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Ouch! Handling Mouth Emergencies.
By Dr. Tareq Khalifeh, DDS

At the end of my dental schooling at NYU, I served as a resident at Albany Medical Center’s Emergency Dental Unit. It was an eye-opening experience for me, that taught me, among other things, just how widespread the dangers are for our mouths. Damage comes in all types and sizes, from a child’s first cavity left untreated, to a bitten tongue or a tooth knocked out on the tennis court. And few people know much about oral first aid.

So here are a few tips you should know for preventing and handling mouth emergencies.

 

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When in Doubt, Check it Out

There are two types of emergencies. Severe infection can cause irreversible damage to teeth, gums, or bone. Such infections may start out as dull aches and pains that grow in intensity until they are unbearable. Left untreated, any infection can be quite dangerous, because of the potential for bacteria to damage living tissue and to spread to other sites in the body. The best prevention is to contact your dentist whenever you have a suspicious toothache or pain in your mouth or jaw. Don’t let it develop into a greater hazard. My motto: “When in doubt, check it out.”

The other type of emergency is injury to a tooth, the gums, lips, tongue, or jaw.

You’d be surprised how commonly people crack or break teeth, for example. Such injuries can result from something as innocuous as biting wrong on a popcorn kernel or an olive pit. Teeth that have undergone root canal treatment or large structural restorations are particularly at risk. Diagnosis can be difficult; if the crack is small, it won’t be visible to the naked eye, or sometimes even with an x-ray. But a cracked tooth will usually cause terrible pain when exposed to cold, heat, or pressure, and is likely to crack more. What’s more, infection can develop quickly, as saliva and bacteria get into the tooth. If you suspect a crack, don’t put off having it evaluated.

What about injuries caused by a fall, a blow, or other trauma? The first worry is that blood or loose teeth aren’t obstructing the person’s breathing. And because head trauma severe enough to fracture a bone or produce heavy bleeding could also mean a spinal injury, don’t move the person at all if you suspect such a trauma. If you are sure there is no serious head, neck, or back injury, have the person sit with their head leaning forward and tilted slightly—or lying on their side—to allow blood to drain out of the mouth.

Look for damage to the person’s lips, tongue, or gums. Place rolled gauze between an injured lip and the gum and place a sterile dressing on the outside of the gum. A bleeding tongue can be dressed with sterile gauze and pressure applied. Ice should always be used to reduce swelling and stanch the bleeding. Bad tears and punctures will need to be stitched and treated with anti-inflammatory and/or antibiotic medications by your dentist or emergency room physician.

If one or more teeth is knocked out, the immediate concerns are to stop bleeding and to find and carefully protect the dislodged tooth or teeth. Some people advise just putting them back into the injured person’s mouth, but this is not really safe for the patient. The best method is to put the tooth in a closed container of milk, if available, or of water. Be careful how you handle it! Pick the tooth up by the chewing edge only. The root of the tooth is lined with fragile fibers that are crucial to reimplantation. Most teeth can be successfully replanted if the tooth is handled properly and replanted within an hour of the injury.

If you suspect that the injured person’s jaw is broken, try to secure it gently with a sling made with a towel, handkerchief, or other cloth. The sling can go over the top of the person’s head to keep the jaw from moving. Apply cold compresses to minimize swelling and go straight to the emergency room.

Everyone should be prepared for trauma or infection, and know when to get help. Always keep an emergency kit with sterile water, dressings, and splint material in your house and car. Be sure everyone knows where they are and how to use them. Keep a card in your wallet or your child’s backpack with the name and phone number of your physician or pediatrician, dentist, and preferred hospital, as well as any medical insurance information. You can never be too prepared for emergencies.

Dr. Khalifeh’s practice, Philmont Family Dentistry, can be reached at 518-672-4077 or online at www.philmontfamillydentistry.com.

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