BELlVAND MEHRl

DMD-2l

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 have
a 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 not
treated 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 to
always seek treatment for a dental injury. Getting injured teeth repaired and treated
as soon as possible after an injury is the best thing to do.
Today, dentists have many options for dealing with dental emergencies. There are
advances in pain management and ways to restore teeth. Teeth can be repaired with
synthetic 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 it
is. He or she almost always can reduce or get rid of your pain within a few
minutes.
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 affect
the living tissues inside the teeth. Quick treatment improves the odds of saving
injured 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 the
future. Your dentist can prevent the damage from getting worse.
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 see
your dentist right away, there's a good chance he or she will be able to repair the
damage more easily.


Tooth abscess
A tooth abscess is a collection of pus that's caused by a bacterial infection in the
root 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 develop
a 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 pain
may decrease significantly but dental treatment is still needed. If the abscess
doesn't drain, the infection may spread to other areas of your head and neck. It may
even become life-threatening.
To treat a tooth abscess, the dentist will likely drain the abscess and prescribe
antibiotics to eliminate the infection. While the area is healing, the dentist may
recommend 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.



Traumatic Injuries of the Lips and Tongue

Trauma to the lips, tongue and the inside of the mouth is quite common. The soft
flesh of the lips and their exposed location make them vulnerable to injury. A blow
to 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 cause
you 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
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.
Prevention
Many lip and tongue injuries occur during sports or other active pastimes. They
often could be prevented through the use of a safety mouth guard. Mouth guards
are made of soft plastic that is adapted to fit the shape of the upper teeth. Guards
made for heavier contact sports may cover both the upper and lower teeth. Mouth
guards protect both the lips and teeth by providing a shield in front of the teeth and
a softer biting surface for the back teeth. Preformed guards are available in
sporting 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 to
swallow this peroxide rinse. However, do not be concerned if it foams. This is
what 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 limit
swelling, 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 the
vermilion border. This is the line that forms the junction between the skin and the
fleshy part of the lip. Experience is required to make sure this boundary heals
correctly. 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 dirt
that might have entered the wound. A betadine solution will then be applied to the
area to disinfect it. Puncture wounds to the lip will then be closed from the inside
out. Stitching all layers reduces the chance of scarring..
Small puncture wounds in the tongue usually heal without any treatment other than
cleansing with antiseptic or hydrogen peroxide rinses. Large cuts may require
stitches.
The mouth contains many bacteria. For this reason, an antibiotic often is prescribed
after a cut to the lip or tongue to prevent infection.
Seek medical care if:
y Bleeding cannot be controlled with pressure and a cold compress
y You have a deep cut
y A cut crosses the border between the lip and facial skin
y The lip is punctured
y An infection develops after an injury Signs of any infection usually will
be evident about four days after the injury. Signs include:
o Redness
o Tenderness
o Fever
o Drainage of pus
If a tooth is loose or broken, visit your dentist.
Prognosis
The outlook is excellent. The rich blood supply in the mouth promotes rapid
healing, often with little scarring.

Abscess
When the inside of your mouth gets hurt or irritated, bacteria may enter and cause
an 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 the
infection. This is one way that your body tries to keep a bacterial infection from

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 an
infection 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 the
tooth. 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 the
surrounding 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, the
infection can last for months or even years. It will not go away on its own, so it's
important not to ignore the symptoms.
If the infection is not treated, it can damage the surrounding bone and teeth. A
hollow 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 opening
inside your mouth. It looks like a pimple. If you have pus draining through a
fistula, you might notice a strange taste in your mouth.
The buildup of pressure causes the pain of an abscess. Draining the abscess
through a fistula reduces the pressure. The pain will disappear. However, the
infection still needs to be treated.
Sometimes, an abscess that isn't treated can form a fluid-filled bubble (cyst) in the
jaw 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 a
root canal to remove the infected nerve. If this treatment does not heal the cyst, you
may need surgery to remove it.
In rare cases, the infection that causes an abscess may spread and lead to serious
health 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 several
times 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 seems
to 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 will
appear on an X-ray and show the dentist where the fistula leads. Once your dentist
cleans 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 the
tooth. 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 the
tooth removed. A large abscess often will need to be drained. The dentist makes a
hole 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.
People with severe periodontal disease may have abscesses. Draining them helps
the 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. These
drugs will help the abscess heal and keep the infection from spreadin.

