First aid for teeth: handling dental emergencies until you reach the dentist

What you do in the first few minutes often decides the outcome — particularly for a knocked-out tooth, where the window is measured in minutes, not hours.

Worth reading before you need it.

First: is this a hospital problem?

Some dental problems are medical emergencies. Go to a hospital emergency department, or call 000, if there is:

• Swelling of the face, jaw or under the eye, or swelling that is spreading
• Difficulty breathing, swallowing, or opening the mouth
• Fever alongside dental pain or swelling
• Bleeding that will not stop with firm pressure after 20 minutes
• A suspected broken jaw, loss of consciousness, or a head injury with confusion, vomiting or drowsiness

Spreading facial swelling from a dental infection can compromise the airway. That is an emergency department presentation, not a dental appointment, and it should not wait until morning.

The first sixty seconds, whatever has happened

1. Check the person, not the tooth. Breathing, consciousness, and any head injury come first
2. Control bleeding with firm pressure on clean gauze or cloth
3. Find the tooth or the fragment, if there is one, before it is lost
4. Get it into milk — or back in the socket — within minutes
5. Call, and say what happened rather than asking for the next available appointment

Everything else can wait five minutes. Those five things cannot.

A knocked-out adult tooth

The most time-critical dental emergency there is. Every minute out of the socket reduces the chance of saving it.

1. Find the tooth and pick it up by the crown — the chewing surface. Never touch the root.
2. Do not scrub it, and do not scrape off any tissue attached to the root. Those cells are what allow it to reattach.
3. If it is dirty, rinse it briefly in milk or the person's own saliva. Not water — water damages the root surface cells and reduces the chance of the tooth surviving.
4. Put it straight back in the socket the right way round if you can, and bite gently on a clean cloth to hold it there. This is the best possible transport.
5. If you cannot reimplant it, keep it moist: in milk, in saliva, or held inside the cheek. Not in the cheek for young children — choking risk. Milk is the best readily available option; plastic wrap is a reasonable fallback.
6. Call us immediately and say a tooth has been knocked out.

A knocked-out baby tooth is never put back. Reimplanting it can damage the adult tooth developing underneath. Still get the child seen.

Storage, ranked

Why the clock matters

The cells on the root surface begin to die within about fifteen minutes of drying. Reimplantation within the first hour gives the best chance; after that, the odds fall steadily.

This is why the advice is to put the tooth back and then telephone, rather than the other way round.

A cracked, chipped or broken tooth

Keep any fragments in milk or saliva and bring them — they can sometimes be bonded back on.

Rinse gently with warm water. Cold compress on the outside of the cheek for swelling. Avoid chewing on that side. Sharp edges can be covered temporarily with orthodontic wax or sugar-free gum.

A small chip with no pain is usually not urgent, but book within a few days. A tooth that hurts, is sensitive to air or cold, is mobile, or has been pushed out of position needs to be seen promptly — that suggests the nerve or the socket is involved.

A pink or red dot visible in the middle of a fresh break means the nerve is exposed. That is a same-day problem, and it is usually painful.

A tooth that has been moved rather than lost

Common in falls and sport, and frequently under-treated because the tooth is still there.

• Loosened but in position — soft diet, avoid touching it, and be seen promptly. It may need splinting
• Pushed sideways or out of line — do not force it back yourself. Same-day dental care; repositioning is time-sensitive
• Pushed up into the gum — common in children. Same-day care; the management differs with age
• Any of the above in a baby tooth — still get it looked at, because the adult tooth is developing right behind it

Toothache

Rinse with warm salty water and floss gently either side to dislodge trapped food, which is a surprisingly common cause.

Over-the-counter pain relief taken as directed on the packet may help. Do not hold aspirin or any tablet against the gum — it burns the tissue and causes an ulcer on top of the toothache.

A cold compress on the outside of the cheek can help. Pain that wakes you at night, or lingers after hot or cold, usually means the nerve is involved and changes what treatment is needed.

If severe pain suddenly stops on its own, that is not recovery. It often means the nerve has died. The infection is still there. Get it seen.

Dental abscess

A collection of pus from infection — typically throbbing pain, a bad taste, sometimes a gum boil or swelling.

