A Roanoke Guide to Dental Emergencies: What Counts and What to Do First

First, the problems that belong at a hospital

Most dental trouble is ours to sort out. A few things aren't, and that difference matters more than anything else on this page. Go to an emergency room, or call 911, if any of these is happening.

• Trouble breathing or swallowing.Call 911. Swelling under the tongue or in the throat can narrow the airway, and that can't wait for a dental appointment.
• Swelling spreading toward your eye or down your neck. An infection on the move needs hospital care now, not an appointment on Monday.
• Bleeding you can't control.If it keeps flowing through firm, steady pressure, or it's heavy enough to fill your mouth, stop trying at home and go.
• A jaw injury from significant trauma. A car wreck, a hard fall, a blow to the head. Go to an emergency room first, especially if you lost consciousness, your teeth no longer meet the way they did, or part of your face feels numb.

An emergency room can treat a spreading infection, control bleeding, image a broken jaw and manage pain. It generally doesn't perform dental treatment, so you'll still need a dentist afterward. After hours, if anything on this list is happening, go now rather than waiting for us to open.

Today: the same day, as soon as you can reach us

These need a dentist the same day if at all possible, and each one has a first step you can take right now. If one happens after hours, call 540-774-8288 and follow the after-hours instructions on the line.

• An adult tooth knocked completely out.This is the one where minutes count. Pick it up by the crown, never the root. If it's dirty, rinse it for a few seconds with milk, saline or cold water, and don't scrub it. Put it back in the socket if you can and bite gently on a clean cloth to hold it. If you can't, keep it in a cup of milk or tucked inside your cheek, never in water, and come straight in. A baby tooth shouldn't be put back, but call us about it just the same. More on a knocked-out tooth.
• Facial or gum swelling, a foul taste, or fever with tooth pain. That combination points to an abscess, and an abscess doesn't clear up on its own. Rinse with warm salt water, hold a cold compress against the outside of your cheek, and don't squeeze or pop it. If the swelling starts moving toward your eye or down your neck, the hospital list above applies.
• Pain that wakes you at night, or that over-the-counter medicine isn't touching. Pain at that level usually means the nerve is involved, and it tends to build rather than fade. Salt water, a cold compress, a pain reliever exactly as the label directs, and a call. Our page on toothache treatment explains what happens next.
• A tooth broken with a sharp edge, bleeding, or a pink or red spot in the middle. That spot is the pulp, where the tooth's nerve lives. Save any pieces in milk or water, rinse gently, use a cold compress for swelling, and chew on the other side until we see you. Our page on broken tooth repair walks through the options.
• An adult tooth that's loose after a hit. Leave it alone, no wiggling and no testing it with your tongue. Soft food only, and call today.
• Bleeding after an extraction that won't slow down. Fold clean gauze into a pad, bite firmly for thirty minutes without checking, and skip rinsing, straws and smoking. If the gauze keeps soaking through, call us. If it's pouring, the hospital list applies.

This week: it won't fix itself, but tonight isn't the night

• A lost filling or crown with no real pain.Keep the crown in a bag and bring it with you. Don't glue it back with anything from the junk drawer, and stay off sticky and hard food on that side. Here's what we do about a lost filling or crown.
• A sharp twinge when you bite, especially as you let go. That's the classic cracked tooth pattern. Chew on the other side and call for an appointment this week, because cracks can spread.
• Cold sensitivity that hangs on after the cold is gone. A quick zing that fades right away is common. An ache that lingers, or one that's been growing over a week or two, is worth a look.
• A sore spot from a denture, a rough edge, or a mouth ulcer. Rinse with salt water and keep off the irritated area. Any sore that hasn't healed in two weeks should be examined rather than watched.
• A sore gum flap over a wisdom tooth, with no swelling and no fever. Rinse with warm salt water a few times a day and call for an appointment. If swelling, fever or trouble opening your mouth shows up, it moves to the today list.

Can wait for a regular appointment

• A small chip with no sharp edge, no pain and no sensitivity.
• Mild sensitivity after a new filling that's getting better week over week.
• Food that keeps packing between two teeth but comes out with floss.
• Sensitivity after whitening, which usually settles on its own.
• Gums that bleed a little when you floss after a stretch of not flossing.

“Can wait” means a regular appointment in the next few weeks, not indefinitely. Gums that bleed every time, a chip that keeps catching your tongue, and sensitivity that isn't improving all belong on the schedule.

What to do in the first hour, whatever it is

A few things help with almost any dental problem while you wait to be seen.

• Rinse with warm salt water. About half a teaspoon of salt in a cup of warm water, swished gently. It keeps the area clean.
• Cold on the outside, never heat. A cold compress against the cheek, twenty minutes on and twenty off. Heat on a swollen face can make an infection worse.
• Take pain medicine as the label directs.Never hold aspirin or any tablet against the gum, because it burns the tissue. If you take other medicines, or you've been told to avoid anti-inflammatories, check with your pharmacist or physician first.
• Sleep with your head propped up. Lying flat tends to make a throbbing tooth throb harder.
• Keep whatever you find. A knocked-out tooth goes in milk, broken pieces in milk or water, and a crown in a clean bag.

Two things worth knowing. Pain medicine doesn't treat an infection, it only quiets it, so swelling that feels better isn't necessarily swelling that's going away. And a toothache that stops on its own isn't always good news, because a nerve that has died stops hurting while the infection underneath carries on quietly.

How to call so we can sort it out quickly

When you call, the front desk is triaging, not stalling. It helps to have this ready.

• When it started, and what makes it better or worse.
• Whether there's swelling, and exactly where.
• Whether you have a fever, and whether it's keeping you up at night.
• Whether there was an injury, and what hit what.
• Whether your teeth still come together the way they normally do.

Both offices are in Cave Spring and see patients Monday to Friday, 8:00 AM to 5:00 PM. The Electric Rd office, where Dr. David Perry practices, is at 2660 Electric Rd, 540-774-8288. The Brambleton Ave office, where Dr. Razi practices, is at 4907 Brambleton Ave, 540-774-3143. Call whichever is closer. We try to fit emergencies in the same day, and an early call gives us more room to do it.

You can also book onlinearound the clock, which works well for anything on the this-week list. For anything on the today list, please call instead, so we can hear what's happening and tell you what to do on the way in. If you're a Virginia Dental Club member, your membership includes one problem-focused emergency exam at no charge each membership year. Our emergency dental care page goes through each of these problems in more detail.