Pericoronitis
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 tissue
covers part of the tooth. This happens more often with the lower wisdom teeth than
with 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 teeth
y 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
Do not use warm compresses on your face. You can swish warm salt water around
in 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 three
things happens:
y The flap of tissue is removed
y The wisdom tooth is removed
y 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 the
area 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 keep
the problem from coming back. You will have to brush and floss every day, and
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. Removing
the flap of tissue may not solve the problem, however. In that case, you will need
to 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, the
upper one may be removed. The oral surgeon may recommend that you have the
upper 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. Be
careful that you don't hurt your gum with the toothpick or accidentally push
anything deeper under your gum.
If you can't remove a foreign body yourself, see your dentist as soon as possible.
Your dentist has special tools that allow him or her to see into your mouth and find
whatever is trapped under your gum. Your dentist also will check for infection.

Severe Pain(Not From Trauma)
Any injury to the gums or teeth can be very painful. At other times, you may have
dental pain and not know why. For example, sudden pain may be caused by pieces
of food that come in contact with a decayed area of the tooth. Food, heat or cold
may create pressure near the nerve and cause pain. The nerve inside the tooth also
may 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. Bacteria
multiply in this area, and an infection of the tooth and gum may develop. This type
of 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 also
notice 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 can
spread. It could even
y become life threatening.
y Rinse your mouth with warm salt water every hour or so. This won't help an
infected 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 and
supermarkets. You also can use a topical anesthetic, such as Anbesol.
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 usually
disappear right away.
If your problem is related to pieces of food stuck under your gums, your dentist
will remove the pieces. If you have an infection, you may be given a prescription
for 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 need
drainage of the abscess or root canal treatment. If the tooth is very damaged, it may
have 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 because
the exposed tooth tissue is often sensitive to temperature, pressure or air. If you
lose a crown, put it in a safe place and make an appointment to see your dentist as
soon as you can.
Don't wait too long. What is left of the tooth will not be as strong as your crown. It
could be damaged more without the crown to protect it. Also, when a crown is
missing for a long time, your teeth may move into the space where the crown was.
If this happens, your crown may no longer fit.
y Apply a little clove oil to the sensitive area with a cotton swab. This will
give you pain relief. You can buy clove oil in drugstores or in the spice
aisles 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 the
crown 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't
find 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 the
tooth surface. This will help to protect and seal the area until you're able to
see your dentist.
Decay 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 the
crown 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.

Steps to Save 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 right
away. The same is true of teeth. They may seem bony and lifeless, but teeth are
alive and can often be saved as long as you act quickly.
The blood vessels and nerves in knocked-out teeth (also called "avulsed" teeth) are
usually damaged beyond repair. But microscopic ligaments in the jaw may reattach
to 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 in
the mouth, the better," says Donald Sadowsky, D.D.S., M.P.H., Ph.D., professor of
dentistry at Columbia University School of Dental and Oral Surgery in New York.
The odds of saving a tooth are highest in young children, but adult teeth can be
saved as well. Even if the tooth reattaches, however, you most likely will need root
canal treatment to clean out the damaged nerve.
How the tooth is handled right after the accident will largely determine whether it
can be saved. To improve the chances of the tooth being saved, Dr. Sadowsky
suggests 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 with
milk 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 the
cheek 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 the
tooth to a young child for safe-keeping in his or her mouth. Place the tooth
in milk or have the child spit into a container and place the tooth in the cup
with the saliva. The most important thing is to keep the tooth moist. Use a
cup of water if nothing else is available.
y Get to a dentist as quickly as possible. If getting to a dentist immediately
after a tooth has been knocked out is impossible, then you may want to try
slipping the tooth back into its socket. In many cases, it will slip right in.
Make sure it's facing the right way. Don't try to force it into the socket. If it
doesn't go back into place easily and without pressure, then it's better just to
hold it between the cheek and gum or to keep it in milk, saliva or water.
Even if the odds of success seem poor, Dr. Sadowsky recommends that you try to
save 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," Dr. Sadowsky
recalls. "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 permanent
solution was feasible."
The Next Step
It usually takes about two weeks for ligaments in the jaw to firmly reattach to the
tooth. Because soft tissues inside the tooth probably are damaged, you'll most
likely need a root canal at some point, which will prevent the tooth from darkening
or becoming infected.

