If you can see or feel a pimple-like swelling on your gum, rinse your mouth severaltimes a day with a mild salt-water solution. Use 1/2 teaspoon of salt in 8 ounces of water. This may help draw the pus out and relieve pressure. Even if the rinse seemsto help, you still need to see your dentist as soon as possible.

Most gum abscesses will heal quickly after three things happen:

y The area is cleaned thoroughly.y The trapped pus is allowed to escape.y The infection is treated.

If a fistula has formed, your dentist will trace it back to the source of the infection.Your dentist will insert a flexible, thin piece of material into the fistula. This willappear on an X-ray and show the dentist where the fistula leads. Once your dentistcleans out the infection, the fistula usually will close on its own.

If the infection started inside a tooth, your dentist will make a small hole in thetooth. This allows the abscess to drain. The tooth will need root canal treatment,followed by a filling or a crown.

If an abscess is very large or the tooth is badly damaged, you may need to have thetooth removed. A large abscess often will need to be drained. The dentist makes ahole in the gum through the bone that provides an exit path for any fluid or pus.This will reduce the

risk of further spread of the infection.


8/21

People with severe periodontal disease may have abscesses. D raining them helpsthe immediate problem. However, the periodontal disease needs to be treated to

prevent another infection.

Your dentist may give you a prescription for antibiotics and painkillers. Thesedrugs will help the abscess heal and keep the infection from spreadin.

P ericoronitis

Wisdom teeth, also known as third molars, do not always come into the mouth properly. Sometimes, a tooth comes in part of the way and a flap of gum tissuecovers part of the tooth. This happens more often with the lower wisdom teeth thanwith the upper ones. Bacteria and pieces of food can get trapped under this flap.The gum may swell and become irritated. This is an infection called pericoronitis.

The symptoms of pericoronitis may include:

y A bad taste in the mouth (this often happens when there's an infection)y Bad breath (halitosis)y Pain in the area around your back teethy Swelling of the gums behind your back teeth (you may not be able to bite

down without pinching the swollen gums between your teeth)y Not being able to open your mouth all the way

D o not use warm compresses on your face. You can swish warm salt water aroundin your mouth. This may help to reduce the swelling, but it will not solve the

problem. Visit a dentist as soon as possible.The inflammation that is, the pericoronitis won't go away until one of threethings happens:

y The flap of tissue is removedy The wisdom tooth is removedy The wisdom tooth comes into your mouth the rest of the way

Your dentist will rinse under the flap of tissue with water to clean the area. If thearea is infected, your dentist most likely will prescribe antibiotics.

Your dentist will tell you how to keep the area clean. This is the best way to keepthe problem from coming back. You will have to brush and floss every day, and


9/21

rinse your mouth several times a day. This will help to prevent bits of food from building up in the area. Even with good oral hygiene, the problem may occur again.

If the condition returns, your dentist probably will send you to an oral surgeon,who may suggest that you remove the flap of gum tissue or the tooth. Removingthe flap of tissue may not solve the problem, however. In that case, you will needto have the tooth extracted.

Once the tooth is out, you rarely have the problem again. If the problem is caused by an upper wisdom tooth biting the gum that covers a lower wisdom tooth, theupper one may be removed. The oral surgeon may recommend that you have theupper wisdom tooth removed to prevent it from biting into the lower gum after the

lower tooth is extracted.

Lodged Foreign Bodies

Small pieces of food especially things like popcorn hulls can get under your gums. If these pieces aren't removed, the area can get irritated, and even infected.

If you feel something wedged under your gum, gently use dental floss to get it out.If this doesn't work, take a toothpick and gently run it around the gum line. Becareful that you don't hurt your gum with the toothpick or accidentally pushanything deeper under your gum.

If you can't remove a foreign body yourself, see your dentist as soon as possible.


10/21

Your dentist has special tools that allow him or her to see into your mouth and findwhatever is trapped under your gum. Your dentist also will check for infection.

