By the Lakehurst Dental Team · Medically reviewed by Brian S. Klohn, DMD, University of Pennsylvania School of Dental Medicine, 1991 · Lakehurst Dental, 19 Union Avenue, Lakehurst, NJ
Quick Answer
Call a dentist the same day for a knocked-out tooth, a tooth pushed out of position, severe or throbbing pain, a broken tooth with bleeding or exposed pulp, facial swelling, or uncontrolled bleeding. A knocked-out adult tooth is the one true race against the clock: pick it up by the crown and never the root, rinse it briefly in milk or saline if dirty, put it straight back in the socket if you can, and if you cannot, transport it in milk — not water — and get to a dentist within an hour. Facial swelling with fever, or any difficulty breathing or swallowing, is a hospital emergency, not a dental appointment.
What This Article Covers
- First: What Needs a Hospital, Not a Dentist
- A Knocked-Out Adult Tooth — the Clock Starts Now
- A Tooth Pushed Loose or Out of Position
- A Broken or Chipped Tooth
- Severe Toothache
- Swelling and Abscess
- Lost Filling, Lost Crown, and Broken Dentures
- Preventing the Preventable Ones
- Frequently Asked Questions
First: What Needs a Hospital, Not a Dentist
Almost everything on this page is handled in a dental office. These are the exceptions, and they matter more than anything else here.
Go to an emergency room immediately if there is:
- Difficulty breathing or swallowing
- Swelling that is spreading down the neck, or closing the eye
- Fever alongside facial swelling
- An injury involving possible jaw fracture, or loss of consciousness
- Bleeding that cannot be controlled with firm pressure
A dental infection that has begun to spread into the tissues of the face and neck can compromise the airway. That is rare, but it is the reason this list comes first rather than last. Swelling that is getting visibly worse over hours, rather than days, should be treated as urgent.
A Knocked-Out Adult Tooth — the Clock Starts Now
This is the single situation where what you do in the next few minutes materially changes the outcome. The cells on the root surface must stay alive, and they begin to die quickly once the tooth is out and dry.
- Find the tooth and pick it up by the crown — the white chewing part. Do not touch the root. The root surface carries the ligament cells that allow reattachment, and handling or scrubbing them destroys them.
- If it is dirty, rinse it briefly — a few seconds in milk, saline or the patient’s own saliva. Do not scrub it, do not use soap, and do not use tap water for prolonged rinsing.
- Put it back in the socket if you possibly can. This is the best transport medium there is. Orient it correctly, press it gently into place, and have the person bite softly on a clean cloth or gauze to hold it.
- If you cannot reinsert it, keep it moist in milk. Milk is far better than water — plain water damages the root cells because of its osmotic difference. Saline or the person’s own saliva (held in the cheek, if the person is old enough not to swallow it) also work. Never transport a tooth dry, and never in tissue paper.
- Get to a dentist immediately. Within an hour gives the best chance. Call on the way.
Baby teeth are the exception: do not reimplant them. Putting a knocked-out primary tooth back can damage the permanent tooth developing above it. Keep the child comfortable and call the dentist for advice.
A Tooth Pushed Loose or Out of Position
A tooth that is loosened or displaced but still in the socket is also time-sensitive, though slightly less so than one fully out.
Do not force it. Very gentle repositioning with light finger pressure is reasonable if it moves easily, but do not push hard. Have the person avoid biting on it, and call the same day. A displaced tooth usually needs to be repositioned and splinted to the neighbouring teeth while the ligament heals.
A Broken or Chipped Tooth
How urgent this is depends on what is exposed.
- A small chip in enamel with no pain is not an emergency. Book a normal appointment. Avoid chewing on that side.
- A larger break with sensitivity means dentine is exposed. See a dentist within a day or two. Covering it and avoiding temperature extremes helps in the meantime.
- A break with visible pink or red in the centre, or bleeding from within the tooth, means the pulp is exposed. This is genuinely urgent — same day. The chance of saving the nerve drops with time.
Save any fragments in milk; they can occasionally be bonded back. Rinse the mouth with warm water, apply a cold compress to the outside of the face for swelling, and use over-the-counter pain relief as directed.
Do not put aspirin against the gum. It is an acid and it burns the tissue — it does nothing for the tooth from the outside. This is a persistent piece of folk advice that causes real chemical burns.
Severe Toothache
Pain that is throbbing, spontaneous, keeps you awake, or is not relieved by over-the-counter pain relief needs to be seen. Pain of that character usually means the pulp is inflamed or infected, and it does not resolve on its own.
While you wait:
- Rinse with warm salt water
- Floss gently around the tooth once, in case food is trapped — this occasionally resolves the whole problem
- Cold compress on the outside of the face
- Keep your head elevated, including when sleeping; lying flat often makes dental pain worse
- Take pain relief as directed on the packet
A warning sign worth knowing: if severe pain suddenly stops entirely and is replaced by a dull ache, pressure or swelling, that is often the nerve having died — not the problem resolving. It still needs treatment, and often more urgently than before.