Knocked-Out Tooth (Avulsed Tooth)
Dentists refer to a knocked-out tooth as an "avulsed" tooth. This is one of the most
serious dental emergencies for permanent teeth. However, the damage can be
fixed. 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 supporting
tissues 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.
Get 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 in
the 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 the
tooth back into its socket. The tooth has a better chance of surviving if it's
kept 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 a
container of milk. You can also buy a kit at some pharmacies. It contains a
solution similar to natural saliva. The most important thing is to keep the
tooth moist.
Remember, if you act quickly and get to your dentist as soon as possible, there's a
good chance the tooth can be saved.
Putting the tooth back in place sometimes can be simple. Other times it can be
complicated, 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.
The tooth does not always reattach in the right way. If it doesn't, it eventually may
fuse to the jawbone. If this happens, the root of the tooth can erode or be
reabsorbed into the body. This occurs very slowly and can take months or even
years. Your dentist will monitor the tooth and may suggest further treatment, such
as a root canal.
The nerves and blood vessels that were injured when the tooth was knocked out
usually can't heal. Root canal treatment often is needed to prevent the tooth from
changing color or developing an abscess.

Fractured and Broken Teeth
Teeth are remarkably strong, but they can chip, crack (fracture) or break. This can
happen in several ways:
y Biting down on something hard
y Being hit in the face or mouth
y Falling
y Having cavities that weaken the tooth
When a tooth chips or breaks, it may not hurt. However, your tongue usually feels
the 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 the
tooth 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

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 the
temperature 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 blood
vessels. This is a serious warning sign.
Broken Teeth
If you have a broken tooth, see your dentist as soon as possible. Your dentist can
figure 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 10
minutes 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 help
reduce swelling and relieve pain.
y If you can't get to your dentist right away, cover the part of the tooth that is
in your mouth with temporary dental cement. You can find this at a
drugstore.
y Take an over-the-counter pain reliever.
Fractured Teeth
There are several types of tooth fractures and breaks, each of which requires
different treatments. These include:
y Minor cracks Also called "craze lines," these are surface cracks that
affect only the outer white surface of the tooth, called the enamel. Minor
cracks rarely need treatment. However, your dentist may lightly polish the
area to smooth out any rough spots.
y Cracked tooth This type of fracture involves the whole tooth, from the
chewing surface all the way down to the nerve. The pieces remain in place,
but the crack gradually spreads. Cracks can sometimes be repaired with
filling material. The tooth often will need a crown to prevent the crack from
getting worse. If the pulp (nerve and other live tissues) is damaged, you may
need a root canal as well.
y Chips Minor chips don't always need treatment. Your dentist may
suggest repairing the damage with filling material to prevent it from getting
worse or to make the tooth look and feel better. If the chip is very small, the
dentist may polish and smooth out the chipped area.
y Broken cusp These breaks affect the pointed chewing surfaces (the
cusps) of the teeth. They usually do not affect the pulp and are unlikely to
cause much pain. Your dentist may repair the damage to restore the tooth's
shape. Frequently, however, an onlay or crown will be required.
y Serious breaks These breaks go deep enough to expose the nerve. They
almost 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 the
exposed nerve and probably a crown to restore the tooth to normal function
so 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 with
a crown. First, you will need root canal treatment. Second, the dentist will
remove 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 tooth
and extend upward toward the chewing surface. These breaks are often
painful because the area around the root may be inflamed or infected. In
most 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 evaluate
the 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 be
removed.


