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Early treatment can often prevent a dental problem from worsening. However, some dental emergencies can be unpredictable. This section lists some of the most common emergency situations that come into the dental office or emergency room. If you have a dental emergency, we recommend seeking attention as soon as possible. In the meantime, there are a few things that you can do that may help to reduce your pain or discomfort.
Below are some of the most common dental emergencies.
Teeth are formed of three layers: the enamel, the dentin and the pulp. The pulp is in the center of the tooth and contains, among other cells, the blood vessels, lymphatic system and nerves of the tooth. The nerve cells in the dentin are connected through the ends of the roots to a signaling network that sends signals to the brain if stimulated. Typically, a stimulus, such as extreme temperature change or physical or chemical irritation, will be interpreted on a spectrum from mild irritation to severe pain.
Most people will be not be consciously aware of irritations to their teeth if their teeth and mouth are healthy. Hypersensitivity results when a particular tooth or set of teeth are regularly irritated and call out for attention, either when stimulated or spontaneously. It is best to discuss hypersensitivity with your dentist because it may be a warning sign of further dental problems.
Some common causes of tooth hypersensitivity include:
Gumline wear of the tooth due to aggressive toothbrushing (abrasion) or unconscious tooth grinding (abfraction)
Chemical or acid breakdown of the enamel (erosion) from foods or acid reflux
Leakage of an old filling
Oral pain can be either chronic or acute (that is, long standing or starting suddenly). While most people with pain usually associate oral pain with a tooth, there can be many other sources, including: the gums, the muscles surrounding the mouth, the jaws or joints (temporalmandibular joint), the maxillary sinuses, the ear canal, or the nerves that conduct the signal from the tooth to the brain.
When the cause of the pain is from the supporting gums and bones or from a tooth itself there can be a number of causes and thus, different ways of treating the problem and alleviating the pain. Therefore, in cases of oral pain it is imperative to seek medical or dental opinion as soon as possible. Rapid diagnosis can minimize the severity of the problem and also minimize the amount of treatment necessary. Listed below are some of the most common sources of oral pain:
Broken filling / broken tooth
In most instances, a fractured tooth or broken filling can be quickly repaired without long-term consequences. In some cases, the live nerve inside the tooth can be sensitive because less tooth or filling material insulates it from the temperature changes or foods in the mouth. By sealing the tooth and protecting the nerve with a temporary or permanent filling, the symptoms of sensitivity can be stopped.
If the damage to the tooth is so severe that a filling would cause a large part of the tooth to be made up of dental material, the structural integrity of the tooth may be compromised. In this case, it is best to discuss with a cosmetic dentist the option and possible benefits of fixing the tooth with an indirect restoration such as a crown or onlay.
Restoring the tooth as soon as possible, sometimes with a temporary filling if circumstances do not permit a permanent restoration, will enhance the long term prognosis of the tooth. See the section on the different restorative options to learn more about these treatments.– add a link or the name of that section here.
Swollen and bleeding gums
The most common cause of inflamed gums is a long term infection due to a build-up of bacteria (plaque) surrounded by a "rock-like" wall of calculus (also known as tartar). The calculus forms from calcium and phosphate in the saliva and once present needs profession attention by a dentist or hygienist. This type of infection will be found in a number of areas of the mouth, particularly around the molars (large back teeth) and behind the lower front teeth next to the tongue.
Mouth bacteria is a constant source of irritation to the gums and will cause an immune response from the body. Imagine a poorly cleaned wound in another area of the body. If left without treatment an infection may result and the area will be red, warm, swollen, painful and bleed easily. You wouldn't ignore something like that on your hand and you shouldn't ignore the same symptoms in your mouth.
The outer-most layer of the gums are not nearly as thick as the skin in other areas and thus is more prone to irritation. Long term irritation of the gums can lead to loss of the supporting bone around the teeth (periodontitis). The long term consequence of this is losing teeth.
Fortunately, regular visits to a dentist and hygienist is a very good start in preventing periodontitis. You can learn more about the home care strategies to keep the gums and bone healthy between recall appointments by talking to your dentist or hygienist. Proper brushing and regular flossing is the foundation for oral health.
See your dentist if you experience symptoms of swollen or bleeding gums. It is important to rule out other causes of these symptoms such as a tooth abscess (see section on swellings and infections), nutritional deficiency, viral infection, fungal infection, hormonal changes (eg. pregnancy), allergic reaction / chemical sensitivity, reaction to medication.
My tooth was sensitive but now I am having severe pain...
Severe tooth pain, especially if it lingers for long periods of time or occurs spontaneously, is a "alarm" for you to see your dentist. Usually this is a tipping point with the nerves in the oral cavity and requires immediate attention. Often, it is not clear which tooth is causing the pain because of a phenomenon called referred pain. The discomfort can feel like it is coming from any tooth or even the lower face up to the ear on the same side as the offending tooth.
You dentist will likely need radiographs (x-rays) to complement the examination and will test the teeth to identify the source of the pain and the appropriate treatment. If the source of the pain is a tooth, treatment may include a new restoration, root canal treatment or an extraction. See links for more information regarding the particular treatment.
Swellings and Infections
The causes of swellings and infections in the oral cavity are numerous and require a number of tests to determine the source. Therefore, the best suggestion is to seek attention immediately if you encounter swelling in the mouth. here are some rare but very serious and even life threatening complications of untreated infections. When in doubt, contact your dentist in Victoria, BC and have an examination.
If a tooth has taken a bump there will be concern over the amount of tooth loss and whether the nerve and blood vessels inside the tooth have been affected.
The larger the fracture of the visible portion of the tooth, the more likely for there to be sensitivity and infection of the dental nerve. Immediate treatment will minimize the risk of further damage. Depending on the extent of the fracture, the tooth can be treated with cosmetic contouring, a filling, a veneer or a crown. If the nerve has been exposed, it may be necessary to have a root canal prior to completing the final treatment.
When the tooth has not fractured but has taken a sharp knock, we still recommend having an examination by a dentist. The symptoms of an irreversibly damaged nerve may not manifest for a number of months, and the first signs may be discolouration of the tooth, pain or swelling. It is immensely valuable to be able to compare the symptoms immediately after an accident to those present a number of months later to determine the long-term prognosis.
Tooth loosened or knocked out
Teeth that have become loose in the socket may be "splinted" or joined to the adjacent teeth to allow them to heal in the correct position. Call your dentist in Victoria, BC for a consultation regarding your situation.
If a tooth has been knocked out, the time prior to proper dental treatment is vital. It may be possible to save the tooth if quick action is taken.
In children the deciduous teeth (baby teeth, milk teeth) are important, but if they are knocked out they are NOT reimplanted. However, children as young as five or six years of age will start having adult teeth. We would like to save these teeth if possible.
So what to do? First, make sure that all essential medical treatment has been attended to before worrying about the teeth. Collect the teeth or pieces and place them in an isotonic solution to carry to the dentist or emergency room. What's an isotonic solution? Something that has approximately as much salt in it as saliva or blood. For example, place the tooth in a container of milk or have the person with the knocked out tooth spit into a plastic baggy and carry the tooth moist in the saliva. Not the most pleasant, but it works. Resist the urge to clean the tooth root, as those red bits around the root are essential to preserving it. If the accident occurs at school or during a sporting event, the centre may be equipped with a isotonic solution in a container as part of the first aid kit, such as the Save-a-tooth system. This is a really handy especially in places where children are playing or accidents usually occur.
Bring the patient and the tooth to see us as soon as possible and hopefully we can save the tooth. Call your dentist in Victoria, BC at Broad Street Dental Centre for an emergency appointment.