Knocked-Out or Cracked Tooth: What to Do in the First Hour

A dental emergency almost never happens at a convenient time. It is a Saturday night, or you are an hour from home, or your kid comes off the trampoline holding a tooth in their hand. Most people freeze for a minute, and that is understandable. But the first hour usually matters more than anything that happens afterward, and what you need to do in that hour is simpler than you would think.

Here is how I would want you to handle the situations we see most often.

A tooth that has been knocked out

This is the one that is genuinely time-sensitive. A permanent tooth that has been fully knocked out has its best chance when it gets back into the socket quickly. Minutes matter here, not hours.

• Pick it up by the crown, the white part you chew with. Try not to handle the root.

• If it is dirty, rinse it gently for a few seconds in milk or saline. Water is fine if that is all you have. Do not scrub it, do not use soap, and do not dry it off. The tissue on the root needs to stay moist.

• If you can manage it, put the tooth back in the socket the right way around and bite gently on a clean cloth to hold it in place.

• If you cannot reseat it, keep it wet. A cup of cold milk is the best easy option. An adult can also hold it in the cheek pouch. Plain water is a last resort.

• Call a dentist right away and say a tooth has been knocked out, so you are seen immediately rather than scheduled.

One exception worth knowing: a knocked-out baby tooth is not put back in, because reimplanting it can damage the permanent tooth still forming underneath. Still call us, since we will want to look at the socket and the neighboring teeth, but do not try to reseat it.

A chipped, cracked, or broken tooth

These range from purely cosmetic to serious, and you usually cannot tell which from the outside. Pain is not a reliable guide. Some badly cracked teeth do not hurt at all at first.

• Rinse your mouth with warm water.

• Hold a cold compress against the cheek if there is swelling, roughly twenty minutes on and twenty minutes off.

• Save any pieces you find in milk or saline. Depending on the break, a fragment can sometimes be bonded back on.

• Stay off that side when you eat, and skip very hot or very cold foods, which tend to set off a cracked tooth.

• Call us even if it has stopped hurting.

A toothache that will not let up

A tooth that aches for more than a day or two is telling you something, and it rarely sorts itself out.

• Rinse with warm salt water and floss carefully around the tooth. Sometimes it is food wedged under the gum.

• Over-the-counter pain relievers, taken as the label directs, are reasonable while you wait for an appointment.

• Do not hold an aspirin against the gum. It does nothing for the tooth and it burns the tissue.

Some things mean you should not wait for a routine opening: swelling in your face or jaw, a fever along with the pain, or a sudden bad taste as the pressure releases, which can mean an abscess has drained. Call the same day.

When to go to the emergency room instead

A dental office is the right place for most of this, but not all of it. Go to an emergency room, or call 911, if you have:

• Trouble breathing or swallowing

• Swelling spreading toward your eye or down into your neck

• Bleeding that will not stop after fifteen minutes of firm pressure

• A jaw that will not open or close properly after an injury, or any head injury with confusion or loss of consciousness

Those can turn into airway or whole-body problems, and they belong in a hospital.

Making an emergency less likely in the first place

• Wear a mouthguard for contact sports. A fitted one is more comfortable, which means it actually gets worn.

• If you grind at night, a night guard protects against the slow cracking that tends to show up years later.

• Do not open packages, bottles, or hair clips with your teeth.

• Go easy on ice, popcorn kernels, and hard candy, especially if you already have large fillings.

• Keep up with regular checkups. A good share of what we catch early would have become an emergency eventually.

If something does happen

Call before you drive over. It lets us block off the right amount of time and have the right room ready, and after hours it gets you real instructions instead of a guess. Bring the tooth or the fragments if you have them, and a list of any medications you take.

This post is general information rather than a diagnosis. Every mouth and every injury is different, so please have yours looked at instead of relying on what you read here.

Hashimi Dental, 3701 Market St. Suite E, Riverside, CA 92501