Over the last year, many people put off their regularly scheduled dentist appointments. For some, it was because their regular dentist’s office was closed for everything but emergency procedures. Others might have been nervous about the pandemic and didn’t consider a visit to the dentist as being worth the risk. Whatever the reason, fewer trips for regular cleanings means that now, more people are winding up contemplating a trip to the emergency dentist. (1)
This raises an important question: what is considered a “dental emergency”?
Some signs are obvious, such as having a tooth knocked out, or suffering from intolerable pain. Others, like swelling around the gums, or a discolored spot on your mouth or tongue, might seem less serious, but they can be equally important to address. The first could be an abscess, and the second could be a sign of oral cancer.
Read on for six signs you might need to give an emergency dentist a call.
1. You’re in pain
Pain is a clear indicator that you should see a dentist right away. The underlying cause of discomfort could be a number of problems—many of which are serious and are unlikely to go away on their own.
So, if you’ve already tried home remedies or a trip to the pharmacy, it’s worth getting in touch with a dentist to investigate the issue.
Orofacial pain—i.e. pain in the region of the neck or face—can manifest in a range of ways, including:
- Neck pain
- Ear pain
- Dental pain
- Facial burning
- Stabbing sensations
- Jaw joint pain (2)
Orofacial pain is relatively common. The authors of an article published in American Family Physician point to a survey that found that 22% of people had “experienced orofacial pain in the preceding six months” and that 12% of people had “experienced toothache.” (3)
Still, you might very reasonably ask, how much pain is too much? Endodontist Judy McIntyre recently gave an interview to the American Association of Endodontists in which she answered this question. The interview focused on the current issues facing health care providers during COVID with a special focus on dentistry and endodontics (diagnosing and treating tooth pain). (1)
Tooth pain can “make life miserable and drive patients a bit crazy,” in the best of circumstances, Dr. McIntyre points out. With the pandemic keeping people inside and limiting the activities they might typically pursue, it may be harder than usual to distract from that pain. This makes patients more likely to put off procedures that might help relieve it. (1)
If you’re experiencing tooth pain, it’s worth remembering this simple fact: “a healthy tooth should not hurt.” According to Dr. McIntyre, while patients may be scared that they’ll need a serious procedure, ignoring pain isn’t going to fix anything. If the pain doesn’t go away after days or even weeks, a tooth could be infected, in which case you might need a root canal. (1)
While the words “root canal” are hardly music to anyone’s ears, it’s worth keeping in mind that procedures like these are aimed at relieving pain, not creating more of it. Dr. McIntyre stresses that a root canal is “nothing to fear” and that it can make a huge difference. Plus, taking on the pain and getting to the “root” of it can prevent a trip to the emergency room down the road—a prospect that most patients are even less excited about. (1)
2. A tooth falls (or gets knocked) out
If one of your teeth or dental implants fall out, you should get in touch with your regular dentist or an emergency dentist to see what they recommend. Minor damage to a crown or something that’s easily resolved with an over-the-counter treatment may not require any intervention, but more serious issues will benefit from immediate help. (1)
In the case of a broken or knocked-out tooth, the very first thing to assess is whether the person who’s suffered the injury needs a paramedic. If someone is unconscious, or they’ve received a blow to the head, you should call 911 before worrying about their dental needs. (4)
Broken or knocked-out teeth can often be reinserted—a tooth that gets reinserted within a half-hour has the best chances—so be sure to take what steps you can to make that possible:
- 1.Collect the tooth, teeth, or fragments: Make sure to handle the teeth carefully since damage may make it harder to re-implant. You should also try to only touch the top, or “crown” of the tooth, not the root. While you’ll want to rinse off dirt, only use lukewarm water for under ten seconds, and be sure to avoid using alcohol or scrubbing the tooth.
- 2.Store, or reinsert the teeth: First, you’ll want the person to rinse their mouth out with warm water. If you can reinsert permanent teeth (into the right sockets) do so, then have the person who’s suffered the injury bite down on some gauze. If you can’t reinsert the teeth (or tooth fragments), you can store them in whole milk, or between the cheek and gum (this will help prevent them from dying).
- 3.Treat the symptoms: You may also need to treat the symptoms. To control bleeding, try a sterile cloth or gauze, while pain and swelling may be eased with a cool compress, as well as acetaminophen or ibuprofen. Kids might do better with something frozen to suck on.
- 4.Call someone: This is a clear-cut dental emergency. You should go to a dentist or emergency room right away and take the teeth (or any fragments) with you. Once you’ve had the tooth reinserted, call your regular dentist (if you saw someone else). For a chipped or broken tooth, you can call an emergency dentist, or your regular dentist to see what they recommend. (4)
While problems with dental implants may seem less serious, they can impact your ability to eat or do other day-to-day activities. Be sure to get in touch with your general dentist or an emergency dentist, since problems with dental implants can cause major disruption to your daily life.
3. You’re experiencing painful swelling
In her interview, Dr. McIntyre also points to painful swelling as a situation that constitutes a dental emergency. That’s because it most likely points to an underlying cause that requires treatment, and an issue that won’t resolve on its own. (1)
Here, it’s worth going through a bit of anatomy in order to understand what parts of the teeth can suffer from an infection. As explained in the article on dental emergencies cited above, teeth are made of three layers:
- Enamel: This part of a tooth is a hard, outer layer which shields the crown of the tooth. It has a highly crystalline structure.
