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EMERGENCY DENTAL CARE

EMERGENCY DENTAL CARE

The chances of an American having a dental emergency in any given year are 1 in 6. Hence, it makes good sense to learn how to identify them when they happen, and how to respond. It makes excellent sense to learn how to prevent dental emergencies from happening in the first place. However, as we’ll see, that’s not always possible.

In a dental emergency, you’ll need immediate treatment to stop oral bleeding, relieve severe pain, or save a tooth.  Many of these scenarios involve teeth not being where they’re supposed to be. Or pieces of teeth. Teeth knocked out or broken are an example. Likewise, teeth that are chipped, cracked, loose, or out of place. About 25% of dental emergencies involve restorations like fillings, crowns, and caps. Restorations fall out, loosen, or break. Finally, infections and abscesses are dental emergencies.

Pain is not a completely reliable indicator of a dental emergency. They don’t always hurt, at least not right away. When they do hurt, the pain can be so severe that nobody would put off getting professional help. Our goal is to intervene before that. Prevention is the best outcome. However, the world is not perfect and life is not fair. Even with the best dental hygiene habits, there’s no guarantee of a life free of dental emergencies. Accidents knock teeth out. Fillings age and fall out.

Immediate treatment can make the difference between losing a tooth and saving it. In fact, sometimes the window of opportunity is as short as 30 minutes. Painless dental emergencies are no less urgent than the painful ones. Unless you’re a dentist, you shouldn’t try to judge the urgency for treatment in an emergency. You should seek care immediately.

CARE FOR DENTAL EMERGENCIES

The best care resource for a dental emergency is a dentist. Yes, the dentist may in some cases refer an emergency patient to an oral surgeon or another dental specialist. However, dentists can treat many common emergencies in their offices. For those requiring specialized dental treatments, the dentist can usually provide initial care and relief.

Hospital emergency rooms are not ideal resources for dental emergencies. Nonetheless, Americans make about 2 million ER visits annually for dental emergencies the ER is not equipped to handle. Hospital ER’s rarely have a dentist on staff. State laws limit what a physician can do. In fact, in most states, it is illegal for anyone but a licensed dentist to fill a cavity, pull a tooth, restore a crown, or perform any other dental procedure. An ER physician and prescribe antibiotics and pain medications, but can’t practice dentistry without a license. So the ER will almost certainly not be the last stop.

A 2010 study of 115,000 Florida ER visits for dental emergencies is instructive. It found that the main benefit for patients was a referral to a dentist. This referral “cost” the patient $765  on average, in ER fees. Coverage by insurance is quite rare. ER fees for dental emergencies are almost always out-of-pocket.

There are two important exceptions to the “dentist-first” rule for dental emergencies. One is there’s been an oral infection persisting untreated for weeks. Persistent oral infections can become quite serious, even life-threatening.  Antibiotics provided in the ER can halt their progress until a dentist treats the underlying cause.  The other is when a dental issue secondary to a medical problem like facial trauma or a broken jaw.

DENTAL FIRST AID KITS

Household emergency planning should address dental emergencies.  First aid kits should include dental supplies. Lists of emergency contacts should include dentists and emergency dental clinics. These preparations are simple and easy. A little goes a long way. In time of need, they’ll be deeply appreciated.

A first aid kit should include a small container for any restoration (crown or filling) that’s fallen out. There should be an over-the-counter topical painkiller gel and a wooden applicator.  Round out the dental section with sugar-free gum, gauze, salt, a handkerchief, and acetaminophen. Note that other NSAIDS like ibuprofen and aspirin are blood thinners, They make it harder to control any bleeding. Acetaminophen is the better choice where there’s a bleeding issue.

First aid for dental emergencies is not going to resolve the problem. The bottom line is that there are no home cures for dental emergencies.  Rather, the aim of dental first aid is to provide comfort and lay the groundwork for the dentist.  The next step is getting to the dentist as soon as possible.

The basics of dental first aid and the uses of the items in the first aid kit can be reviewed here.  The equipment won’t be of much use if no one knows what to do with it. Therefore, it’s a good idea to become familiar with the procedures. Some people find it helpful to print out a dental first aid “cheat sheet” and store it in the first aid kit.

NEXT STEPS

In addition to the first aid hardware listed above, a dental first aid kit should include key software items. The telephone numbers for the family dentist and for accessible dental emergency facilities that are open when the dentist isn’t.

Time is of the essence.

AN EMERGENCY SCENARIO

Susan is a 38-year-old mother of two. She was weeding her garden one Saturday morning.  Her two young boys worked alongside her, mowing and raking. The boys took to horsing around, then rough-housing. Rita finally decided she ought to break it up. She stood, turned to face them, and was struck full in the mouth by the rake tossed aside by her older son. Susan stood still. She was aware the boys had suddenly fallen silent and frozen, staring at her. She soon found out why The rake handle had knocked out her left front tooth.

In dental terminology, Rita had suffered an avulsion of the left maxillary central incisor.

DENTAL FIRST AID

Susan was prepared for a dental emergency. She knew what to do.  Susan set her two sons to searching for the missing tooth in the grass. She whipped out her cell phone and called the family dentist. Her younger son found the tooth, whole and apparently intact, a few minutes later.

Susan brought her tooth indoors. Susan then slowly and gently slipped her tooth back into its socket.

The tooth wouldn’t stay put.  It was plain it wouldn’t stay in the socket during the drive to the dentist.  Susan went to Plan B. She got our her dental first aid kit. In it, she found a  small covered container. Susan filled the container halfway with milk and plopped her tooth into it.  With her tooth immersed in milk, she and the boys drove to the dentist’s office. By the time she settled into the dentist’s chair, about 30 minutes had elapsed since her accident.

EMERGENCY DENTAL CARE

Her dentist performed a replantation with Susan under anesthesia. He splinted the tooth to its neighbors with composite resin. Additionally, he stitched a cut in her gums caused by the rake’s impact.  He sent Susan home with a prescription for antibiotics and advised her to ask with her primary care physician about a tetanus booster shot.

The dentist removed the gum sutures a week later, and the splinting three days after that.  He scheduled a root canal procedure. After the root canal, he followed up with x-rays to monitor the replanted tooth’s accommodation. Susan got her tooth back. It served her as before, and her smile was as pretty as ever.

YOUR TURN

Susan had a great outcome after having her tooth knocked. She had prepared herself for dental emergencies.  Susan knew what to do, and had the critical items on hand and ready when she needed them.  She was one of about 5 million Americans who had a tooth knocked out that year. Some of the others didn’t have ideal outcomes like Susan’s. Unfortunately,  in some cases, the extent of damage to the tooth puts her kind of outcome out of reach. However,  many of these folks could have done better by making simple preparations, as she did.

Be like Susan. Prepare for dental emergencies.

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