Swelling and Abscess
A dental abscess is a collection of pus caused by infection, either from the nerve inside a tooth or from a deep gum pocket. Signs include a persistent throbbing ache, tenderness to touch or biting, a pimple-like bump on the gum that may discharge, a foul taste, and swelling.
Swelling is what changes the urgency. Any facial swelling from a dental source should be seen the same day. Swelling that is enlarging over hours, involves the eye or the floor of the mouth, or comes with fever or difficulty swallowing, means the emergency room.
Two things not to do: do not apply heat to the outside of the face, which encourages the infection to spread, and do not attempt to lance or squeeze a swelling yourself.
Antibiotics alone are frequently not the answer. They may control spread, but the source — an infected nerve or a deep pocket — still has to be treated, whether by root canal treatment, drainage, or extraction.
Lost Filling, Lost Crown, and Broken Dentures
These are urgent-ish rather than emergencies, but they are uncomfortable and worth handling correctly.
A lost filling leaves a cavity open. Keep it clean, avoid chewing on it, and book promptly. Temporary filling material from a pharmacy is a reasonable short-term measure.
A lost crown should be kept and brought in — it can often be recemented. The exposed tooth underneath is frequently sensitive. Temporary dental cement from a pharmacy can hold it for a day or two, but never use household adhesive of any kind.
A broken denture should not be repaired with glue. Household adhesives are toxic in the mouth and make a professional repair harder or impossible. Bring the pieces in.
Soft tissue injuries — a bitten lip, tongue or cheek — are managed with clean gauze and firm pressure for fifteen minutes, and a cold compress. If bleeding does not stop after fifteen minutes of continuous pressure, seek care.
Preventing the Preventable Ones
A meaningful proportion of dental emergencies are avoidable, and two measures cover most of them.
Wear a mouthguard for contact sport. A custom-fitted guard is more protective and considerably more comfortable than a boil-and-bite version, which means it actually gets worn.
Do not use your teeth as tools. Opening packaging, cutting thread, holding nails, and chewing ice are all common ways teeth crack. So is biting into hard sweets and popcorn kernels.
And the least dramatic but most effective measure: attend routine examinations. Most emergencies are the end point of something that was small and symptomless a year earlier.
Frequently Asked Questions
Pick it up by the crown, never the root. If it is dirty, rinse it for a few seconds in milk or saline — do not scrub it. Put it back into the socket if you can and bite gently on gauze to hold it in place. If you cannot reinsert it, keep it moist in milk and get to a dentist within an hour. Never let the tooth dry out and never transport it in tissue. Baby teeth are the exception and should not be put back in.
Plain water damages the delicate ligament cells on the root surface because of its osmotic difference from the fluid those cells are adapted to. Those cells are what allow the tooth to reattach, so keeping them alive determines whether the tooth can be saved. Milk is close enough in composition to preserve them. Saline works, as does the person’s own saliva. A brief rinse under water to remove visible dirt is acceptable, but the tooth should not be stored in it.
Go to an emergency room for difficulty breathing or swallowing, swelling spreading down the neck or closing the eye, fever alongside facial swelling, a suspected jaw fracture, loss of consciousness, or bleeding that cannot be controlled with firm pressure. A dental infection that spreads into the tissues of the face and neck can affect the airway, which is why swelling that worsens over hours rather than days should always be treated as urgent.
Usually not. When intense pain disappears abruptly and is replaced by a dull ache, pressure or swelling, it commonly means the nerve inside the tooth has died rather than that the problem has resolved. The infection remains and can spread into the surrounding bone. This still needs treatment, often more urgently than before the pain stopped. Book an appointment rather than assuming the issue has passed.
No. Aspirin is an acid, and holding it against the gum causes a chemical burn to the soft tissue while doing nothing whatsoever for the tooth. Pain relief works by being swallowed and absorbed. Take it according to the packet directions instead, rinse with warm salt water, use a cold compress on the outside of the face, and keep your head elevated, since lying flat often makes dental pain worse.
No. Household adhesives are toxic in the mouth and frequently make a proper repair impossible, turning a straightforward fix into a remake. For a lost crown, keep it and bring it in — it can often be recemented, and pharmacy temporary dental cement is acceptable for a day or two. For a broken denture, bring the pieces in without attempting a repair. Denture fit is precise, and a misaligned glued join cannot be corrected.
Antibiotics can control the spread of infection and reduce swelling, but they do not resolve the cause. The source is usually an infected nerve inside the tooth or a deep gum pocket, and that has to be treated directly — through root canal treatment, drainage, or removal of the tooth. An abscess treated with antibiotics alone commonly recurs once the course finishes. Antibiotics are a supporting measure, not the treatment.
Speak With a Dentist in Lakehurst
If something has happened and you are not sure whether it counts as an emergency, call and describe it — that is exactly the kind of call we would rather receive than not. Lakehurst Dental has cared for families in Lakehurst, Toms River and across Ocean and Monmouth counties for more than 34 years. To ask a question or arrange a consultation, call (732) 943-4090 or contact our office.
This article is general information and is not a substitute for an examination and personal advice from your dentist.