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Dental Emergency

How can a patient prepare for a dental emergency?

There are several types of dental emergencies, which I will address specifically in another section. The very best way to prepare for a dental emergency is to have established you and your family with a “good dental home”. If your answer to having a dental home is ‘yeah I see a dentist once a year, but can’t remember their name’, and if you don’t have the number to call that you know will be answered 24/7 with detailed instructions on what to do if it is an emergency, then you don’t have a ‘good dental home’. The good dental home, which consists of a team of professionals including hygienists, assistants and office personnel, will take care of you like your trusted mechanic takes care of your car. I doubt that we all really remember exactly when our ‘fluids and filters’ need changed or when it is time for that 20,000 or 50,000 mile checkup. But we know the best way to keep our car running smoothly is to follow the mechanic’s instructions to keep up with these little maintenance items. Ask yourself this as well, does your “car insurance” take car of those items? Of course not!! But you know it is important to get those things done….. so you what??.. You pay for it out of pocket. My point being, if you do not have dental insurance or the one you do have doesn’t cover certain procedures, you STILL can follow the basic care guidelines you receive from a good dental home to keep you from having dental emergencies which can be very costly. (think- I didn’t change my oil now I need a whole new engine, Yikes!). If you have the foresight to have made this choice, you AND your dentist will be prepared for almost ANY dental emergency

When do you recommend your patients call about their injury and why?

As I said before, there should be a number that can be reached 24/7. I don’t know of any dentist worth the paper their degree is printed on, who wouldn’t prefer to hear about ANY of their patients problems sooner rather than later. I can handle most emergency calls that I receive after hours and on weekends with a few simple instructions that usually help put the patient at ease and prevent future bad consequences. Sometimes, based on conditions a patient of record that I am familiar with describes, it may be necessary to phone prescriptions to a pharmacy. If you have not established this rapport with a dentist, many are very reluctant to phone prescriptions in for ‘unknown’ patients due to legal issues and the unfortunate fact that there are many unscrupulous drug seekers rampant in our world. There are rare occasions when it is necessary to see a patient in the dental office immediately or direct them to a local hospital emergency room. But again, “your dentist” will be able to make that call and see that you are taken care of properly. Once you feel the dental conditions are not normal, or if a sudden injury or accident occurs involving your mouth, ‘Make the Call!’ …because it will make it easier for your dentist to provide better treatment with chances for better results.

What are the most common dental emergencies?

First we should define “dental emergency”. This is a condition involving the teeth or gums or dental appliances or restorations that an individual has no working knowledge of on how to handle the situation. If that happens, again, you should….’Make the Call!’ Sometimes just by having a phone conversation with your dentist, you feel better about the fractured cusp on the molar, the cracked /broken denture or suspected infection and you also know that the dentist will see you on a timely basis, usually the next working day.

I had a call just today during regular hours from a patient who was in Florida for a few weeks and their fixed bridge had come out. Since they had no symptoms or sensitive teeth, they wondered if it would be okay if they just left it out till they returned to see me next month. I was able to inform them that, no, they should not and why they should not. After we talked, they were very glad that they had called and they thanked me for preventing them from making a costly mistake. They decided to see a dentist in Florida immediately. And yes, the advice was free, no charge for the phone call. So, if a dental appliance like a bridge or partial or full denture is changed or damaged, it should be evaluated as soon as possible. If a filling comes out, the tooth should be checked as soon as possible. Delaying or ignoring any changes in the mouth can result in having to have more costly treatment later to remedy the problem rather than just a minor repair done at the time of the change.

Probably, the most common emergency call is for the abscessed/infected tooth or gum. Many people will take a wait and see attitude if dental pain begins to develop, if for no other reason than they are ‘afraid’ to go to the dentist or maybe they are very busy and don’t want to take the time to go. Murphy’s Law then takes effect and Friday night or Sunday morning the pain eventually turns into a swollen gum or worse, a disfiguring swelling of the face or jaw. This requires immediate attention to prevent a truly life-threatening condition from occurring. So again, don’t delay, especially if a pain is severe and or persistent. It may just be a popcorn hull lodged deep in the gum between the teeth or it could be a root abscess that will require hospitalization if left untreated.

Other emergencies I have seen have been from hockey sticks to the face, pool balls thrown by little sisters, slips on rocks in rushing streams. All resulted in fractured or displaced or knocked out teeth requiring immediate attention.

If a tooth is knocked out, can it be re-implanted and saved?

The quick answer is, maybe. The conditions have to be just right for this re-implantation to occur successfully and it helps to have someone experienced in handling this situation, such as a ‘good dental home’. Ask your dentist there, the next time you go into see them, (which will probably be within the next 6 months, right?) what they recommend and do when a patient calls with a knocked out tooth. But briefly, most baby teeth would not be re-implanted if they become knocked out. If a permanent tooth is knocked out (this is usually one of the front teeth), chances for success are much better if they are replaced within the first hour and if the tooth is kept moist and the root surface is not disturbed or ‘cleaned’ off. The most available solution for preserving the tooth in transport to the dentist is milk. I have seen more than one patient arrive in my office with their tooth in a cup of milk. There are special ‘nutrient’ solutions that a dentist can place the tooth in when you get to his office that will very likely increase the chances for success. Not all dentists have this available, but the time and handling of the tooth are the most important factors. And yes, if it does reattach to the bone, it will still need a root canal and most likely a crown.

Why is it important to not ignore an injury to baby teeth?

Baby teeth are very important as ‘guides’ and place holders for the eruption and final alignment of the permanent teeth. In some instances, an injury to a baby tooth can have long term effects on the tooth ‘bud’ of the developing permanent tooth in the jaw bone. Ideally, children should be seen by their dentist before they turn 3 and preferably between the ages of one and two. This usually works best if they come along with Mommy or Daddy while they get their teeth checked. The child can even sit on the parent’s lap when the exam is done. In our office, we call this a ‘happy visit’. It offers the opportunity to at least ‘count the teeth’ and get a look see for any early developing problems that, if treated, can prevent early tooth loss. Every effort should be made to hold the baby teeth in their original positions to allow normal eruption of the permanent teeth and insure future straight, white smiles!

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