(see also Practice Policies)
If a tooth only hurts when taking very cold foods or drinks, avoid cold foods and drinks and contact a dentist. Eat on the other side of your mouth. Use a fluoride containing mouthwash and/or toothpaste. Early treatment reduces long-term problems.
If a tooth only hurts when eating hot foods, contact a dentist urgently - you most probably require special dental treatment. Avoid hot foods and drinks. Sucking on a clove may help. Eat on the other side of your mouth.
If a tooth only hurts when biting on it, avoid hard foods and contact a dentist. The causes for the pain can be very difficult to diagnose, and will usually require dental treatment. Microscopic cracks in your tooth or a dental abscess are possible causes of your pain.
If a tooth is spontaneously throbbing with a dull kind of ache, contact a dentist urgently. The nerve of the tooth is probably very ill and will require removal. Take painkillers as prescribed, and use, if tolerable, hot and cold mouth washes. Sucking on a clove may help. Pulpal pain is spontaneous, strong, often throbbing, and exacerbated by temperature and outlasts the evoking stimulus. Localisation is poor, and pain tends to radiate to the ear, temple, or cheek of the same side of the face. The pain may go away spontaneously, but you should still seek dental advice, as the pulp has probably necrosed, and acute periapical periodontitis (dental abscess) will probably follow in due course. Endodontics (root canal treatment) or tooth extraction is required.
If a tooth is not heat or cold sensitive but there is a swelling around it and it is rather painful, make an appointment with a dentist - you most probably have a dental abscess, which requires urgent treatment. Periapical periodontitis pain is spontaneous and severe, persists for hours, is well localised, is exacerbated by biting and may keep one awake at night. The adjacent gum is often tender to palpation. An abscess may form ("gumboil"), sometimes with facial swelling, fever, and illness. In the absence of immediate dental attention it is best to incise a fluctuant abscess and give antimicrobials and analgesics. The acute situation usually then resolves, but the abscess will recur, since the necrotic pulp will become re-infected unless the tooth is endodontically treated or extracted, though a chronic abscess may be asymptomatic apart from a discharging sinus. Rarely, this may open on to the skin.
Pain and/or swelling around the very back tooth (especially the lower) in a person aged 17-30 years old may be caused by infection around a wisdom tooth. Antibiotics are usually required as well as a decision on the future treatment of the tooth, so a dentist should be seen as soon as possible. Rinsing with hot salty water, the water hot but not burning, can help, as can meticulous cleaning, although this may be sore and might cause bleeding.
Some dos and don’ts for toothache:
Do not place pain-killing tablets on the site of any aching tooth or gum. It can cause severe burns on the gum.
Do try and take a balanced diet. If it is too painful to eat regular foods, take liquid supplements. Dental treatment can be complicated by an unbalanced diet.
Do take care when taking painkillers. People who should be especially careful are: People with stomach ulcers; People with bleeding tendencies; People with kidney diseases; Pregnant women; Patients taking anti-coagulants; Patients on medication.
Do not postpone your dental appointment. Early treatment is most often more simple than late treatment and can save you trouble and money. Contact a dentist.
Pain after a visit for root-filling
Increasing pain after a visit to have a root-canal dressed can be relieved by removing the dressing from the back or top of the tooth. This can be done with a pin or a toothpick. The tooth should than be rinsed with hot salty water and a further visit to the dentist arranged.
Bleeding after an extraction
After a tooth is extracted, the socket bleeds normally for a few minutes but then clots. Since clots are easily disturbed, do not to rinse the site or disturb the clot for the next 24 hours. If the socket continues to bleed lay a gauze pad across the socket and bite on it for 15-30 minutes. If it is still bleeding a haemostatic agent may need to be placed in the socket or suturing may be necessary: contact a dentist.
Bruising after a dental visit
This is often due to inadvertent injury to a blood vessel when the local anaesthetic is being administered. Although sometimes alarming in appearance the condition rarely gives rise to pain, and normally resolves over several days. If concerned contact the dental surgery for advice.
Pain after an extraction
Some pain and swelling after tooth extraction is common but will normally ease over a few hours. Paracetamol usually provides adequate analgesia. Pain from complex procedures may last longer and should be controlled with regularly administered analgesics. If pain persists or increases you should see a dentist to exclude pathology (such as dry socket or jaw fracture).
Localised osteitis (dry socket) occasionally follows an extraction. After two to four days there is usually increasing pain, halitosis, unpleasant taste, an empty socket, and tenderness. Treat by irrigating with warm (50°C) saline or aqueous chlorhexidine. A dentist may need to dress the socket, and prescribe analgesics and antimicrobials.
Injuries to the primary teeth may be of little consequence with regard to emergency care, but even seemingly mild injuries can damage the permanent successors. Upwards of 30% of children damage their permanent teeth by the age of 15.
Enamel fracture needs no emergency care, but dental attention should be sought later. More severe injuries affecting the dentine should be treated as urgent as there might be pulpal infection. Emergency care consists of placing a suitable dentine lining material on to the fractured dentine, and so prompt treatment by a dentist within the same working day or at least by the following morning is required.
Avulsed teeth (teeth which have been knocked out)
Avulsed permanent anterior teeth can be replanted successfully in a child, particularly if the root apex is not completely formed (under 16 years old). Avulsed primary (baby) teeth should not be replanted. The younger the child and the sooner the replantation, the better the success; teeth replanted within 15 minutes stand a 98% chance of being retained after further dental attention.
Immediate replantation gives the best results. Hold the tooth by the crown (do not handle root as that could damage the periodontal ligament). If the tooth is contaminated rinse it with sterile saline, and if the socket contains a clot remove it with saline irrigation. Replant the tooth the right way round (ensure the labial (convex) surface is facing forward) and manually compress the socket. Splint the tooth; "finger crimping" some metal foil can act as a temporary measure; an alternative is tissue adhesive. The child should see a dentist within 72 hours.
If immediate replantation is not possible, place tooth in an isotonic fluid (cool fresh pasteurised or long life milk, saline, or contact lens fluid). Otherwise, if the child is cooperative, place tooth in the buccal sulcus (between the cheek and the teeth) and get to a dentist within 30 minutes. Unsuitable and slightly damaging fluids are water, disinfectants, bleach, and fruit juice.
Pain beneath a denture
New or old dentures may cause pain if they are too tight or are cutting into the gum. They can also cause pain if a tooth or root surfaces beneath them or a swelling appears.
In case of such pain remove the denture and store it in water. Attend a dentist to have the area examined and the denture eased. Wear the denture on the day of the dental appointment so that the denture marks the area involved making any treatment more exact.
B.Dent. Sc., M.A., Dubl., M.F.D.S., Dip.P.C.D., R.C.S.I.,
35 Forster Street,