In An Emergency

For registered patients who are having severe problems, there is an out of hours emergency number that will put you in contact with the Hertfordshire Out-of-Hours Dental Service.

Contact the practice first to see if we are open and to check our opening times (option 2 on the answerphone). If we are closed and you cannot wait until we re-open, the emergency number is 03000 33 32 24. This number is part of the NHS direct service.

Any dental emergency like an injury to the teeth or gums can be potentially serious and should not be ignored. Ignoring a dental problem can increase the risk of permanent damage as well as the need for more extensive and expensive treatment in the future. Certain emergencies require immediate hospital attention. These include any incident where consciousness is lost, where there is the possibility that bones are broken eg. a fractured jaw, where  there is uncontrolled bleeding or large facial swelling. With less serious problems the dentist should be contacted as soon as possible to arrange an appointment. Here's a quick summary of some temporary remedies for some common dental problems:

Chipped or Broken Teeth. If possible, save any pieces. Rinse the mouth using warm water; rinse any broken pieces. If there's bleeding, apply pressure with a clean cloth or cotton handkerchief to the area for about 10 minutes or until the bleeding stops. Apply a cold compress to the outside of the mouth, cheek, or lip near the broken/chipped tooth to keep any swelling down and relieve pain. If there is a hole in the tooth this can be temporarily filled with temporary dental cement available in kits from some pharmacies and supermarkets. See the dentist as soon as possible.

Knocked-out Tooth. Retrieve the tooth, hold it by the crown (the part that is usually exposed in the mouth), and rinse off the tooth root with water if it's dirty. Do not scrub it or remove any attached tissue fragments. If possible, try to put the tooth back in place. Make sure it's facing the right way. Never force it into the socket. If it's not possible to reinsert the tooth in the socket, put the tooth in a small container of milk or saliva, or hold inside the mouth in the cheek. In all cases, see the dentist as quickly as possible. Knocked out teeth with the highest chances of being saved are those seen by the dentist and returned to their socket within 1 hour of being knocked out. For more information see below.

Extruded (partially dislodged) Tooth. See the dentist right away. Until you reach the dental practice, to relieve pain, apply a cold compress to the outside of the mouth or cheek in the affected area. Take your normal pain reliever if needed. Avoid anything with Aspirin in it as this may cause problems with bleeding.

Objects Caught Between Teeth. First, try using dental floss to very gently and carefully remove the object. If you can't get the object out, see your dentist. Never use a pin or other sharp object to poke at the stuck object. These instruments can cut your gums or scratch your tooth surface.

Lost Filling. As a temporary measure, stick a piece of sugarless gum into the cavity (sugar-filled gum will cause pain) or use a temporary dental cement available in kits from some pharmacies and supermarkets.

Lost Crown. If the crown falls off, make an appointment to see the dentist as soon as possible and bring the crown with you. If possible, slip the crown back over the tooth. Before doing so gently try to remove any debris from within the crown and around the tooth. Coat the inner surface with a temporary dental cement, toothpaste, denture adhesive or softened chewing gum to help hold the crown in place. Do not use super glue! Use only a very small amount of these things and make sure the crown is the right way around.

Broken Brace Wires. If a wire breaks or sticks out of a bracket or band and is poking your cheek, tongue, or gum, try using the eraser end of a pencil to push the wire into a more comfortable position. If you can't reposition the wire, cover the end with orthodontic wax, a small cotton ball, or piece of gauze until you can get to your orthodontist. Never try cutting the wire.

Abscess. Abscesses are infections that occur around the root of a tooth or in the space between the teeth and gums. Abscesses are a serious condition that can damage tissue and surrounding teeth, with the infection possibly spreading to other parts of the body if left untreated. Because of the serious oral health and general health problems that can result from an abscess, if you have a swelling or discharge in or around the mouth, it is important to see the dentist as soon as possible.

Soft Tissue Injuries (lips, tongue, etc). You can clean injured skin surfaces with mild soapy water and a soft clean cloth. To clean cuts inside the mouth, rinse with a salt water solution. If your lip is swollen or bruised, apply a cold compress. If there is bleeding, apply pressure with a clean cloth.