S evere P ain(Not From Trauma)

Any injury to the gums or teeth can be very painful. At other times, you may havedental pain and not know why. For example, sudden pain may be caused by piecesof food that come in contact with a decayed area of the tooth. Food, heat or coldmay create pressure near the nerve and cause pain. The nerve inside the tooth alsomay be exposed if you lose a filling or crown.

Pain that gets worse over time can also be caused by food that's stuck between your tooth and gum. If you don't brush and floss well, the bits of food remain. Bacteriamultiply in this area, and an infection of the tooth and gum may develop. This typeof infection is called an abscess. It can be at the root end of the tooth (in bone) or in the gums. An abscess can be a serious health problem if it is not treated.

Pain when you bite or chew can be a sign of an abscess, especially if you alsonotice a bad smell or a bad taste in your mouth.

First, call your dentist and make an appointment.

In the meantime, here are a few steps you can take at home to try to relieve the pain:

y Take an over-the-counter pain reliever, such as ibuprofen (Advil, Motrin) or acetaminophen (Tylenol). Even if this helps, you still need to see your dentist. If you medicate the pain and don't get treatment, the infection canspread. It could even

y become life threatening.y Rinse your mouth with warm salt water every hour or so. This won't help aninfected tooth, but it may ease the gum swelling.y If the pain is caused by food stuck in a cavity, brushing and using dental

floss in the area may remove it.y If you've lost a filling or crown, dip a cotton swab in clove oil and apply it to

the exposed part of the tooth. You can buy clove oil in drugstores andsupermarkets. You also can use a topical anesthetic, such as Anbesol.


11/21

y If you will be traveling in an airplane, the changes in pressure may make the pain worse. Try to get dental treatment before traveling by air.

Even when dental problems cause a lot of pain, the problems, and the treatments,often are relatively simple if you seek help right away.

If you have a cavity, your dentist will remove the decayed part of the tooth and place a filling. Once the inner part of the tooth is protected, the pain will usuallydisappear right away.

If your problem is related to pieces of food stuck under your gums, your dentistwill remove the pieces. If you have an infection, you may be given a prescriptionfor antibiotics and pain medicine. Take your antibiotics exactly as directed, even if you start

to feel much better after only a day or two.

An abscess in the tooth or gum may require more treatment. You may needdrainage of the abscess or root canal treatment. If the tooth is very damaged, it mayhave to be removed.

Lost Filling or Crown

Fillings are materials used to fill cavities in the teeth. Crowns cover the tops of damaged teeth. Sometimes, fillings or crowns fall out. In some cases, a filling or crown may come loose because there is decay underneath it. The decay destroys

part of the tooth, so it no longer has a tight hold on the crown or filling.

A lost filling or crown is rarely an emergency. However, it can be painful becausethe exposed tooth tissue is often sensitive to temperature, pressure or air. If youlose a crown, put it in a safe place and make an appointment to see your dentist assoon as you can.

D on't wait too long. What is left of the tooth will not be as strong as your crown. Itcould be damaged more without the crown to protect it. Also, when a crown ismissing for a long time, your teeth may move into the space where the crown was.If this happens, your crown may no longer fit.


12/21

y Apply a little clove oil to the sensitive area with a cotton swab. This willgive you pain relief. You can buy clove oil in drugstores or in the spiceaisles of many supermarkets.

y If you still have the crown, you may be able to slip it back over the tooth.Before you do that, clean the inside of the crown. Then coat the inside of thecrown with tooth "cement," which you can buy in the dental section of your

pharmacy. Some tooth cements need to be mixed; others don't. If you can'tfind tooth cement, you can use

y denture adhesive or even petroleum jelly. These aren't permanent solutions, but they will help to hold the crown in place until you can see your dentist.You should not use any household glues. They are not safe to put in your mouth. They can damage the tooth and crown.

y If you've lost the filling or crown, you can put dental cement directly on thetooth surface. This will help to protect and seal the area until you're able tosee your dentist.