Rinse with warm salt water. Do not attempt to squeeze or drain it yourself. This will not resolve on its own and needs treatment. If swelling is spreading, or you have a fever or difficulty swallowing, see the hospital section above.

If a gum boil bursts and the pain suddenly eases, the infection has not gone — it has found a way out. It still needs treating.

Lost filling or crown

Usually uncomfortable rather than urgent. Keep the crown if you have it — it can often be recemented. Temporary dental cement from a pharmacy can cover the tooth meanwhile. Avoid chewing on that side and book within a few days.

Never use superglue. It is toxic to the pulp and it usually makes proper recementing impossible, which turns a recement into a new crown.

Other things that come up

Something wedged between teeth. Floss gently. If it will not come out, leave it and call — pins, knives and paperclips cause more damage than the popcorn husk did.

A cut lip, tongue or cheek. Clean gently, firm pressure with gauze for fifteen to twenty minutes, cold outside. These bleed dramatically and usually look worse than they are. Still bleeding after twenty minutes of proper pressure: emergency department.

Bleeding after an extraction. Roll gauze into a firm pad, place it directly over the socket rather than between the teeth, bite steadily for thirty minutes without checking, and sit upright.

Dry socket. A severe throbbing ache starting three to four days after an extraction, often radiating to the ear. Not an infection — the clot has been lost. It responds quickly to a dressing, so call rather than enduring it.

A broken denture. Do not glue it. Bring all the pieces.

An orthodontic wire poking. Cover the end with orthodontic wax or sugar-free gum, or tuck it down gently with the blunt end of a teaspoon. Contact the practitioner managing your treatment.

A burn to the palate from hot food. Cold water, soft cool food, and it heals in a few days. See someone if it has not settled in a week.

Bleeding gums

Gums that bleed when you brush are not an emergency. It is a sign of inflammation — usually gingivitis — and it needs an appointment, not a same-day one. Keep brushing gently; stopping makes it worse.

Bleeding that will not stop with firm pressure, or heavy bleeding after an extraction, is different — bite firmly on clean gauze for 20 minutes without checking. If it continues, call us or go to an emergency department.

What not to do

• Do not scrub a knocked-out tooth, or store it dry or in water
• Do not put a baby tooth back in
• Do not hold aspirin against a gum
• Do not use superglue on anything in your mouth
• Do not apply heat to a swollen face — it helps infection spread
• Do not take someone else's leftover antibiotics
• Do not attempt to pull out a loose tooth, or drain a swelling
• Do not assume that pain stopping means the problem stopped

What to have on hand

A small kit is worth assembling if you have children playing sport: gauze, a small sealable container, orthodontic wax, temporary filling cement, and a cold pack. Milk from the fridge covers the rest.

For a school, workplace or sports club, the two items that make the difference cost almost nothing: a small carton of long-life milk and a clean container with a lid. Neither is in most first aid kits, and both should be.

Telling us what happened

When you call, have this ready — it determines how quickly you are seen:

• What happened and exactly when
• Whether a tooth is out, and where it is right now
• Whether there is swelling, and whether it is growing
• Whether there is a fever
• Any head injury, and whether the person was knocked out
• Medical history and medications, particularly blood thinners
• Whether the person is pregnant

Reaching us

Victorian Dental Group — 291 Wattletree Road, Malvern East VIC 3145 · (03) 9088 5808 · Monday to Friday, 8:00am–5:00pm. Closed weekends and public holidays.

We are a general dental practice, hold no specialist registration, and do not operate an after-hours or on-call service. Outside those hours:

• Life-threatening symptoms — call 000 or attend the nearest emergency department
• Urgent but not life-threatening — Nurse-on-Call on 1300 60 60 24, 24 hours, staffed by registered nurses
• Public emergency dental care — the Royal Dental Hospital of Melbourne, 720 Swanston Street, Carlton, for eligible patients
• Can wait until morning — manage the pain and call when we open. Online booking is available at any hour

See our dental emergency page for more detail, the after-hours checklist, or what to do when dental disaster strikes.

General information only, not personal dental advice, and not a substitute for being examined. If in doubt, seek care rather than waiting. See our disclaimer.