Dental emergencies explained

There are typically three scenarios that present as a dental emergency:

Dental trauma
Infection or toothache
A broken filling or loose crown

Each is handled differently, and the first one has a decision point that comes before any dental treatment.

Before anything else: is this a hospital problem?

Call 000 or go to a hospital emergency department — do not wait for a dental appointment — for any of these:

Difficulty breathing, or difficulty swallowing your own saliva
Swelling under the tongue, or spreading down the neck, or a voice that has changed
Swelling closing the eye, or spreading towards it
Fever with dental pain, feeling generally unwell, confusion, or a racing pulse
Inability to open the mouth
Loss of consciousness, vomiting or drowsiness after a head injury
A suspected fracture of the jaw or facial bones
Bleeding that will not stop with fifteen minutes of firm pressure

These are not “bad toothache”. Dental infection can spread into the spaces of the floor of the mouth and neck and obstruct the airway. It is treated in hospital, not in a dental chair — and telling the hospital it started as a dental infection, and which tooth, changes where they look.

That list is not written for effect. Writing in Australian Family Physician for the RACGP, Goh, Lynham and Beech note that most dental infections decompress harmlessly into the cheek, but "deep extension is more likely when the mandibular molars are involved", and progression along those tissue planes "will ultimately result in airway compromise by entering the parapharyngeal spaces and mediastinum".

They also describe what that looks like from outside: "as the infection progresses, the patient may complain of the much more serious features of trismus, dysphagia, dyspnea, inability to protrude the tongue or swallow saliva, hoarse voice and stridor. The patient may lean forward in an effort to open their own airway." Someone sitting forward to breathe is not managing — that is an ambulance. And the priority on arrival is unambiguous: "the most important feature on examination is the patency of the airway."

Everything below assumes none of the above applies.

1. Dental trauma

A knock to the mouth or face — from a fall, a sporting injury, a bike accident, or an assault.

Trauma to the mouth can cause broken or displaced teeth, and in severe cases fractures of the facial bones.

The first thing to determine

Whether the injury involves only the teeth, or whether the soft tissues and bones are involved.

If a facial fracture or concussion is suspected, a hospital emergency department is the first place to go. These severe injuries must be dealt with before the teeth themselves are assessed.

This is the point most worth remembering. A broken tooth is distressing and visible, and it draws attention away from a head injury that matters far more. Deal with the head first.

Once major facial injuries have been ruled out or treated, the dental trauma should be assessed by a dentist. Where the facial skeleton is involved, that is the province of an oral and maxillofacial surgeon.

What to do, by injury

A tooth knocked out completely — an adult tooth. This is the most time-critical dental emergency there is. The International Association of Dental Traumatology calls it "one of the few real emergency situations in dentistry", and its guidance is that immediate replantation at the place of the accident is the best treatment.

Keep the patient calm, then find the tooth. Hold it by the crown, never the root.
If dirty, rinse it gently in milk, saline or the person's own saliva — not water, and do not scrub it. The cells on the root surface are what allow it to reattach, and scrubbing destroys them.
Put it back in the socket the right way round, and bite gently on a clean cloth to hold it in place.
If you cannot reinsert it, keep it moist, immediately. The IADT warns that dehydration of the root surface "starts to happen in a matter of a few minutes". It gives the storage media in descending order of preference as milk, then HBSS or a tooth-preservation solution, then the person's own saliva, then saline. Water only as a last resort — the IADT is explicit that "although water is a poor medium, it is better than leaving the tooth to air-dry". Never a dry tissue and never an empty container: letting the tooth dry out is the worst outcome of all. Do not use antiseptic.
Get to a dentist immediately. What the tooth's survival turns on is how long it spends DRY, not simply how long it has been out — so getting it into milk or back in the socket is the urgent part.

If you are hesitating over step 3, the IADT's own framing settles it: some replanted teeth do have a low probability of long-term survival, but "not replanting a tooth is an irreversible decision and therefore saving it should be attempted".

What should I do when a tooth is knocked out? explains why the drying is what does the damage, and what the years of follow-up involve.

A tooth knocked out — a baby tooth. Do NOT put it back. The IADT is categorical that primary teeth should not be replanted: reinserting one can damage the permanent tooth developing above. Control the bleeding with gentle pressure and see a dentist. See My child has knocked out a baby tooth and Paediatric Dentists.

A tooth pushed out of position, loosened, or driven into the gum. Do not try to force it back yourself. See a dentist the same day — repositioning and splinting have a time window too, and the nerve may need monitoring for months afterwards.

A chipped or broken tooth. Find the fragment if you can and keep it in milk — it can sometimes be bonded back on. See a dentist promptly even if it does not hurt; an exposed inner layer can be sealed and the nerve saved. See What should I do if I have a chipped tooth? and Do I have to get a chipped tooth fixed?.

