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Common Dental Emergencies & Conditions

Dental Emergencies

What is a Dental Emergency?

Dental emergencies can have many causes, including accidents, sports-related injuries, tooth decay and infection. You may have a dental emergency if you have any of the following:

  • a traumatic injury to your mouth, jaw or teeth
  • severe pain that you cannot control with over-the-counter pain medication
  • uncontrolled bleeding
  • severe swelling in your mouth, face or neck


NOTE:
 If you have trouble breathing or your mouth continuously fills with blood, call 9-1-1 or go to your nearest hospital emergency department. Also seek an immediate medical assessment if you suffer a head trauma.

The following highlights some common dental emergencies. If you experience an injury to your mouth, face or neck it is important to ensure you receive any necessary medical attention first. Contact your dentist for any additional questions related to your individual circumstances and dental treatment needs.

A knocked-out permanent tooth may be saved but time is of the essence. If you knock out your permanent tooth, follow these steps

  • Hold the tooth by the crown (the top part of the tooth); never touch the root.
  • Rinse the tooth with water.
  • Reposition the tooth in the socket. Gently hold in place with a clean piece of gauze, a tea towel or face cloth to hold it in place; if you are unable to replace the tooth, put it in a glass of milk.
  • It is essential to contact your dentist, or nearest dental office immediately. In the case of a knocked-out tooth getting immediate treatment (within the hour) can make a huge difference to a dentist’s ability to preserve your tooth.

Please note: Do not try and reinsert a baby tooth. Contact your dentist to discuss the options.

Contact your dentist as soon as possible if an injury has caused your tooth to move. A displaced tooth can interfere with your bite and cause discomfort. If addressed early your dentist may be able to move the tooth back into position.

In most cases a small chip in the tooth does not constitute an emergency, particularly if it’s not causing pain. Speak to your dentist about the injury and treatment options.

Extensive cracks or fractures to a tooth require immediate attention: such injuries usually involve enamel (outer layer of the tooth) as well as the underlying dentin and possibly the pulp (vital structure of the tooth). This may cause pain and could lead to further damage if left untreated.

If you experience trauma to your tooth:

  • Look in the mouth to understand the extent of the injury.
  • Gently rinse your mouth with water to clean the damaged area.
  • Apply a cold compress to the impacted area, as required.
  • Take anti-inflammatory analgesics (e.g. Ibuprofen) to alleviate any discomfort and reduce inflammation. Do not apply medication directly to the tooth/gum.
  • Talk to your dentist as soon as possible.

Cuts, lacerations or other wounds can also occur to the lips, tongue, cheeks and other soft tissues of the mouth. If you experience a trauma to the tissue:

  • Gently rinse the mouth with water to assess the extent of the injury.
  • Apply a clean cloth or piece of gauze to the area; apply pressure.
  • If extensive or persistent bleeding occurs you should seek immediate care.

It is important to see your dentist if you have an infection in your teeth or gums. Pain will usually be the first sign of an infection but you may also notice redness in the gums or swelling in your mouth. In the case of swelling that affects your ability to swallow or breathe call 911 or visit the nearest hospital emergency.

In most cases, an issue such as a dislodged filling or a displaced crown does not require urgent care. However, call your dentist immediately to discuss your concern and to arrange an appointment for further care. Also ask if there is anything you can do in the interim.

Conditions

Tooth decay is caused by plaque bacteria in the mouth. Decay occurs when the bacteria in the mouth feed on carbohydrates (sugars and starches) in certain foods to create an acid. This acid eats away at the tooth enamel (the outer surface of the tooth) causing pitted areas and holes. Without effectively removing the plaque bacteria it can build up and increase the likelihood of developing decay. Decay cannot be reversed yet it can be prevented.
Prevention
  • Brush twice daily with a fluoride toothpaste. It is especially important to brush before bedtime.
  • Eat a well-balanced diet. Limit sugary foods and drinks as well as the number of times you eat during the day.
  • Floss daily to remove plaque between the teeth. Brushing alone only cleans two-thirds of the tooth’s surface.
  • Visit your dentist. Regular professional cleanings and dental examinations. Your dentist is trained to identify the early signs of disease and through regular dental exams will monitor your mouth and work with you to prevent and/or stop the progression of disease

Gum disease (also known as periodontal disease) is a condition that affects the soft tissues and bone that support and anchor the teeth. In its mildest form it can lead to inflamed or bleeding gums, while more advanced forms can result in bone loss, gum recession and eventually, tooth loss. Gum disease is largely preventable; early detection is important to stop the progression of disease.

