Question 1

I have an abscess or a swollen cheek: what should I do?

Accepted Answer

Contact the practice promptly. If you have a fever, swelling spreading towards the eye or neck, or difficulty swallowing or breathing, go to the hospital emergency department without delay. A dental abscess is an infection that usually develops around a tooth whose nerve is affected, or in the gum. It shows up as pain, sometimes throbbing, swelling of the gum or cheek, and sometimes an unpleasant taste in the mouth. While you wait for your appointment, you can apply something cold to the cheek for short periods and keep up careful hygiene. Do not apply heat, do not burst the abscess yourself and do not take antibiotics without medical advice. The dentist examines the tooth, takes an X-ray and starts the appropriate treatment, which may combine drainage, treatment of the tooth and, if necessary, a prescription. Some signs require immediate care: fever, swelling spreading towards the eye or neck, difficulty swallowing or breathing, or bleeding that will not stop. In these situations, go to the hospital emergency department without delay.

Question 2

I have broken a tooth: what should I do?

Accepted Answer

Keep the fragment if you have found it, rinse your mouth with water and contact the practice. Depending on the fracture, bonding the fragment back, a filling or a crown may be considered. A tooth can break after a knock, when biting on something hard, or because it was already weakened by a cavity or an old filling. The fracture may affect only the enamel, reach the dentine, or even expose the nerve. If you find the piece, keep it in a little milk or saliva: it can sometimes be bonded back. Rinse your mouth with lukewarm water and apply something cold to the cheek if the lip or gum is swollen. If a sharp edge hurts your tongue, avoid chewing on that side. Contact the practice for an appointment. A small fracture can often be repaired simply. A more extensive fracture may require a crown, and an exposed nerve may require root canal treatment. If the knock also affected your face, or if there is bleeding that will not stop, a fever, swelling spreading towards the eye or neck, or difficulty swallowing or breathing, go to the hospital emergency department.

Question 3

A tooth has come out after a knock: what should I do?

Accepted Answer

Act quickly. Hold the tooth by the crown without touching the root, rinse it briefly, keep it in milk or in your mouth, and seek care as soon as possible. When a permanent tooth is knocked out, the chances of putting it back depend greatly on how quickly it is treated. The first few minutes count. Pick the tooth up by the white part, without touching the root. If it is dirty, rinse it very briefly under cold water, without rubbing or disinfecting it. If you can, gently put it back into its socket and bite on a gauze pad. Otherwise, keep it in milk or saline solution, or failing that in your mouth, against the cheek. Contact the practice immediately. A baby tooth is not put back in place, but a check-up is still useful to examine the permanent tooth underneath. If the knock caused a loss of consciousness, bleeding that will not stop, a serious facial injury, a fever afterwards, swelling towards the eye or neck, or difficulty swallowing or breathing, go straight to the hospital emergency department.

Question 4

My crown or filling has come out: what should I do?

Accepted Answer

Keep the crown, avoid chewing on that side and contact the practice. An intact crown can often be re-cemented. Do not stick it back with household glue. A crown can come loose over time, sometimes because the tooth underneath has decayed. A filling can also come away or break. In both cases, the tooth becomes more sensitive and more fragile. Put the crown in a small clean container and bring it to your appointment. Avoid chewing on the side concerned, particularly hard or sticky foods, and brush the area gently. Sensitivity to cold or sugar is common. Never use strong glue or household glue: it could damage the tooth and prevent the crown from being re-cemented properly. Some pharmacies sell temporary pastes, to be used only as a stopgap. The dentist examines the tooth and the crown, checks that there is no decay, then re-cements it or proposes a new restoration. If you have swelling spreading towards the eye or neck, a fever, difficulty swallowing or breathing, or bleeding that will not stop, go to the hospital emergency department.

Question 5

My temporary crown has come off: is it serious?

Accepted Answer

It is generally not serious, but it should be put back quickly to protect the prepared tooth and to stop the neighbouring teeth from shifting. Contact the practice. A temporary crown is fixed with a temporary cement, designed to be removed easily when the final crown is fitted. It can therefore come loose, particularly when eating sticky foods. Keep it and call the practice so that it can be put back. In the meantime, avoid chewing on that side and brush the tooth gently. It may be sensitive to cold, as it has been prepared. It is important not to go too long without the temporary crown: the tooth is more exposed, the gum may change and the neighbouring or opposing teeth may move slightly, which would complicate fitting the final crown. Do not use household glue. If you notice pain that is getting worse, a fever, swelling spreading towards the eye or neck, difficulty swallowing or breathing, or bleeding that will not stop, go to the hospital emergency department.

Question 6

I am still in pain several days after an extraction: is that normal?

Accepted Answer

Discomfort that eases gradually is usual. Pain that increases after two or three days may point to a dry socket and is a reason to contact the practice. After an extraction, moderate pain, mild swelling and a little bleeding in the first few hours are part of the usual aftermath. They generally ease day by day, as you follow the instructions and the prescribed treatment. If the pain becomes stronger after two to four days, spreads towards the ear and comes with a bad taste, it may be a dry socket: the blood clot that protects the bone has not formed or has come away. It is not dangerous in itself, but it is painful and it is treated at the practice. To help healing: avoid smoking, spitting forcefully or using a straw for the first few days, do not rinse vigorously on the first day, and choose soft, lukewarm food. Heavy bleeding that does not stop despite biting firmly on a gauze pad for several minutes, a fever, swelling spreading towards the eye or neck, or difficulty swallowing or breathing mean you should go to the hospital emergency department.

Question 7

I have severe toothache at night: how can I relieve it?

Accepted Answer

Your usual painkiller, following the leaflet, and keeping your head raised can bring relief in the meantime. Contact the practice as soon as it opens: the cause needs treating. Severe toothache at night is often linked to inflammation of the nerve of the tooth. It tends to get worse when you lie down, because the increased blood flow to the head raises the pressure inside the tooth. Until you can see the dentist, you can take a painkiller you are used to taking, following the leaflet and any contraindications you have, sleep with your head raised, avoid hot and cold on the tooth, and apply something cold to the cheek. Do not place a tablet directly on the gum. Contact the practice as soon as it opens. Even if the pain settles, the underlying problem remains and can develop into an abscess. If the pain comes with a fever, swelling spreading towards the eye or neck, difficulty swallowing or breathing, or bleeding that will not stop, go to the hospital emergency department without delay.

Dental emergencies

Dental emergencies

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