A cut lip, cheek or tongue. Firm pressure with a clean cloth for fifteen minutes, and a cold pack outside. Deep cuts, or any wound that may contain tooth fragments or grit, need to be seen.

In every case, note the time the injury happened. It affects what treatment is possible.

2. Dental infection or toothache

Common types include tooth abscess, gum infection, and wisdom tooth infection.

What they look like

inflammation, redness, bleeding
pus
tenderness to touch
pain on biting

Severe infections may cause an ache that disturbs sleep or appetite. The RACGP authors describe the early picture as "localised pain, facial swelling, halitosis and general malaise", often on a long history of dental pain.

Working out which of the possible causes is yours is covered on What could be causing my toothache? and Tooth Pain and Toothaches; where the gum rather than the tooth is infected, see Bleeding Gums and Periodontists.

When it becomes urgent beyond dentistry

Severe cases can cause significant facial swelling, which may result in hospitalisation due to facial cellulitis. Whether swelling has crossed the lower border of the jaw is one of the things a clinician checks, because it marks the infection moving out of the mouth and into the neck.

For infection or suspected infection, immediate assessment by a dentist is required, and treatment is usually performed the same day to reduce the infection and the pain with it.

Why antibiotics alone are not the answer

Antibiotics reduce the bacterial load; they do not remove the source or release the pressure. A dead pulp has no blood supply, so the drug cannot reach the bacteria inside the root canal at all. Predictable relief comes from drainage — root canal treatment, gum treatment, or removing the tooth; difficult root canal cases go to a specialist endodontist. Why are dental abscesses so painful? and Should I see my GP for antibiotics for a toothache?

The false reassurance

Severe toothache that stops on its own over a day or two usually means the nerve has died, not that the tooth has recovered. The problem has moved to the next stage silently. A tooth that hurt badly and then went quiet still needs to be examined.

The same applies if an abscess bursts and the pain fades: the pressure has gone, the infection has not. See How is a tooth abscess treated? and Can a dental abscess affect your general health?.

While you are waiting

Take simple analgesia as directed on the packet, and tell the dentist what you took and when.
Sleep propped up rather than flat.
A cold pack outside the cheek for short periods. Do not apply heat — it can worsen swelling.
Rinse gently with warm salty water.
Do not put aspirin, clove oil or any tablet against the gum — it does not reach the infection and burns the tissue.
Do not take antibiotics left over from a previous prescription.

How can I relieve a toothache? covers the interim measures in more detail.

3. Broken filling or loose crown

This happens when the integrity of a filling is lost through wear over time, or when a hard piece of food fractures a filling.

If it is causing pain or discomfort, you need to be seen as soon as possible. Sometimes a temporary filling is placed, with a return appointment booked for a permanent restoration.

The part that is easy to underestimate

A dentist needs to assess the severity, because a tooth can have a complicated fracture that requires immediate restoration without causing any pain at all.

So the absence of pain is not a reason to leave it. A fracture left open can progress from a restorable tooth to one needing root canal treatment, or to an unrestorable one. See Chipped or Cracked Teeth and How will my cracked tooth be treated?.

In the meantime

Keep the crown if it comes off whole and bring it with you — it can often be re-cemented. See Dental Crowns.
Do not glue it back yourself. Household adhesives are not safe in the mouth and can make the tooth unrestorable.
Keep the area clean, chew on the other side, and avoid extremes of temperature.
A pharmacy temporary filling material can cover a sharp edge or an open cavity for a day or two. It is a stopgap, not a repair. What do I do if a temporary filling comes out?
Dental wax or sugar-free gum over a sharp edge stops it cutting the tongue until you are seen.

Other things that turn up as emergencies

Bleeding after an extraction. Bite firmly on a rolled gauze or clean handkerchief for twenty minutes without checking. If it continues after an hour of firm pressure, contact the practice. Uncontrollable bleeding is an emergency department matter.
Severe pain two to four days after an extraction, often with a bad taste. This may be a dry socket — the clot has been lost. It is treatable at the practice and relief is usually quick. See Wisdom Teeth for the aftercare that lowers the risk.
A broken or sharp denture. Do not attempt to repair it with glue. Stop wearing it if it is cutting, and contact the practice. See My denture is broken — can it be fixed on the spot? and Prosthodontists.
A poking orthodontic wire. Cover the end with orthodontic wax or a small piece of clean cotton wool, and contact the orthodontist. Do not cut a wire yourself unless it cannot be covered and is causing injury. See Braces and Orthodontists.
A swollen flap of gum over a partly erupted wisdom tooth. Rinse with warm salty water and be seen — it can escalate quickly. Wisdom Teeth

What to do

Contact the practice as soon as possible in any of these situations. Smile Solutions is open six days a week, with Sunday by appointment, which makes it possible to accommodate emergency appointments.