Gingivitis: Gingivitis is a mild form of gum disease. It can cause inflamed and swollen gums that bleed when teeth are brushed or flossed.

Periodontitis: Periodontitis is an advanced form of gum disease. It results in deepening pockets between the gums and the tooth, followed by bone loss and loosening of teeth. Periodontitis is a major cause of tooth loss in adults.

Causes

Gum disease is caused by an accumulation of bacterial plaque at the point where your teeth and your gums meet. Plaque, a sticky film, forms on your teeth daily. Brushing and flossing help to remove plaque from your mouth. Plaque can build up and harden to form calculus (tartar). Without removing tartar (professional dental cleanings are required) plaque will continue to build up while the bacteria within the plaque can irritate the gums and progress to break down bone.

Other contributing factors include tobacco use, diet, and some medications. Certain systemic diseases such as diabetes can also make you more susceptible to gum disease.

Signs

Signs that you may have gum disease include:

  • Red and swollen (puffy) gums
  • Bleeding gums when brushing or flossing
  • Persistent bad breath
  • Receding gums
  • Loose teeth
Dry mouth (also known as xerostomia) occurs when there is not enough saliva, or spit to keep your mouth moist and comfortable. Dry mouth is not a disease. It is a side effect of taking medications or can be a symptom of certain diseases or conditions. Dry mouth is a common complaint amongst older adults but can occur at any age. It is not a normal sign of aging.
Causes
The most common cause of dry mouth is prescribed and over-the counter medications, such as:
Amphetamines Antihypertensives Bronchodilators
Antianxiety drugs Antiparkinsonians Decongestants
Antidepressants (tricyclics) Antipsychotics Diuretics
Anticholinergics (atropine) Antispasmodics Hypnotics
Anticonvulsants Appetite suppressants Muscle relaxants
Antihistamines Barbiturates Opioid (narcotic) analgesics
Symptoms
  • A sticky, dry or burning feeling in the mouth, throat or nasal passages
  • Lips or corners of mouth are cracked
  • Lips may stick to teeth or dentures
  • Saliva is thick and stringy
  • Trouble chewing, swallowing, tasting or speaking
Affect on Oral Health
Saliva helps to protect teeth by neutralizing the acid caused by plaque that leads to tooth decay. In addition, decreased saliva leads to:
  • plaque buildup
  • gingivitis and gum disease
  • dentures being less comfortable to wear
  • bad breath
Tips to Manage
  • Daily mouth care: clean teeth, gums and dentures
  • Brush teeth with a high fluoride toothpaste
  • Use a high fluoride mouth rinse
  • Take frequent sips of water to keep the mouth moist
  • Chew sugar-free gum or candy to stimulate saliva
  • Avoid tobacco, alcohol, caffeinated beverages and sugary drinks
  • Speak to your dentist about products that can help keep your mouth moist
  • Have regular dental examinations and professional cleanings

At one time or another we all suffer from bad breath (Halitosis). For many, bad breath is a temporary problem, however, if bad breath persists there may be an underlying cause. If you have persistent bad breath you should speak to your dentist or physician to rule out any disease and take steps to prevent a future recurrence.

Causes

Food. Foods heavy in garlic, onions, and spices are among the culprits contributing to bad breath. Bad breath can also be triggered by infrequent eating or food particles left in the mouth.

Poor dental hygiene. Infrequent or poor brushing and flossing techniques can leave food in the mouth to decompose. Your mouth is warm, moist and dark—the perfect place for bacteria to grow if not properly cared for. It is important to remember to brush twice daily and floss to remove food particles between teeth. Bad breath can also affect those that wear dentures; always ensure you clean your denture daily.

