Knocked-out permanent tooth

A permanent tooth that has been completely knocked out can often be replanted, but the window is short. The best outcomes happen when the tooth is back in the socket within thirty minutes. After about an hour outside the mouth, the odds drop sharply.

  1. Pick it up by the crown, never the root

    The crown is the part you normally see in the mouth. The root surface is covered in living cells that must survive for the tooth to reattach, and handling or scrubbing the root kills them.

  2. Rinse gently only if it is dirty

    Use milk, saline or the patient's own saliva. Rinse for no more than ten seconds. Do not use tap water for storage, do not scrub, do not use soap, and do not dry the tooth or wrap it in a tissue.

  3. Put it back in the socket if you can

    This is the best storage medium there is. Line it up with the neighboring teeth, push gently but firmly into place, and have the patient bite on a clean cloth or gauze to hold it there.

  4. If you cannot replant it, keep it wet

    Cold milk is the most widely available good option. A tooth preservation solution is better if you have one. Saliva works, including holding the tooth inside the cheek for an older child or adult who will not swallow it. Plain water is the worst of these choices because it damages the root cells.

  5. Call us and come straight in

    Call (559) 683-4694 on the way so we can be ready. Bring the tooth even if it is broken or you are unsure it can be saved.

What to do for other common emergencies

These are the situations we see most often. In every case, call the office. These steps are for the time between the injury and your appointment.

Broken or chipped tooth
Save any pieces you can find and bring them with you. Rinse your mouth with warm water. Use a cold compress on the outside of the face to limit swelling. If the broken edge is sharp, cover it with orthodontic wax or sugar-free chewing gum so it does not cut your tongue or cheek.
Toothache that will not settle
Rinse with warm salt water and floss gently on either side of the tooth in case food is trapped. Take over-the-counter pain relief as directed on the label if you are able to take it safely. Do not hold aspirin against the gum, which burns the tissue. Heat on the face can make an infection worse, so use cold instead.
Lost filling or crown
Keep the crown and bring it in. Temporary dental cement from a pharmacy can hold a crown in place for a day or two. Denture adhesive works in a pinch. Never use household glue. Avoid chewing on that side, and be careful with hot and cold, because the exposed tooth will be sensitive.
Swelling in the face or gum
Facial swelling means an infection has spread beyond the tooth and needs prompt attention. Call the office the same day. If the swelling is growing quickly, involves your eye or your neck, or comes with fever or trouble swallowing, go to an emergency department instead of waiting.
Something stuck between teeth
Try dental floss first, easing it gently. If floss does not work, stop. Do not use a pin, a knife, a needle or anything metal, which can damage the gum and push the object deeper. Call us.
Bitten lip, cheek or tongue
Clean the area gently, apply firm pressure with clean gauze or cloth for ten to fifteen minutes, and use a cold compress. Mouth wounds bleed heavily and often look worse than they are. If bleeding does not slow after twenty minutes of steady pressure, seek urgent care.
Broken jaw or suspected fracture
Do not try to reposition the jaw. Support it with a bandage or a folded towel wrapped over the top of the head to keep it still, apply cold to the outside, and go to an emergency department.
Orthodontic wire poking the cheek
Cover the end with orthodontic wax or a small piece of cotton. If a wire is embedded in tissue, do not pull it out. Call for an appointment.

What happens when you arrive

The first job is to make you comfortable and to find out what is actually going on, which is not always what it feels like. Referred pain is common in the mouth, and an upper tooth can feel like a lower tooth, a sinus problem can feel like a toothache, and a cracked tooth can hurt without showing anything obvious to the eye.

Expect a focused examination of the area, an x-ray of the tooth and the bone around it, and tests to work out whether the nerve inside the tooth is alive, inflamed or dead. That answer determines everything that follows. A tooth with a reversibly inflamed nerve may only need the source of irritation removed. A tooth with an infected or dying nerve needs either root canal therapy or extraction.

We will tell you what we found, what your options are, what each one costs, and what happens if you do nothing. In an emergency the goal is usually to get you out of pain and stabilize the situation the same day, then plan the definitive repair for a scheduled visit when you are comfortable and not making decisions under pressure.

How to avoid most dental emergencies

Some emergencies are pure bad luck. Most of the ones we treat were predictable months in advance, and were visible on an x-ray or a chart note long before they hurt.

  • Wear a mouthguard for sport. A custom-fitted guard protects better than a boil-and-bite one and is far more likely to be worn, because it is comfortable enough to keep in.
  • Treat a cracked tooth before it splits. A crack that is caught early can often be crowned. Once it runs below the bone the tooth usually cannot be saved.
  • Do not use your teeth as tools. Opening packaging, cutting thread, holding nails and cracking shells account for a real share of the fractured teeth we see.
  • Take care with hard foods. Ice, unpopped popcorn kernels, hard candy and olive pits break teeth that were otherwise fine, especially teeth with large old fillings.
  • Keep your recall appointments. Almost every emergency we treat had an earlier, cheaper, less painful version that was visible at a routine exam.
  • Address grinding. If you clench or grind at night you are loading your teeth for hours at a time. A night guard is a small investment against fractured cusps and failed restorations.

Emergency questions we hear most

Will I be seen the same day?

We hold time in the schedule for genuine emergencies and we do our best to see you the same day during business hours. Call as early in the day as you can. The office is open Monday to Wednesday from 8:30 am to 5:00 pm and Thursday from 7:30 am to 4:00 pm.

What do I do if it happens on a Friday or over the weekend?

Follow the first-aid steps above, which are what matters most in the first hour. Call the office when it opens. If the problem involves spreading swelling, fever, difficulty breathing or swallowing, or bleeding you cannot control, do not wait for the office to open. Go to an urgent care center or an emergency department.

Can a knocked-out tooth really be saved?

Often, yes, if it is a permanent tooth and it is handled correctly and quickly. The single biggest factor is how long the root surface is dry. Replanting it yourself within a few minutes gives the best result. Storing it in milk and getting to the office within the hour gives a good one. Letting it dry out on a bathroom counter usually does not.

Is a toothache always an infection?

No. Sensitivity to cold that disappears in a second or two is usually not infection. Pain that lingers after the cold is gone, pain that wakes you at night, pain on biting, or pain with swelling points to something more serious. Only an examination and an x-ray can tell you which one you have.

Should I go to the emergency room for a toothache?

A hospital can give you antibiotics and pain relief, but very few emergency departments can treat the tooth itself, so the problem usually returns once the medication runs out. Go to a hospital for airway problems, spreading infection, trauma involving the head, or uncontrolled bleeding. For the tooth, you still need a dentist.

I have not been to a dentist in years and I am embarrassed. Will I be judged?

No. People stay away for all sorts of reasons, and by the time they call, they are usually already worried enough. Our job is to get you comfortable and give you an honest picture of where things stand and what your realistic options are.