The reception team will ask a series of questions during an emergency call — to determine how soon you need to be seen, and to give you advice for the interim.

Answer those questions as precisely as you can. Whether the swelling is spreading, whether you can swallow normally, and whether a tooth was knocked out completely all change the urgency substantially.

Useful to have ready when you call: what happened and when, where the pain is, whether there is swelling and whether it is growing, whether you can open and swallow normally, your temperature if you have taken it, what medication you take, any allergies, and what you have already taken for the pain.

If it is outside opening hours and the situation is not on the 000 list above, the options are a hospital emergency department, a dental hospital where one is accessible, or a locum service — and then the practice at the first opportunity.

If dread is part of why you are hesitating to call, say so when you do — it changes how the appointment is arranged. See Dental Anxiety and Sleep Dentistry.

Common questions

The tooth has been out for over an hour. Is it too late to put it back?

Almost certainly not too late to try, and this is the single most important correction to the folklore around avulsed teeth.

The variable that matters is extra-oral DRY time, not total time out of the mouth. The International Association of Dental Traumatology is explicit: "minimizing the dry time is critical for survival of the PDL cells", and "after an extra-alveolar dry time of 30 minutes, most PDL cells are non-viable." A tooth that went straight into milk at minute two and arrives at the surgery ninety minutes later has a dry time of two minutes, not ninety. A tooth that sat on a tissue for forty minutes and then went into milk has already used up its chances — the milk cannot reverse what the drying did.

That is why the IADT sorts avulsed teeth by what happened to them rather than by the clock:

replanted immediately at the scene;
kept in a storage medium with total extra-oral dry time under 60 minutes — the cells "may be viable but compromised";
total extra-oral dry time over 60 minutes — the cells are "likely to be non-viable", regardless of the tooth having been stored in a medium or not.

And even in that third group the guidance is to go ahead. The IADT states that delayed replantation has a poor long-term prognosis and that the expected outcome is ankylosis-related replacement resorption — but that the goal is "to restore, at least temporarily, esthetics and function while maintaining alveolar bone contour, width and height", and therefore that "the decision to replant a permanent tooth is almost always the correct decision even if the extra-oral dry time is more than 60 minutes. Replantation will keep future treatment options open. The tooth can always be extracted, if needed."

So: bring the tooth. Bring it even if it has been hours, even if it looks beyond saving, and even if someone has told you it is too late. The irreversible decision is the one to throw it away. This applies only to adult teeth — a knocked-out baby tooth is never replanted.

The tooth is back in. Is that the end of it?

No — replantation is the beginning of a course of treatment that runs for years, and knowing that in advance prevents a lot of disappointment later.

The IADT's protocol for a replanted permanent tooth includes stabilising it for 2 weeks with a passive, flexible splint — a fine wire up to 0.4 mm, or nylon line — rather than a rigid one, because the ligament needs a little movement to heal. It also specifies that root canal treatment should be initiated within 2 weeks of replantation in most cases: the pulp of a fully formed tooth does not survive being severed from its blood supply, and leaving it in place is what drives inflammatory resorption of the root. An immature tooth with an open root end is handled differently, because it may revascularise.

Two further items on the same list that patients rarely expect. Tetanus status is checked — the tooth has been on the ground. And follow-up is scheduled and long: the outcomes being watched for are root resorption and ankylosis, and the IADT notes that "the rate of ankylosis and resorption varies considerably and can be unpredictable".

For a child this matters especially. Where a replanted tooth fuses to the bone and stops moving while the rest of the face keeps growing, it gradually ends up sitting higher than its neighbours, and the IADT records that a procedure to remove the crown while preserving the root may be needed later "depending on the patient's growth rate and the likelihood of eventual tooth loss". Parents should be told this at the start rather than at year three.

None of which argues against replanting. It argues for replanting and keeping every review appointment.

What should I actually keep at home, in the car or in the sports bag?

Very little, and none of it expensive.

Milk is the item that matters. The IADT ranks storage media in descending order of preference as milk, then a balanced salt solution such as HBSS or a commercial tooth-preservation product, then the person's own saliva, then saline. Water is the last resort. Long-life milk in a sports bag does the job, and so does the canteen.

A small clean container with a lid, so a tooth or a fragment does not roll around dry in someone's pocket.

Gauze or a clean handkerchief for pressure on bleeding, and a cold pack for outside the cheek.

Orthodontic wax, if anyone in the family is in braces.

A pharmacy temporary filling kit is worth having for a lost filling on a weekend — but it covers a sharp edge for a day or two and is not a repair.

And the practice's number in your phone, along with 000. Deciding which of those to ring is easier when neither requires looking anything up.

What not to reach for: antiseptic on an avulsed tooth, household glue for a crown, aspirin held against a gum, or heat on a swelling. Each of those makes the eventual treatment harder.