Gum (periodontal) diseasePersistent bad breath is often an indicator of gum disease. Gum disease is caused by an accumulation of bacterial plaque at the point where your teeth and your gums meet. If untreated this condition can continue to advance, eventually leading to tooth loss.

Dry mouth. If you suffer from reduced saliva flow in the mouth you are more susceptible to bad breath. Saliva helps clean food particles from the mouth. Without this added protection bacteria can grow, leading to bad breath and other dental conditions. Many medications can contribute to dry mouth.

Tobacco use. The use of tobacco products can cause bad breath and increase your risk of developing oral conditions, including gum disease and oral cancer. Speak to your dentist for tips to help you quit or visit Quit Now.

Other medical conditions. While rare, bad breath can also be associated with other medical conditions such as sinus or throat infections, diabetes and some liver and kidney diseases.

Prevention
  • Brush, floss and clean your tongue at least twice a day to remove food and bacteria from the mouth and prevent dental disease
  • Let your dentist know if you are taking any medications and ask about treatment for dry mouth
  • See your dentist to replace broken fillings (that may act as a food trap) and restore areas of decay
Dental decay, gum disease or injury may result in the loss of a natural tooth. It is important to visit your dentist regularly to catch any signs of disease early in order to prevent tooth loss.
Importance of Natural Teeth
Your teeth support your health and well-being. Missing teeth may affect the comfort and function of your mouth, your ability to eat a variety of nutritious foods as well as your speech. Gaps in the mouth can also cause esthetic changes as teeth shift to fill in the missing space.
Replacing Missing Teeth
In the event that you lose a tooth or need to have a tooth extracted it is recommended to replace the missing tooth. Tooth replacement options include a bridge, a partial denture and a dental implant. In the event that a young child loses a tooth, a space maintainer may be recommended to ‘hold’ the place for the permanent tooth growing below. If this is not done, the baby teeth may shift, blocking the permanent tooth from growing in straight. This may affect the bite and further treatment, such as orthodontics, may be recommended to restore function to the mouth.
Prevention
  • Eat a well-balanced diet
  • Brush twice daily and floss at least once a day to protect your teeth and gums
  • Don’t smoke
  • Visit your dentist regularly for an examination to diagnose disease early and prevent more complex treatment in the future

Clenching, or grinding of teeth, most often at night, is a common problem for many adults and children. According to the Canadian Sleep Society, approximately 8% of adults and close to 13% of children experience sleep bruxism.

Causes

Anxiety, stress, disrupted sleep, misaligned and/or missing teeth are among the causes. More often than not those that clench, grind or gnash their teeth are not even aware they are doing it.

Signs

In many cases sound is the first indicator, as a partner and/or parent (of a child) hears the grinding. Other signs may include:

  • Headaches
  • Earaches
  • Tooth Sensitivity
  • Pain, either in the teeth or the jaws
Affects on Oral Health

When you clench and/or grind, your teeth exert a huge amount of pressure on your teeth. Prolonged bruxism can lead to cracked, chipped, broken or loose teeth, or damage to the temporomandibular joint of the jaws.

Diagnosing Bruxism

Through regular dental visits, your dentist will monitor your mouth including any irregular wear on the surfaces of your teeth. It’s important to let your dentist know if you’ve experienced any unusual or increased sensitivity or pain in your head and neck area. This can help to diagnose bruxism early, and limit any damage to your mouth.

