What should I do in a dental emergency?

Call a dentist immediately, and while you wait, follow the first aid for your specific problem below. The one exception is facial swelling that is spreading, or any difficulty breathing or swallowing — that is a hospital emergency department, not a dental appointment.

A dental emergency is any problem needing treatment to relieve severe pain, stop uncontrolled bleeding, or save a tooth — plus any tooth-related swelling of the face or neck.

Go to hospital, not a dentist, if

• Difficulty breathing or swallowing
• Swelling spreading toward the eye, under the jaw, or into the neck
• High fever with rapidly worsening swelling
• You cannot open your mouth
• Significant facial trauma, a head injury, or loss of consciousness
• Bleeding that will not stop with sustained pressure

Dental infections can spread through the tissue spaces of the head and neck. This is uncommon, but it can progress within hours. In a life-threatening emergency call 000.

How urgent is it? A triage table

If you only read one thing on this page, read this. The left column decides everything else.

The single most common mistake is waiting to see whether it settles. Nerve damage and infection are both time-dependent, and the treatment that would have worked on day one is often no longer the treatment available on day four.

A knocked-out adult tooth

This is the most time-critical dental emergency there is. Minutes decide the outcome.

1. Find the tooth and hold it by the crown, never the root.
2. If dirty, rinse briefly in milk, saline or the person's own saliva. A few seconds under cold water is acceptable if nothing else is available. Do not scrub it.
3. Put it back in the socket immediately — rounded surface facing the lip — and bite gently on a clean cloth to hold it.
4. If you cannot replant it, keep it wet. The International Association of Dental Traumatology gives the order of preference as milk, then HBSS, then the person's own saliva (inside their cheek), then saline. If you have none of those, use water — it is a poor medium, but the IADT is explicit that "although water is a poor medium, it is better than leaving the tooth to air-dry". Never let the tooth dry.
5. Get to a dentist immediately. Call ahead.

Do not replant a knocked-out baby tooth — it can damage the permanent tooth developing underneath. Find it, keep it, and take the child to a dentist. If it cannot be found, have the child checked in case it was inhaled.

Why the clock matters, and what the clock is actually measuring

The root of a tooth is not bare. It is covered by the periodontal ligament — a thin layer of living cells that attaches the tooth to the bone. Those cells are what reattach the tooth if it is put back. They die from drying, not from the passage of time as such.

That distinction is the whole of the first aid. A tooth replanted into the socket within a few minutes has ligament cells that never dried out. A tooth carried in milk has cells kept alive by a fluid that roughly matches them for salt concentration and acidity. A tooth carried dry in a tissue, in a pocket, or in a cupped hand has cells that are dying the entire way to the surgery.

Handle the tooth once. Every pick-up and wipe removes more ligament. If it falls on the ground, a brief rinse in milk is enough — the aim is not a clean tooth, it is a live one.

For a child's tooth specifically, Children's Dental Emergencies sets out the differences that matter, and What do I do about a knocked-out baby tooth? covers why a baby tooth is never put back. For the fuller account of replantation and what follows it, see Tooth knocked out.

A broken or chipped tooth

• Keep any fragment, stored in milk or saline — it can sometimes be bonded back on
• Rinse with warm salty water
• Cover a sharp edge with sugar-free gum or orthodontic wax
• Chew on the other side

See a dentist promptly if the nerve is exposed (a pink or red spot on the broken surface, sharply painful to air and cold), if the tooth is loose, or if it happened during trauma.

The pink spot is the detail worth knowing. A break that stops within enamel is a cosmetic problem you can attend to in your own time. A break that reaches the pulp exposes living nerve tissue to the mouth, and the window in which that pulp can be protected and kept alive is measured in hours to a day or two, not weeks. It is the difference between a filling and root canal treatment.

Chipped and Cracked Teeth explains the repair options by depth of break, What should I do if I have a chipped tooth? covers the immediate steps, and Why does a cracked tooth hurt so much? explains the mechanism behind pain that appears only when you bite and release.

A tooth pushed out of position or loosened

Do not force it. Try to reposition it very gently with light finger pressure if it is displaced, avoid biting on it, and get to a dentist the same day. Repositioning and splinting is time-sensitive.