Partially Dislodged (Extruded) Tooth
Sometimes a tooth is knocked loose or comes partway out of its socket because of
an injury. Dentists call this an extruded tooth. If the tooth is not broken and its
nerve 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 pain
reliever 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 the
tooth is intact and there is no sign of severe periodontal disease in the bone around
it, the dentist will guide the tooth back into the socket. An X-ray may be taken to
ensure 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 wire
y Bonding an orthodontic bracket to each tooth and then connecting these
brackets (braces) with a wire
y Using a synthetic cloth or metal mesh and bonding it to the back of the teeth
involved
y 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 root
canal treatment. This keeps the tooth from becoming discolored or
developing an abscess, which is an infection. Your dentist will test in the
next weeks and months to see whether the nerve was damaged. These tests
are not always reliable right after a tooth is injured.
y If the dentist decides that root canal treatment is needed, you may need to
have the tooth crowned (capped) after the root canal. In some cases, it may
not 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 the
missing tooth.
y How Do I Know if I Need Treatment?
As with any trauma to the mouth, you should consult with your dentist
immediately to determine if treatment is required. The dentist will examine
the affected area and may take X-rays.
If you are in pain from a broken, cracked or chipped tooth, you may want to
take an over-the-counter pain reliever. If possible, keep any part of the tooth
that 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 tooth
to 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 How Does a Dentist Treat a:
Chipped tooth If there is no pain and the chip is small, it's up to you to
decide if, when and how the tooth should be repaired. Depending on the size
of the chip, it can be smoothed or cosmetically corrected. Other options
include veneers, crowns and fillings. Ask your dentist to explain these
options. If a filling or artificial tooth becomes chipped, it should be replaced.
Cracked or broken tooth Cracked and broken teeth should be repaired as
soon as possible to prevent further damage. Root canal therapy or tooth
extraction 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 are
not always visible, even on X-rays. Symptoms may involve pain while
chewing and Sensitivity to cold and possibly hot foods and liquids, as well
as air, which may over time become more pronounced.
Tooth knocked out The key to successfully reattaching a tooth is to get it
reimplanted 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 with
water only, then reimplant the tooth at the site and hurry to a dentist as
quickly as possible. The tooth should be picked up by the crown only and
must not be allowed to dry. The best chance for success is reimplantation
within the first 30 minutes, with chances still good for up to two hours. It
may be necessary for your dentist to do a Root canal treatment one to two
weeks 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 such
as difficulty chewing and speaking, a shifting of position among remaining
teeth, temporomandibular joint (TMJ) disorders caused by chewing on the
side with more teeth, and a weakening of the jawbone. Options for replacing
lost 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 handkerchief, necktie or towel tied around the
jaw and over the top of the head. Cold compresses should be used to reduce
swelling, if present. Go immediately to a hospital emergency room, or call your
dentist


Chipped front
tooth

Chipped tooth
after repair

"Permanent tooth
knocked out"

Carefully reinsert
knocked out tooth
and visit your
dentist
immediately
Dental Emergency Procedures Can Help 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 Dental Association recommends that you become familiar
with these dental emergency procedures just in case you ever have a dental
emergency.
y If a tooth is knocked out, hold the tooth by the crown and rinse the root in
water if it's dirty. Do 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 the
dentist immediately.
y Treat a bitten tongue or lip by cleaning gently with a cloth and applying cold
compresses to reduce swelling. If bleeding is heavy or doesn't stop after a
short 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. Do NOT apply aspirin to the tooth or gum
tissues.
y A jaw injury or possible fracture needs immediate attention at your dentist's
office or the emergency room. Apply cold compresses on the way to reduce
swelling.
y If a loose or broken wire from your braces is irritating your mouth, cover the
wire end with a small cotton ball, beeswax or a piece of gauze until you can
get 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; the
society will be able to refer you to a nearby dentist. Or, visit the local
emergency room and ask for a dentist referral. If you are abroad, contact the
U.S. Embassy or hotel personnel for a dentist referral.