Prevention
  • If you tend to grind or clench your teeth while awake, try to be aware of this and make an effort to correct the behaviour as it occurs. Your teeth should always be apart during the day.
  • Find stress reducing activities such as exercise, reading or listening to music.
  • Limit caffeine or alcohol and find ways to relax before bedtime to sleep better.
  • If bruxism results from misaligned, missing teeth, your dentist may recommend treatment to correct these problems.
  • Your dentist may also recommend wearing a custom-fit nightguard. A nightguard works to reduce the pressure on the teeth, and protect them from wear.
Tooth sensitivity occurs when the protective enamel on the tooth is damaged or when receding gums or periodontal disease exposes the underlying dentin at the roots. If your teeth are sensitive it is important to talk to your dentist to rule out anything serious and address the source of the problem.
Causes
  • tooth decay or damage;
  • gum diseaseand recession; or
  • tooth grinding
Always tell your dentist if your teeth are sensitive to hot, cold or sweet and call your dentist at once if you experience any of these symptoms:
  • Your teeth are also sensitive to pressure.
  • Your tooth sensitivity doesn’t decrease after using desensitizing toothpaste for a few weeks.
  • The pain from tooth sensitivity lasts longer than one hour.
  • The gums around your sensitive teeth appear to be changing colour.

Oral cancer can occur anywhere in the mouth including the lips, tongue, gums, cheeks, the palate or throat. Many oral cancers can be successfully treated if detected early—an examination by a dentist is an important step in the early detection of oral cancers.

The following summarizes the approach to oral cancer screening as outlined in the Guidelines for the Early Detection of Oral Cancer in British Columbia 2008, published by the BC College of Oral Health Professionals (BCCOHP).

Screening

Dental exams: During your exam, your dentist will:

  • discuss your health history, oral habits and lifestyle factors along with any oral pain or discomfort you may have
  • perform an extraoral examination whereby they inspect the head, neck and perioral tissues for abnormalities
  • perform an intraoral examination to inspect all oral soft tissues

Based on completion of the above guidelines, your dentist may recommend the use of an optional screening tool. These screening tools do not replace the exam and are not required for all patients.

Optional Screening Tools

At times an optional screening tool, such as Velscope or Toluidine Blue Staining, may be used for more detailed examination of certain areas of your mouth or for patients with a history of oral cancer. These are not a required part of your dental exam, but may be used by your dentist following a review of your health history and lifestyle factors, or if they need to examine a particular area of your mouth more closely. Only a dentist can diagnose tissue abnormalities based on the use of the screening tools as part of their overall examination.

Suspicious Lesions

If your dentist notices something suspicious, they will monitor it for a short period of time and a biopsy may be required. Your dentist will inform you of your results. If further care is required this may be provided by your dentists or they may refer you to specialist.

There is no single cause of oral cancer. It results from a variety of factors and how individual patients react to those factors. Oral cancer occurs most often in people who use tobacco, and the combination of tobacco with alcohol greatly increases the risk.

Early Detection

Healthy behaviours and early detection are key factors to reducing cancer incidence and improving outcomes. Become familiar with your mouth and visit your dentist regularly for an exam. Call your dentist if you notice any of the following:

  • White or red patches on the lips or anywhere inside the mouth
  • Any sores that bleed easily but don’t heal within three weeks
  • Persistent lumps or ulcers
  • Unexpected loosening of teeth
  • Pain or numbness in the mouth or lips
HPV

Since September 2017, the HPV vaccine has been made available to all Grade 6 students, regardless of gender. There is not a ‘catch-up’ program for boys older than Grade 6, however the program does cover the vaccine for high risk boys and young men up to age 26. This program change is due in part to the continued lobbying efforts of the British Columbia Dental Association. To learn more please visit Immunize BC.

Don’t ignore a mouth sore because it doesn’t hurt. Most pre-cancerous and cancerous lesions are completely painless. Minimize your risk for developing oral cancer: Avoid tobacco and excessive alcohol use, and wear lip balm that contains sunscreen.

Sun-damaged lips are vulnerable to skin cancer. Sunburns can occur in less than 15 minutes and it is the repeated sun exposure that can cause long lasting damage.

Signs
  • Lips that feel chronically dry
  • White patches on the lip
  • Areas of redness or scaling
Early Lip Cancer
  • An isolated, thickened area
  • Considerable scaling in one area
  • An ulcer that does not heal
Prevention
  • Limit sun exposure
  • Use lip balm containing SPF 30 sunscreen
  • Wear a broad-brimmed hat
  • Seek shade