Emergencies

The purpose of this section was to provide advice to anyone with an acute dental problem when normal dental services are not available. Guidance is given on the understanding that these are short term solutions and everyone should contact their surgery as soon as possible once it has reopened. None of what is given should ever be used as a permanent solution.

What to do in a dental emergency

If you ever have had the misfortune to have a dental emergency then you will know first-hand how painful this can be and how confusing and difficult it can be to get it sorted out. Firstly, you must determine what is an emergency. It is important to understand how different dental problems are classified so that you can obtain the right type of help when our practice is closed.

  • When we are open, we put appointments aside every working day to deal will all dental emergencies.
  • Non emergencies will be booked in at appropriate timescales and advice can always be sought.

We consider emergency cases to be;

Bleeding after an extraction that will not stop.

Follow our post extraction instructions, however, if you have followed this and you are still bleeding then it would be reasonable to proceed to A&E for prolonged bleeds. NHS111 and denplan emergency on call service can be used for minor bleeds.

Knocked out tooth.

If you have the tooth, the best solution is to re-implant the tooth as fast as you can. The tooth can reattach to the jaw if it is replaced within an hour. There are some simple steps to follow.1) Clean the root by rinsing in milk or saline solution. Try to only hold the crown of the tooth (whitest part) Never scrub the tooth as this will damage the attachment apparatus of the tooth. 2) Reposition the tooth into the socket. Don’t worry if the tooth isn’t perfectly straight as we can correct this at a later date. 3) Eat a soft diet and contact NHS 111or denplan emergency on-call. If you do not feel confident in replacing the tooth, place the tooth in milk, or hold the tooth in your cheek (provided it’s your tooth). Never replace a baby tooth as you can easily damage the underlying adult tooth.

Broken jaw.

Go straight to A&E

Dislocated jaw

See the link for treatment of a dislocated jaw or go straight to A&E

Large swelling

Contact NHS 111 or Denplan emergency cover. Both of these services will triage this problem. If however you have any of the following: fever, malaise, Inability to swallow and difficulty in breathing Go straight to A&E. This can potentially be a life-threatening condition where your airway becomes compromised. Do not under any circumstances wait with this problem and have someone by your side.

Severe Toothache

That will not calm down after simple home steps( see toothache under non-emergencies). Contact NHS 111 or Denplan emergency cover. A&E will not treat simple toothache, you need a dentist.

We consider non-emergency cases to be;

Any unpredicted need for dental treatment that falls between routine check ups that does not follow into the emergency categories.

This is often due to food caught between teeth. Try using floss to dislodge any food that may have packed between teeth. Rinse with cold saltwater and stay away from food and drink with high sugar content.

If the resultant fracture has not traumatized either the tongue or cheek then the resultant hole can be simply cleaned with a salt mouth rinse and a measure of toothpaste placed in the hole will reduce any sensitivity. If the hole leaves a sharp edge or leaves the tooth feeling sharp, then temporary dressing materials can be bought at local pharmacies. Some more inventive remedies include using blue tack, chewing gum (non-sugar) and wet cotton wool which will keep food out of the hole and smooth any sharp edges.

Generally, don’t try to use any cement other than dental cement. If the supporting tooth is intact, toothpaste can work as a temporary cement but only if you are confident you can reseat the crown properly. If the tooth is in the bridge or crown, then hold onto it as sometimes we can remove the broken piece of tooth and recement the original crown/bridge. Generally, though, it will involve a new crown or bridge.

Baby bell wax can be used to smooth a rough arch wire, other than that contact the surgery when it reopens.

Do not be tempted to repair the denture with super glue. This is a water-soluble adhesive and it will breakdown in the mouth. The adhesive reacts badly with acrylic and will worsen the problem possibly to a point where the appliance can no longer be repaired. Keep all the pieces and contact the surgery when it re opens. Sometimes we can repair fractures in a day.

In most cases the cause is food packing between the partly erupted wisdom tooth and the surrounding gum. The food stagnates for a day or so and the natural bacteria in the mouth break down this food and the resultant toxins causes the gum to swell. Use a soft toothbrush to remove any visible debris. Never be tempted to poke with your finger or anything else as this will only press the food further in. Bathe, not rinse with warm salty water as this will relax the gum and allow the food to float out of the gum pocket. It also gives a more instant relief that is better than any painkiller. Contact the surgery when it reopens.

A mouth ulcer is a break in the skin. There are a number of reasons as to why they should occur. A typical ulcer will last about a week provided the area is kept free from infection. This can be done by cleaning the area with warm salty water or chlorhexidine mouthwash prior to placing a barrier over it which can be obtained from a pharmacist. Any ulcer lasting longer than a week should be investigated. If in any doubt, contact your surgery as soon as it re opens.

Is one of the most common reasons for a person reaching out to the dental practice. Unfortunately, this cannot be predicted and often we are caught out with toothache after closing hours. This advice is for those who are having a sleepless night because of this. The following, is advice that will get you through a night with toothache.

  • Over the counter painkillers. We advise for adults 400mg Ibuprofen or 600mg Aspirin every 4 hours. Do not take Aspirin and Ibuprofen together as this is very harmful to the stomach. Do not take Aspirin when bleeding is a problem or if you are asthmatic or under the age of 16 years. 500mg of Paracetamol can be taken every 4 hours, spaced 2 hours after either Ibuprofen or Aspirin is taken. Do not exceed the recommended doses on the boxes. Overdosing of Paracetamol can kill.
  • Apply to the sore area, numbing pastes containing benzocaine. Do not do this to infants or children under 2 years.
  • Keep your head elevated above the level of your heart. This will reduce the throbbing feeling in the tooth.
  • Brush your teeth as this will reduce the bacteria load in your mouth.
  • Avoid eating acidic/ cold or hard food as this can worsen the feeling.
  • Rinse with salt water (100ml glass of warm water with a teaspoon of table salt) or hydrogen peroxide mouthwash.
  • Use an ice pack (wrapped in a towel) and apply to the painful area for approximately 10 minutes every hour.
  • Peppermint tea, cloves and garlic pastes can be applied direct to the open cavity of the tooth.

A dry socket is a in infected wound that classically develops after three days after an extraction. The area, instead of feeling gradually better after an extraction, gradually feels worse. A bad taste becomes apparent and often there is a malodour. The use of hot salt mouthwash after every meal and general pain relief is the best approach. As soon as the practice reopens, please contact the surgery.

A cold sore is an open wound of the skin that is infected with the herpes virus. This virus hides in the nerve that supplies sensation of the skin and becomes activated when you are feeling run down or the area of skin becomes damaged. Sun damage is a common cause. It is highly contagious and can be very dangerous to the elderly, anyone receiving anti immune drug therapy and the very young. People with a cold sore should use separate cutlery/ face cloths / towels and never rub the wound with their hands and then touch either some one else or themselves as this will spread the virus. Acyclovir cream can be obtained from all pharmacies and tablets can be prescribed to limit the spread of the virus and generally the person affected is treated for what has originally depressed their immune system.

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