- Dentine: A tooth’s fundamental structure is made of dentine. This firm tissue is softer than enamel but harder than bone.
- Pulp: Inside the core is the “pulp chamber” containing the blood vessels and nerves that link to the vascular and nervous system of the jaw. Many emergency dental procedures address infection of the pulp (“pulpitis”). (3)
Swelling can occur in a range of places for many different reasons. For example, the following conditions can all involve swelling:
- Abscess: This will be covered in more depth below, but swelling can be one symptom you might notice.
- Cellulitis: A bacterial infection of soft tissue, it presents with swelling among other symptoms.
- Pericoronitis: This condition describes the inflammation of the gum over a partially erupted tooth. (3)
4. Gum infection
An infection of the gums—the tissues that hold your teeth in place—can have a whole range of negative consequences. If it gets bad enough, it can cause:
- Sore or bleeding gums
- Pain when chewing
- Tooth loss (6)
Generally, gum infection is caused by the buildup of “plaque” on teeth. Plaque is made up of dead bacteria, mucus, and other particles, and if it’s not eliminated, it can harden to form tartar which brushing won’t remove. At that point, only professional cleaning will be able to get rid of it. When tartar spreads below the gum line, it can lead to bigger problems. (6)
If you’re experiencing signs of gum infection you should seek emergency dental care. The long-term effects of the condition are much harder to treat, so it pays to try to prevent that damage if possible. Resulting problems like tooth loss may not eventuate with early intervention. In the case of acute pain or signs of an advancing infection, be sure to seek out help from a dentist.
5. An infected abscess
An abscess is a pocket of pus that develops as a result of a bacterial infection. When it occurs at the tip of the root of a tooth, it’s called a “periapical” abscess. In the case of a “periodontal” abscess, it’s commonly found in the gums on either side of the tooth’s root. (7)
Abscesses often present with localized pain and swelling. Usually, these occur due to an untreated cavity, prior dental work, or an injury to the tooth. Dentists can treat them by draining the pus and treating the infection. (3) (7)
So, why is an abscess a dental emergency? Because if you leave one untreated for too long, the tooth may need to be removed. Even worse, some abscesses can lead to serious complications. For instance, if you feel like you’re having trouble breathing or swallowing, this may indicate that the infection from the abscess has spread into your jaw or other parts of your body. (7)
While an abscess may rupture, and the pain may decrease, you should still seek treatment from an emergency dentist to assess what you need to do on an ongoing basis. (7)
6. Possible oral cancer
While the conditions above all involve pain, there are other dental conditions worth having checked out that doesn’t necessarily hurt. This is especially true when it comes to oral cancer. If you have a visible lesion or discoloration in your mouth, it’s a good idea to keep an eye on it and consult with your dentist or doctor about whether it merits further investigation. (8)
According to the Oral Cancer Foundation, there are around 54,000 cases of oral cancer in the United States each year. Death rates are higher for these cancers than some others that are better known, but not because of the danger of cancer itself. Instead, it’s because oral cancer often goes undetected until it has already metastasized, spreading to the lymph nodes, for instance. (8)
Cases that do get caught early are often spotted when visible lesions or discolorations occur in the front of the mouth or tongue. Unfortunately, if these same signs occur somewhere that they can’t be seen, it’s hard to diagnose the condition. (8)
People at the highest risk for oral cancer are usually over 40, though there has been an increase in younger people developing it as well. While tobacco had previously been seen as the primary cause of the disease, human papillomavirus version 16 is becoming the most common cause for people under 50. (8)
If you ever experience or encounter the six signs explained in this article, consider consulting an emergency dentist.
Pain is always a good indicator you need help since healthy teeth shouldn’t hurt. You can try some home remedies, or use over-the-counter treatments as a temporary measure, but don’t ignore persistent pain. If you’ve had a tooth fall out, or one has been knocked out, seek treatment and keep the advice above in mind about how to treat the tooth in the meantime. An emergency dentist should be able to help. You should also call your dentist if you have an issue with a dental implant. Any signs of infection, like inflammation, are also worth investigating, whether the underlying issue is an abscess or something else. Finally, don’t ignore spots or lesions, especially if you’re in a group at high risk for oral cancer.
When making decisions that impact your health, dental or otherwise, it pays to consult an expert. Also, keep in mind that routine dental care can save you from needing a trip to the emergency dentist, or worse, the emergency room. Stay in regular contact with your dentist and determine how you can keep up your scheduled cleanings safely.
 What is Orofacial Pain?” Source: https://dentistry.tamu.edu/oral-surgery/cfp/what-is-facial-pain.html
 "Common Dental Emergencies,” Source: https://www.aafp.org/afp/2003/0201/p511.html
 “Treatment for Broken or Knocked-Out Teeth,” Source: https://www.webmd.com/first-aid/broken-or-knocked-out-teeth-treatment
 “The Emergency Dental Appointment: Restorative Emergencies Part 2 - Dental Implant Related Problems,” Source: https://pubmed.ncbi.nlm.nih.gov/28668102/
 “Periodontal (Gum) Disease,” Source: https://www.nidcr.nih.gov/health-info/gum-disease/more-info
 “Tooth abscess,” Source: https://www.mayoclinic.org/diseases-conditions/tooth-abscess/symptoms-causes/syc-20350901
 “Oral Cancer Facts,” Source: https://oralcancerfoundation.org/facts/