D ecay may have changed the shape of your tooth. Usually, this means that your dentist will need to prepare the tooth again to ensure the new crown will fit. If thecrown does not fit securely, it will come off again.

If you lose a filling, your dentist will remove the decay and place a new filling.

S teps to S ave a Knocked-Out Tooth

Act quickly and a knocked-out tooth may be able to be reimplanted in the jaw.

Plants that are pulled up by the roots may survive if they're put back into soil rightaway. The same is true of teeth. They may seem bony and lifeless, but teeth arealive and can often be saved as long as you act quickly.

The blood vessels and nerves in knocked-out teeth (also called "avulsed" teeth) areusually damaged beyond repair. But microscopic ligaments in the jaw may reattachto the root of the tooth once it's put back into place.

"After a tooth is avulsed, time is of the essence and the quicker you get it back inthe mouth, the better," says D onald Sadowsky, D .D .S., M.P.H., Ph. D ., professor of dentistry at Columbia University School of D ental and Oral Surgery in New York.


13/21

The odds of saving a tooth are highest in young children, but adult teeth can besaved as well. Even if the tooth reattaches, however, you most likely will need rootcanal treatment to clean out the damaged nerve.

How the tooth is handled right after the accident will largely determine whether itcan be saved. To improve the chances of the tooth being saved, D r. Sadowskysuggests doing the following:

y Handle the tooth carefully. Avoid touching the root of the tooth (the part of the tooth that was embedded in the gum) because it can be damaged easily.

y If the tooth is dirty, hold it by the upper part (the crown) and rinse it off withmilk until most of the dirt is washed away. If you don't have any milk available, then it is best to

y leave the tooth alone. Wiping it off with a handkerchief or shirttail may

cause additional damage.y It is important to keep the tooth moist. If possible, drop it into a glass of

milk. If no milk is available, then place the tooth in the mouth between thecheek and gum.

y A young child who has had a tooth knocked out may not be able to safely"store" the tooth in his or her mouth without swallowing it, so don't give thetooth to a young child for safe-keeping in his or her mouth. Place the toothin milk or have the child spit into a container and place the tooth in the cupwith the saliva. The most important thing is to keep the tooth moist. Use acup of water if nothing else is available.

y Get to a dentist as quickly as possible. If getting to a dentist immediatelyafter a tooth has been knocked out is impossible, then you may want to tryslipping the tooth back into its socket. In many cases, it will slip right in.Make sure it's facing the right way. D on't try to force it into the socket. If itdoesn't go back into place easily and without pressure, then it's better just tohold it between the cheek and gum or to keep it in milk, saliva or water.

Even if the odds of success seem poor, D r. Sadowsky recommends that you try tosave the tooth. "I can remember seeing a youngster who appeared in the office with

a knocked-out tooth after a three-hour trip from summer camp,"D

r. Sadowskyrecalls. "I reimplanted the tooth, hoping for the best. The front tooth remained in place for five years until she reached her late teens, at which time a permanentsolution was feasible."

The Next Step


14/21

It usually takes about two weeks for ligaments in the jaw to firmly reattach to thetooth. Because soft tissues inside the tooth probably are damaged, you'll mostlikely need a root canal at some point, which will prevent the tooth from darkeningor becoming infected.

Knocked-Out Tooth (Avulsed Tooth)

D entists refer to a knocked-out tooth as an "avulsed" tooth. This is one of the mostserious dental emergencies for permanent teeth. However, the damage can befixed. If you act quickly, there's a good chance the tooth can be saved.

When a tooth has been knocked out, the nerves, blood vessels and supportingtissues are damaged, too. The nerves and blood vessels can't be repaired. But if your dentist can put the tooth back in place within an hour after it was knocked out,there's a good chance that the supporting tissues will reattach and hold the tooth in

place.