Toothache. Most of the above remedies should prevent toothache, but tooth pain may be controlled by your normal painkiller. If you have no medical contraindications to it, Ibuprofen (Nurofen) is one of the best painkillers for toothache. Applying oil of cloves on some cotton wool onto the tooth can temporarily numb the tooth. Antiseptic gels and mouthwashes can also make the mouth more comfortable in some circumstances. Use of sensitive toothpastes works in reducing the pain of sensitive teeth.

Of course the best way of avoiding problems is prevention. Attending the dentist for regular check-ups allows most problems to be caught early before they give pain.

If you have had a tooth completely knocked out (known as an avulsed tooth) the following information may be of use:

The Avulsed Tooth

What is an avulsed tooth?

An avulsed tooth is one that has been knocked out.

I’m bleeding – what can I do?

Don’t panic. Get a clean handkerchief and fold it up, then hold it over the socket and bite down. Keep your jaws together to apply pressure. If you need something for the pain, don’t take any medication containing aspirin as this can encourage further bleeding. Do not apply clove oil to the wound.

I’ve still got the complete tooth, can it be replaced?

Maybe. The complete tooth needs to be replaced in the socket as soon as possible, ideally in under 30 minutes. Teeth have been successfully replaced up to 60 minutes after being knocked out.

What should I do with the tooth?

Avoid handling the root. If it is very dirty, rinse it with milk and wipe it with a clean cloth. Do not clean it with disinfectant or water or let it dry out.

How do I put the tooth back in?

Hold the tooth by the crown and put it back into the socket firmly, root first. Bite on a clean handkerchief for about 15-20 minutes.

What should I do if I can’t get the tooth back in?

Your tooth has more chance of survival if you keep it in your cheek until you can get emergency dental treatment. This will keep the tooth in its most natural environment. If this is not possible, keep it in some milk.

What if I have only got part of the tooth that has been knocked out?

It is not a good idea to try and put the tooth back into the socket if it is not complete. Contact the dental surgery as soon as possible and we will tell you what options are available to restore the tooth. You may need dental x-rays to see if there is any root damage.

Is there anything I should do if I haven’t got the tooth?

If you cannot find the tooth, you may have swallowed it. If you think you may have swallowed or inhaled it, you may need an x-ray to be sure of this. Again contact us as soon as possible so that we can assess the situation.

What should I do if a baby tooth has been knocked out?

We would not recommend re-implanting a baby tooth in case an infection damaged the adult tooth underneath. Contact us as soon as possible for advice. We may need to examine the child to check if any fragments of tooth are still in the gum. There is no way of temporarily replacing a baby tooth, so the treatment is to wait for the adult tooth to come through.

Where should I get emergency dental treatment if a tooth has been knocked out?

It is important to get emergency dental treatment. Contact the Dental Centre as soon as possible and explain what has happened. If the incident has happened out of normal dental practice hours, phone the practice number and you will be given information of the emergency on-call dentist (details above).

What should happen at my emergency visit?

There will be an initial assessment of the situation. You may need treatment of any facial injuries However, treatment may be limited if there is any bruising or bleeding. You will probably need more appointments for follow up treatment.

What further treatment options will be available to me?

If the tooth has re-implanted successfully you may not need any further treatment as long as you keep up your regular check-ups to keep an eye on it. If the tooth becomes loose, it can be splinted to the teeth next to it. This means it will be temporarily attached to keep it firm until we can tell whether it has re-implanted successfully. If the tooth is lost or doesn’t implant successfully, it can be replaced at first with a denture. Then, when the socket has healed fully, you may be able to have a bridge or dental implant.

Is there anything that I can do to avoid getting a tooth knocked out?

If you play certain sports, when a tooth is most likely to be knocked out, you could wear a mouthguard – a rubber-like cover that fits over your teeth and protects you against a blow to the mouth. We can have one made for you by taking an impression of your teeth and sending it to a laboratory. The laboratory then makes the mouthguard so that it fits your mouth exactly. Mouthguards can be clear or coloured – for example in the colours of the team kit if you want to wear one while playing sport.

A mouthguard can help prevent tooth loss during sport

If you would like any further information or advice, please do not hesitate to contact us at The Rickmansworth Dental Centre.

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