Would a mouthguard have prevented this?

For a sporting injury, often yes — and the Australian Dental Association is direct about why it is worth the trouble. Its policy on oral injuries states that "every year thousands of people are treated for dental injuries that could have been avoided by wearing a protective, custom-fitted mouthguard", that such a guard "helps to absorb and spread the impact of a blow to the face", and that "the cost of an injury to the teeth or jaw far exceeds the cost of a mouthguard."

On which type, the ADA's position is that "the most effective protection against oral damage is a custom fitted mouthguard, where precision fit and quality materials offer maximum comfort and injury prevention", while over-the-counter boil-and-bite guards "provide better protection than no mouthguard, however their protection varies" and can dislodge during play. The exception worth knowing: for someone in fixed braces, the ADA notes an over-the-counter guard "may be appropriate during orthodontic treatment", because a custom guard made over moving teeth stops fitting.

On which sports, the ADA sorts them into four risk levels, and the group where mouthguards are "strongly recommended" is wider than most people assume: off-road bike riding, skateboarding, rock climbing, white-water rafting, trampolining, combat sports, football, basketball, squash and field hockey. Protection should be worn "during training as well as competition", and whether one is needed at all "should be assessed by a dentist based on risk factors, including an individual's sporting or occupational activities and dental anatomy."

Two things the ADA adds that are not about sport. Certain occupations carry their own risk — it names impact hazards for labourers, tradespeople and riggers, and abrasion from dust for miners, bricklayers and tilers. And "oral piercing jewellery may also increase the risk and degree of oral injury."

See Sport Mouthguards, Should I wear a mouthguard while playing sports? and New mouthguard — chemist or dentist?.

What does an emergency appointment cost, and does anything cover it?

It depends on what has to be done, which is why nobody can quote it on the phone — but the components are predictable and you are entitled to ask about each.

An emergency visit is usually an examination, often a radiograph, and then whatever treatment relieves the problem — drainage, a temporary dressing, opening a tooth, re-cementing a crown, or an extraction. The definitive treatment, if one is needed, is typically a separate appointment and a separate fee. Ask for the cost of today and the estimated cost of what follows, in writing, with the item numbers on it.

There is no national dental fee schedule in Australia, so fees are set practice by practice and vary genuinely. The Australian Dental Association's Dental Fees Survey 2022 reported "considerable variation in the fees charged within and between states", which is a reason to ask rather than to assume you are being treated unusually.

For an eligible child, the Child Dental Benefits Schedule covers a list of basic services that includes check-ups, X-rays, fillings, root canals and extractions, up to $1,158 for each eligible child over 2 calendar years. It does not cover "any dental services in a hospital" — so the same treatment can be partly covered in a chair and not at all in theatre. See Child Dental Benefit Schedule.

For adults, private health insurance is the usual offset; ask the fund for the rebate against the item numbers rather than for a percentage. Medicare does not cover general dental treatment, although a consultation with a registered specialist may attract a rebate.

And the honest framing on cost: the Australian Institute of Health and Welfare counted 88,600 potentially preventable hospital admissions for dental conditions in Australia in 2023–24. A potentially preventable hospitalisation is, by definition, one that timely care outside hospital could have avoided. Cost is a real barrier and it deserves to be discussed openly at the first appointment — but a dental emergency left to escalate does not become cheaper. Say the word if money is the obstacle. See Price Guide and Payment Plans.

Practical details

Smile Solutions, Level 1, 220 Collins Street, Manchester Unity Building, Melbourne VIC 3000. Phone 13 13 96, or theteam@smilesolutions.com.au. Monday–Friday 8.00am–6.00pm, Saturday 8.30am–1.30pm, Sunday by appointment. Full details on Contact Us.

For difficulty breathing or swallowing, rapidly spreading facial swelling, suspected facial fracture or concussion, call 000 or attend a hospital emergency department.

Registration for any practitioner can be verified free on the AHPRA public register at ahpra.gov.au.

Published 29 August 2014.

General information only — it is not a diagnosis, a treatment plan, a quote or a promise of any particular clinical outcome, and it does not replace advice from your treating practitioner. The first-aid measures described are interim steps before professional treatment, not treatment, and none of them resolves the underlying problem. Nothing here is medical or medication advice — take analgesia only as directed on the packaging or by a practitioner. If you are unsure how serious something is, treat it as serious: call the practice, or 000 if any of the emergency signs above are present. Avulsion management quoted here is the International Association of Dental Traumatology's published guidance; mouthguard and fee statements are the Australian Dental Association's; hospitalisation figures are the Australian Institute of Health and Welfare's; Child Dental Benefits Schedule coverage is set by Services Australia and changes.

Smile Solutions trades under ABN 28 193 514 103.