When we talk of dental emergencies, instinctively people think of the medical emergencies that could happen in a dental clinic. But dental emergencies are specifically those conditions that are beyond endurance and bring the patient to the dentist immediately. The two-edged sword that both keeps the patient from and brings the patient to a dentist is pain.
But other than pain there are conditions that need immediate attention. Let’s first look at the structure of the tooth.
The human tooth is made of 3 layers, the inner core which contains the nerve, and blood vessels this is called the pulp chamber. This is followed by the dentinal layer which is made up of minute tubules. The outer most layer is the enamel which is hard and crystalline in nature. This protects the dentine and pulp from insult. The tooth rests in the tooth socket and is attached to the underlying bone through the periodontal ligaments. This is commonly referred to as gums.
How do dental emergencies arise?
Dental emergencies could arise from the following:
- Infection of the tooth and structures surrounding the tooth.
- Inflammation of the tooth and structures surrounding the tooth.
- Fractures to tooth, bone, orthodontic appliances, or previous restoration.
Toothache in a dental emergency is typically unbearable and tracing its origin is very important in managing it. Most common cause of tooth ache is caries.
Caries is when the mineral component of the tooth occurs due to acid increase. There could also be tearing due to overzealous brushing. It starts as brown colour discoloration.
- Then becomes reversible where pain or discomfort is felt on eating hot, cold or sweet things. This can be treated with restorations.
- It then becomes irreversible the pain becomes spontaneous, it may not be localized. May require root canal treatment or extraction.
In both the cases the clinical examination and radiographs are taken.
Swelling of the gums
This is usually due to bacterial infections coming from the plaque. Particles getting stuck during mastication could cause injury or get embedded in the gums. The tooth is very tender to touch, and sometimes there is mobility or shaking of the tooth.
- Clinical examination, radiographs are done.
- The abscess is drained.
There could be swelling in the gums due to impacted tooth particularly the 3rd molar. Usually the person likes to constantly bite on that area resulting in redness, swelling there is lot of pain radiating to the ear and throat. Bad taste in mouth.
- Clinical examination and radiographs are done.
- The person is put on painkillers and warm saline gargles. Sometimes antibiotics are prescribed.
- At a later stage the tooth might have to be either guided to erupt properly or totally extracted.
There can be fracture, loosening of the tooth (luxation), displacement of the tooth (avulsion), or the tooth could completely leave the socket (expulsion). Lot to attention is required here. The dentist would:
- Assess the patient through clinical examination and radiographs.
- Emergency root canal might be required with splinting of the teeth.
- Suturing of the soft tissue.
An avulsed tooth or expulsed tooth is a true emergency. It can be re-implanted immediately. But if the tooth is contaminated, then it should be rinsed in water and re-implanted immediately. Care should be taken not to wash away the tissues attached to the tooth. This makes it easier for the tooth to have its natural space.
Just in case immediate re-implantation is not possible, then place the tooth either in the place between the cheek and other teeth of the patient, or place it in milk, and transport it as early as possible to the dentist’s office. Preferably in an hour. Less optimal alternates are available for avulsed tooth, so that the natural tooth can be held in place.
Fractured orthodontic appliance
Emergency due to orthodontics could be either due the fracture of appliance or due to the maintenance.
- Loosening of the appliance.
- Fractured appliance if the appliance is removable the user should stop using it.
- Fractured fixed appliance. Often the appliance breaks when the user chews hard. Contact sports could result in fractured appliances too. This calls for both repair of the fractured appliance and management of any soft tissue damage.
- Loss of small wires or ligatures that are used to secure archwires. This could happen with wear and tear. Sometimes the ligature or bracket in itself can cause soft tissue irritation.
- Many times space is created for orthodontic treatment by extraction; this space is held by what is known as separators. These separators can get lost particularly since the users tend to try and manipulate it to a comfortable space.
- Protruding wires or brackets cause soft tissue damage.
- Allergy or hypersensitivity.
A ready reckoner on when is it a dental emergency
Pain with hot, cold, and sweet stimuli
It could be pulpal inflammation(reversible). Possible complications include abscess at the bottom of the tooth and swelling of the jaw
Spontaneous pain, not able to locate exactly where
Could be due to pulpal inflammation (irreversible). Possible complications include abscess at the bottom of the tooth and swelling in the jaw.
Swelling the gums, local tooth is painful to touch
Usually occurs due to an abscess. Possible complications include increased swelling and spread of infection
Diffused swelling, dull ache, redness
It could be soft tissue infection(cellulites). Spreading to adjacent areas could be a possible complication.
Broken tooth, loose tooth etc. also may require emergency dental assistance.
If you ever find yourself in unbearable pain or if you have had some sort of dental trauma, get in touch with the nearest emergency dental clinic immediately.