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Most dental emergencies fall into a small number of categories. The right first step is different for each one.

An emergency room is the right place if you have uncontrolled bleeding, jaw fracture, swelling that is interfering with breathing or swallowing, or trauma to the head along with the dental injury. Hospital emergency rooms are not set up to do dental restorations, but they can stabilize life-threatening problems and prescribe antibiotics when needed. Call us afterward and we will handle the dental work.

Pain that comes and goes with hot or cold and disappears within seconds usually means a sensitive tooth or an early cavity — not an emergency, but something to look at. Pain that lingers for minutes after hot or cold, or that wakes you up at night, usually means the nerve inside the tooth is inflamed or infected and the tooth probably needs a root canal or extraction. Pain when you bite down often means a cracked tooth or a tooth with an abscess.

Pressure-related pain combined with swelling on the face or gum is a clear sign of infection. Do not wait. Call us. Antibiotics may be appropriate to start, but the source of the infection — the tooth itself — needs treatment to actually resolve the problem.

An adult tooth that has been completely knocked out has its best chance of being saved if it is reimplanted within 30 to 60 minutes. Pick the tooth up by the crown — the part you chew on — never by the root. If the tooth is dirty, rinse it gently with milk or saline (not tap water and never scrubbed). If you can place it back in the socket, do so and bite gently on a clean cloth on the way to our office. If you cannot, store it in cold milk or, if nothing else is available, between your cheek and gum.

Baby teeth that have been knocked out are not reimplanted — that can damage the developing adult tooth underneath. Save the tooth and call us; we will check the area and discuss whether a space maintainer is needed.

A broken or cracked tooth ranges from a tiny chip on a corner (cosmetic, easy fix) to a tooth split through the root (often unsalvageable). Most fall somewhere in the middle. The pieces of the tooth, if you can save them, sometimes can be bonded back. More often we restore the tooth with a filling, a crown, or — if the crack extends below the gum line — extraction and a replacement plan.

Cracked teeth that hurt only when biting are common after years of grinding or chewing on hard foods (ice, popcorn kernels, hard candy). They need to be evaluated quickly because cracks tend to extend further with continued use. The earlier we see it, the better the chance of saving the tooth.

A crown that comes off intact can usually be cemented back on. Save the crown, keep the tooth clean, and avoid chewing on that side. Do not use super glue or household adhesives — they damage both the crown and the tooth. Pharmacy temporary cement is fine for a day or two.

A filling that has come out leaves a hole that food can pack into and that can be sensitive to temperature. We will replace it. Sometimes a lost filling means the underlying decay was larger than originally diagnosed and the tooth needs a crown instead of a new filling; we will tell you what we find.

Ibuprofen 400-600 mg every six hours (if you can take it) plus acetaminophen 500-1000 mg every six hours, alternating, is usually the best over-the-counter combination for dental pain. A cold compress on the outside of the cheek for 15 minutes at a time helps with swelling. Avoid heat. Avoid lying flat — propping your head up reduces throbbing.

These are short-term measures while you wait to be seen. They do not treat the underlying problem. Call us.