G et to a dentist right away. In the meantime, here's what you should do:

y Pick the tooth up by the crown. This is the part of the tooth that you see inthe mouth. Avoid touching the root end (the part that was under the gum).

y If the tooth is dirty, do NOT clean it. This could damage the tooth. Place thetooth back into its socket. The tooth has a better chance of surviving if it'skept in its natural environment. If you cannot get the tooth back in its socket,tuck it between your cheek and gum. Another option is to put the tooth in acontainer of milk. You can also buy a kit at some pharmacies. It contains asolution similar to natural saliva. The most important thing is to keep thetooth moist.

Remember, if you act quickly and get to your dentist as soon as possible, there's agood chance the tooth can be saved.

Putting the tooth back in place sometimes can be simple. Other times it can becomplicated, such as when the tooth or bone is broken. Your dentist will use water to flush debris from the socket. Then he or she will slip the tooth back into place.The tooth will be splinted to adjacent teeth with plastic resin and orthodontic wire.This keeps the tooth stable so it can heal and reattach.


15/21

The tooth does not always reattach in the right way. If it doesn't, it eventually mayfuse to the jawbone. If this happens, the root of the tooth can erode or bereabsorbed into the body. This occurs very slowly and can take months or evenyears. Your dentist will monitor the tooth and may suggest further treatment, suchas a root canal.

The nerves and blood vessels that were injured when the tooth was knocked outusually can't heal. Root canal treatment often is needed to prevent the tooth fromchanging color or developing an abscess.

Fractured and Broken Teeth

Teeth are remarkably strong, but they can chip, crack (fracture) or break. This canhappen in several ways:

y Biting down on something hardy Being hit in the face or mouthy Fallingy Having cavities that weaken the tooth

When a tooth chips or breaks, it may not hurt. However, your tongue usually feelsthe sharp area quite quickly. Minor tooth fractures usually don't cause pain, but if a

large piece of the tooth breaks off, it can hurt. That's because the nerve inside thetooth may be damaged. If it is exposed to air, or hot or cold foods or drinks, it can be extremely uncomfortable.

Pain from a broken or cracked tooth may be constant or may come and go. Many people feel pain when they chew because chewing puts pressure on the tooth.

Cracked (Fractured) Teeth


16/21

There is no way to treat a cracked tooth at home. You need to see your dentist.Sometimes the tooth looks fine, but it hurts only when you eat or when thetemperature in your mouth changes (because you drank something hot or cold, for example). If your tooth hurts all the time, it may have a damaged nerve or bloodvessels. This is a serious warning sign.

B roken Teeth If you have a broken tooth, see your dentist as soon as possible. Your dentist canfigure out if the break was caused by cavities, and if the tooth's nerve is in danger.A damaged nerve usually will require root canal treatment.

Until you get to the dentist's office:

y Rinse your mouth well with warm water.y

Apply pressure with a piece of gauze on any bleeding areas for about 10minutes or until the bleeding stops. If this doesn't work, use a tea bag with pressure on the area to stop the bleeding.

y Apply a cold pack to the cheek or lips over the broken tooth. This will helpreduce swelling and relieve pain.

y If you can't get to your dentist right away, cover the part of the tooth that isin your mouth with temporary dental cement. You can find this at adrugstore.

y Take an over-the-counter pain reliever.

F ractured Teeth There are several types of tooth fractures and breaks, each of which requiresdifferent treatments. These include:

y M inor cracks Also called "craze lines," these are surface cracks thataffect only the outer white surface of the tooth, called the enamel. Minor cracks rarely need treatment. However, your dentist may lightly polish thearea to smooth out any rough spots.

y C racked tooth This type of fracture involves the whole tooth, from thechewing surface all the way down to the nerve. The pieces remain in place,

but the crack gradually spreads. Cracks can sometimes be repaired withfilling material. The tooth often will need a crown to prevent the crack fromgetting worse. If the pulp (nerve and other live tissues) is damaged, you mayneed a root canal as well.


