Tooth Pain Making You Think About Going to the Emergency Room?

Dental pain, and toothaches specifically, are a HUGE source of avoidable trips to the emergency room.  We always want to keep ER beds clear for true emergencies, and that will especially be true in the coming weeks.  So let’s review when you DO have an urgent situation that warrants a trip to the ER, when it’s better to call your dentist, and what options you have if you don’t have a dentist, or can’t get in touch with him/her, and are in pain.  

You SHOULD go to the emergency room if:

• You have swelling from a toothache that has spread to other parts of your face, especially your eye or below your jaw line.
• You have a toothache accompanied by a high fever (>101).
• You have bleeding that can’t be controlled with pressure (more on this below).
• You have a toothache, and start to have trouble swallowing or breathing.
• You have been on oral antibiotics for at least 24 hours, and are still continuing to get worse.
• You have had a trauma or blow to the face or jaw, that results in swelling, bleeding, or your teeth not fitting together properly.  
  

Tooth infections and orofacial traumas can be very serious.  Even when I prescribe someone antibiotics, sometimes it’s not enough or too late to prevent the infection from becoming serious.  Your mouth is VERY close to a lot of other important structures in your head and neck, so when you need to go, don’t take it lightly.  However…

You do NOT need to go to the ER (at least not yet) if:

• Your only symptom is pain.  I know this is harsh, but while pain is certainly a signal that something is wrong, medically speaking, it is not an emergency.
• You had a tooth extracted earlier in the day, and you’re continuing to bleed.  This almost always looks way worse than it actually is, because blood will mix with saliva and look like a lot.  
• You broke a tooth, or you (or your child) knocked a permanent tooth completely out (root and all).
  

These are all things that warrant a call to your dentist, even if it’s after hours, so that they can walk you through what to do.  Especially if a tooth was knocked out; the quicker you see a dentist, the greater the chances that the tooth can be saved.  

What if you don’t have a dentist, or can’t get in touch with him or her?

• If you’re in pain, alternate doses of acetaminophen and ibuprofen (ie, acetaminophen at 12:00, ibuprofen at 2:00, acetaminophen at 4:00, etc).  Keep your head elevated at night, and apply ice for 20 minutes at a time. Find a dentist (or worst case scenario, and urgent care clinic) first thing in the morning.
• If you’re bleeding after an extraction, and can’t get in touch with the dentist who performed the procedure, take some clean gauze or a clean washcloth, and apply firm pressure directly to the site for 15 minutes.  If the bleeding (not including saliva) is still heavy enough to fill a ¼ cup measuring cup, and not improving, then seek medical attention.
• Increasingly, there are dental offices that are open after hours for this very purpose. One in this area, open from 6pm until midnight, is After Hours Dental Care but you can search to see if there’s one near you.  
• Check out The Teledentists.  I’m proud to be one of the first dentists in this startup, and while they are increasing available through telemedicine channels, you can also contact them directly.  
  

If you do have a dentist, rest assured that none of us want to see you go to the emergency room unnecessarily.  Most of us take calls after hours for our existing patients, and I am increasing my teledentistry capabilities in my practice to make this even easier.  Hospital emergency rooms are EXCELLENT at taking care of emergency situations, but simply aren’t set up for dental care.  Let’s help keep you out of there when we can, and help ER staff focus on those that truly need emergency care.