Emergency dentistry

What is emergency dental care?

Emergency dental care can include advice given over the phone, during a consultation, or prompt medical treatment arranged with an emergency dentist or one who runs an after-hours dental service or a 24-hour service.

Emergency dental care: treating a dental emergency

Some dental problems need immediate attention by a dentist; they cannot wait, even if the dental emergency arises in the middle of the night or at a weekend. Emergency dental care is vital if you have:

• Knocked a tooth completely out of its socket in an accident

• Knocked a tooth out of place, causing bleeding to the gum and a loose tooth

• A severe tooth abscess or infection that is causing obvious swelling as well as pain

In the first two cases, access to emergency dental care within an hour of the injury is important to have a good chance of saving the tooth. The emergency dentist will prepare the gum and the tooth and re-insert or reposition the tooth so that it can heal and stay in position. If there is a delay of more than an hour in getting emergency dental care there is an increasing risk that the blood vessels will be so badly damaged that the tooth will die and will have to be removed and replaced by a tooth implant or a denture.

Prompt emergency dental care can also reduce the risk of infection in the damaged tooth, which can lead to an abscess.

If an abscess has developed and is causing considerable pain, it needs urgent attention, but emergency dental care becomes necessary if the gum or surrounding tissues start to swell alarmingly. If swelling is so bad that breathing or swallowing becomes a problem, you should go straight to an accident and emergency department for immediate treatment to drain the abscess and relieve the swelling.

Providing emergency dental care advice

If you are not sure whether your dental emergency needs immediate treatment, you can phone for emergency dental care advice. Your local PCT will provide information on how to contact an emergency dentist, or you can phone the NHS helpline for details of out-of-hours dentists working in your area.

Explaining the problem over the phone will allow the dentist to assess whether emergency dental care is needed immediately or whether you can wait until the next day, or even the next working day. If you have recently had a tooth extraction and then experience bleeding, your emergency dentist will make sure first of all that you are not taking anticoagulants. Drugs such as warfarin can be prescribed to reduce stroke risk, but will inhibit blood clotting and could put you at risk of losing too much blood.

If not, you will be advised to carry out your own emergency dental care by holding a damp pad of cotton wool in the gum socket and keeping it firmly in place for about 20 minutes while you sit up. Rinsing out your mouth with warm water is a good idea beforehand, as this can reduce the amount of blood in your mouth and reduce discomfort.

This should stop the bleeding and you should then not need emergency dental care from a dentist. To prevent the bleeding reoccurring you should then stay in an upright position, and remember not to drink any alcohol as this can bring your blood vessels nearer to the surface of the gum. Leave the socket alone; the clot needs to stay in place.

Only if you cannot stop the bleeding should you call the emergency dental care line again and request an emergency dental appointment.

Guidelines on when emergency dental care is essential

There are few published guidelines on how to decide whether emergency dental care is necessary. The Scottish Dental Clinical Effectiveness Programme, however, put some guidance together at the end of 2007, and their advice on how to prioritise dental emergencies is summarised below:

Emergency dental care is required if:

• You have a dental abscess that is causing swelling that either causes you problems when swallowing or breathing, or affects tissues up to and including the eye

• If you have avulsed one of your permanent teeth. This means you have knocked your tooth out and it is not attached at all to your gum. 

• If you have had a tooth extraction and later experience bleeding that will not stop

Urgent but not emergency dental care is necessary if:

• You are in severe pain that cannot be controlled with over-the-counter pain relief

• A child has knocked out a primary tooth

• You have an abscess and swelling but this does not affect your swallowing or breathing and is limited to the region of the gum or jaw

• You have injured a permanent tooth and the dentine is showing

Routine dental care with your own dentist within a week is advised in all other cases. If the problem gets worse and you start to fall into one of the above categories, you then need to ask again for urgent or emergency dental care.