Any dental problem, such as a toothache or broken tooth, that requires immediate attention is described as a dental emergency. Dental emergencies cover a myriad list of dental issues, and most of them require immediate attention from a dentist. Depending up on the severity of the situation, the treatment will vary. Most of the time, the treatment provided during an emergency is only a stopgap measure to address the pain, while follow-up visits are required to complete the treatment.
Severe tooth pain is one of the most common dental emergencies. A patient’s treatment will vary depending on the dentist’s diagnosis.
• Reversible pulpitis: If the pain was induced by a stimuli; (hot, cold or sweet) it is usually a reversible condition. Removing the stimuli and placement of a filling is often the treatment. Sometimes a temporary filling is used to heal the pain. However, patient will need to return after a few days to get the tooth filled permanently.
• Irreversible pulpitis: If the pain was spontaneous and persists, it means the pulp is severely inflamed. In such cases, root canal therapy (RCT) is required. During the emergency visit, RCT may be initiated. It includes drilling in to the pulp chamber to remove the pulp and filling the empty pulp chamber and root canals. The patient is required to come back to complete the treatment and have the tooth filled permanently. If there is enough damage to the tooth structure, a crown is advised. In some cases emergency extraction is done depending on the severity. Judging by the level of discomfort to patient, RCT can be delayed for few days but not more than that. Pain should be managed with appropriate analgesics.
• Along with oral examination X-rays are often required for correct diagnosis.
Tooth & Gum Swelling
If the tooth with an infected pulp is left untreated, the progression leads to an abscess formation due to bacterial infection.
• In cases with a localized swelling accompanied with severe, sponataneous and persistent pain, incision and drainage of the pus might be required. RCT or extraction is the definitive treatment and patient should visit the dentist within one to two days. Pain can be managed by analgesics. Antibiotics may or may not be prescribed depending on the severity of the infection.
• In some cases the infection can spread in to the surrounding tissues and can cause extensive swelling. (Cellulitis). Fever may be present along with severe pain. If not treated this can lead to serious complications. In addition to incision and drainage oral antibiotics are prescribed and patient is required to visit the dentist for RCT or extraction after the swelling has subsided.
• If the swelling has extended into deep spaces of the head and neck there is risk of life-threatening complications and the patient should be hospitalized.
Dental trauma is very common, especially in children. Injuries to teeth and supporting structures can be tooth fracture, luxation (loosening and displacement of the tooth), Intrusion (vertical displacement of tooth in to the bone) and avulsion (complete displacement of the tooth out of its socket). Treatment options are determined after thorough oral examination and X-rays. In any case of dental trauma, long term follow up is needed.
• Fractures: Depending on the extent of fracture, immediate treatment may be required which involves pain management and filling. RCT or extraction may or may not be required depending on the nature of the fracture.
• Luxation: Luxated tooth in primary dentition may require extraction if it is interfering with the occlusion or if there is danger of being aspirated. Luxated permanent teeth may require repositioning, splinting and RCT or extraction.
• Intrusion: Intruded teeth should be monitored to determine whether the tooth would re-erupt. If not, surgical or orthodontic treatment may be needed along with RCT to promote re-eruption.
• Avulsion: Immediate re-implantation of an avulsed tooth is preferred. Splinting and antibiotic prophylaxis is required. Primary avulsed teeth are never re-implanted.
Wisdom Teeth Emergencies
Bacterial plaque and food debris can accumulate beneath the flap of gum covering a partially erupted wisdom tooth and can cause swelling of the flap, pain, tenderness and a bad taste due to pus accumulation. This condition is called pericoronitis. It can progress to severe swelling and may result in inability to open the mouth fully.
• In localized cases, mechanical therapy including irrigation under the flap can resolve symptoms.
• In severe cases, analgesics and antibiotics are prescribed and tooth is evaluated to see if surgical removal of the gum flap or tooth is necessary.
Broken Crowns & Lost Fillings
• Emergency treatment may or may not include new impressions for crowns or bridges.
• Temporary crowns/bridges/fillings are placed if needed.
If you are experiencing any of these issues, we recommend contacting your local emergency dentist. If you live in Riverside, CA, Dr. Joel Manalese and the caring staff at Regal Dentistry & Orthodontics can help resolve your dental emergency right away. Specialists are available to take your call 24 hours a day. Learn more at www.regaldentistry.net