17/21

y C hips Minor chips don't always need treatment. Your dentist maysuggest repairing the damage with filling material to prevent it from gettingworse or to make the tooth look and feel better. If the chip is very small, thedentist may polish and smooth out the chipped area.

y B roken cusp These breaks affect the pointed chewing surfaces (thecusps) of the teeth. They usually do not affect the pulp and are unlikely tocause much pain. Your dentist may repair the damage to restore the tooth'sshape. Frequently, however, an onlay or crown will be required.

y Serious breaks These breaks go deep enough to expose the nerve. Theyalmost always cause the tooth to hurt and be sensitive. Usually, the broken

part of the tooth will bleed. You will need root canal treatment to remove theexposed nerve and probably a crown to restore the tooth to normal functionso you can eat and chew properly

y Split tooth This means that the tooth has split vertically into two separate parts. Some teeth, such as your back teeth (molars), have more than one root.It may be possible to keep one of the roots, which will then be covered witha crown. First, you will need root canal treatment. Second, the dentist willremove any roots that cannot be kept. Third, you will need a crown to cover the root and replace the tooth. In some cases, when a root cannot be saved,the tooth will have to be removed.

y Vertical breaks or split root These cracks start in the root of the toothand extend upward toward the chewing surface. These breaks are often

painful because the area around the root may be inflamed or infected. Inmost cases, the tooth will have to be removed.

y Decay-induced break In this case, the tooth has broken or crumbled because a cavity weakened it from the inside out. Your dentist will evaluatethe cavity and recommend the best way to restore the tooth. In some cases, if the decay is extensive and goes down to the bone,the tooth may have to beremoved.

P artially Dislodged (Extruded) Tooth


18/21

Sometimes a tooth is knocked loose or comes partway out of its socket because of an injury. D entists call this an extruded tooth. If the tooth is not broken and itsnerve and blood vessels are still attached, the tooth may be saved.

To save the tooth, you must see your dentist right away. Leave the tooth in your mouth even though it is partially out of the socket. Take an over-the-counter painreliever or apply a cold pack or ice to relieve pain until you reach the dental office.

Your dentist will give you some local anesthetic and clean the area. Then, if thetooth is intact and there is no sign of severe periodontal disease in the bone aroundit, the dentist will guide the tooth back into the socket. An X-ray may be taken toensure there is no root fracture.

The tooth needs to be secured in its original position by connecting it to the healthy

teeth on either side. There are three ways to do this:y Using a wire and bonding it with a composite resin material along the length

of the wirey Bonding an orthodontic bracket to each tooth and then connecting these

brackets (braces) with a wirey Using a synthetic cloth or metal mesh and bonding it to the back of the teeth

involvedy These materials will be left on for 7 to 10 days while the tooth heals in the

socket.y It is critical to follow up with your dentist 7 to 10 days later. If the tooth's

nerve or blood vessels were damaged, your dentist may want to do rootcanal treatment. This keeps the tooth from becoming discolored or developing an abscess, which is an infection. Your dentist will test in thenext weeks and months to see whether the nerve was damaged. These testsare not always reliable right after a tooth is injured.

y If the dentist decides that root canal treatment is needed, you may need tohave the tooth crowned (capped) after the root canal. In some cases, it maynot be possible to save the tooth. In this case, it will have to be removed.Your dentist will decide the best way to restore the space created by themissing tooth.

y H ow Do I Know if I Need Treatment? As with any trauma to the mouth, you should consult with your dentistimmediately to determine if treatment is required. The dentist will examinethe affected area and may take X-rays.If you are in pain from a broken, cracked or chipped tooth, you may want to


19/21

take an over-the-counter pain reliever. If possible, keep any part of the tooththat has broken off and take this with you to the dentist.If a tooth is completely knocked out of the mouth by an injury, take the toothto your dentist as soon as possible. It may be possible for your tooth to be

placed back into your mouth, a procedure called reimplantation.y H ow Does a Dentist Treat a:

C hipped tooth If there is no pain and the chip is small, it's up to you todecide if, when and how the tooth should be repaired. D epending on the sizeof the chip, it can be smoothed or cosmetically corrected. Other optionsinclude veneers, crowns and fillings. Ask your dentist to explain theseoptions. If a filling or artificial tooth becomes chipped, it should be replaced.C racked or broken tooth Cracked and broken teeth should be repaired assoon as possible to prevent further damage. Root canal therapy or toothextraction may be necessary. If a crack affects the enamel and dentin of the

tooth, a crown is frequently the best treatment. Keep in mind that cracks arenot always visible, even on X-rays. Symptoms may involve pain whilechewing and Sensitivity to cold and possibly hot foods and liquids, as wellas air, which may over time become more pronounced.Tooth knocked out The key to successfully reattaching a tooth is to get itreimplanted in the socket as soon as possible. With each minute that passes,more of the cells on the root of the tooth die. If possible, rinse the tooth withwater only, then reimplant the tooth at the site and hurry to a dentist asquickly as possible. The tooth should be picked up by the crown only andmust not be allowed to dry. The best chance for success is reimplantationwithin the first 30 minutes, with chances still good for up to two hours. Itmay be necessary for your dentist to do a Root canal treatment one to twoweeks after the tooth has been stabilized.Permanently lost teeth, whether they've been removed by a dentist or accidentally knocked out, should be replaced. This is to avoid problems suchas difficulty chewing and speaking, a shifting of position among remainingteeth, temporomandibular joint (TMJ) disorders caused by chewing on theside with more teeth, and a weakening of the jawbone. Options for replacinglost teeth include bridges, dentures and implants.

Broken jaw

If you suspect you or someone else has a broken jaw, do not move it. The jaw

should be secured in place with a handkerchie f , necktie or towel tied around the


20/21

jaw and over the top o f the head. Cold compresses should be used to reduce

swelling, i f present. Go immediately to a hospital emergency room, or call your

dentist

Chipped fronttooth

Chipped toothafter repair

"Permanent toothknocked out"

Carefully reinsertknocked out tooth

and visit your dentist

immediately

Dental Emergency P rocedures C an H elp Save a Tooth

y Handling a dental emergency can be tricky when you or a loved one is in pain, but a quick and appropriate reaction can help save a tooth in danger.The American D ental Association recommends that you become familiar with these dental emergency procedures just in case you ever have a dentalemergency.

y If a tooth is knocked out, hold the tooth by the crown and rinse the root inwater if it's dirty. D o NOT scrub it or remove any attached tissue fragments.

If you can, gently place the tooth back in its socket or store it in a cup of milk and head for the dentist (with the tooth) immediately.y If you break a tooth, rinse your mouth with warm water to keep the area

clean and apply cold compresses on your face to reduce swelling. Go to thedentist immediately.


21/21

y Treat a bitten tongue or lip by cleaning gently with a cloth and applying coldcompresses to reduce swelling. If bleeding is heavy or doesn't stop after ashort time, seek immediate treatment from your dentist or emergency room.

y If a toothache is getting you down, rinse your mouth with warm water,gently floss to remove food that may be trapped around it and see your dentist as soon as possible. D o NOT apply aspirin to the tooth or gumtissues.

y A jaw injury or possible fracture needs immediate attention at your dentist'soffice or the emergency room. Apply cold compresses on the way to reduceswelling.

y If a loose or broken wire from your braces is irritating your mouth, cover thewire end with a small cotton ball, beeswax or a piece of gauze until you canget to the dentist. Seek immediate treatment if a wire gets stuck in the cheek,tongue or gum tissue, but don't try to pull it out yourself.

y If you have a dental emergency while you are traveling, check the yellow pages under "dentist" for the number of the state or local dental society; thesociety will be able to refer you to a nearby dentist. Or, visit the localemergency room and ask for a dentist referral. If you are abroad, contact theU.S. Embassy or hotel personnel for a dentist referral.

dental emergency 3

Documents