These injuries are easy to underestimate because the tooth is still there. A tooth driven up into the bone, pushed sideways, or hanging partly out has usually torn its ligament and may have damaged the blood supply to the nerve. The tooth can look almost normal and still need splinting, monitoring and sometimes root canal treatment months later. Do not let the fact that nothing came out of your mouth talk you out of the appointment.

Severe toothache

Usually an inflamed or dying nerve, or an abscess. Neither resolves on its own.

• Over-the-counter pain relief per the packet directions
• Rinse with warm salty water
• Keep the area clean; keep brushing gently
• Avoid very hot and very cold food and drink
• Sleep propped up if it throbs

Do not place aspirin against the gum — it causes a chemical burn.

A point worth understanding: pain that stops is not the same as a problem that has resolved. When an abscess finds a route to drain, the pain often disappears while the infection continues destroying bone. Keep the appointment.

What the pain is telling you is more specific than it feels. Sharp pain to cold that goes away within seconds usually means a reversibly inflamed nerve or exposed dentine. Pain to heat, pain that lingers for minutes after the stimulus, or pain that wakes you at night generally means the pulp is dying and will not recover. Pain on biting, or on releasing a bite, points at a crack or at inflammation around the root tip. A dull ache with a tooth that feels raised out of the socket usually means infection has reached the bone around the root tip.

None of that is a diagnosis you can make on yourself, but it is the vocabulary that makes your description useful when you call. See Tooth Pain and Ache, What could be causing my toothache? and How to relieve toothache.

Facial or gum swelling

See a dentist the same day. Do not apply heat to a facial swelling — it can encourage the infection to spread. A cold compress on the outside of the face is appropriate.

If the swelling is spreading, or you have fever, difficulty swallowing or difficulty opening your mouth, go to hospital.

Antibiotics on their own are not a treatment for a dental abscess. They can control a spreading infection and buy time, but the source is inside the tooth or in the gum, and until that source is dealt with — by draining it, treating the root canal system, or removing the tooth — the problem is paused, not solved. A course that settles the swelling and is never followed up is one of the more common routes to losing the tooth. Should I see my GP for antibiotics for a toothache? covers why the answer is usually to see a dentist as well.

Bleeding after an extraction

Some oozing for a few hours is normal. If it is more than that:

1. Roll a clean gauze pad or handkerchief, place it over the socket, and bite firmly for 20 minutes without checking
2. Sit upright; do not lie flat
3. Avoid rinsing, spitting, smoking and hot drinks for the rest of the day — all dislodge the clot

If firm pressure for 20 minutes does not control it, contact your dentist. Tell them if you take blood-thinning medication.

Checking the gauze every two minutes is the reason pressure often fails. Each look disturbs the clot that was forming. Set a timer, keep biting, and do not look until it goes off.

Severe pain starting two to four days after an extraction, rather than immediately, is a different problem — the clot has been lost from the socket, and it needs a dressing rather than more painkillers. It is not an infection in the usual sense and it will not settle quickly on its own. Call the practice. See Wisdom Teeth for the aftercare that reduces the risk.

A lost filling or crown

Rarely an emergency, but do not leave it for months. Keep the crown if you have it. Keep the area meticulously clean, chew on the other side, and avoid hard or sticky food — a prepared tooth has thin walls and a fracture below the gumline can make it unrestorable.

Do not glue a crown back yourself. Household adhesives are not removable, are not made for the mouth, and can set the crown in the wrong position, which is how a repairable situation becomes an extraction. Keep it in a container and bring it. See Dental Crowns and Tooth Fillings.

Soft tissue injuries

For a cut lip, tongue or cheek: rinse with warm salty water, apply firm pressure with clean gauze, and use a cold compress. If bleeding does not stop after 15 minutes of pressure, or the wound is deep or gaping, seek care — it may need suturing, and other injuries need excluding.

A lip wound after a tooth has been broken needs specific mention. Tooth fragments can be driven into the lip and stay there, and they do not always show up on examination. Say what was broken and say that a fragment is missing, so it can be looked for properly.

Something stuck between the teeth

Try floss, used gently. Do not use a pin, a knife or anything sharp — you will damage the gum or the tooth. If it will not come out, see a dentist.

Something that keeps getting stuck in the same spot is a finding, not bad luck. It usually means a broken filling edge, a cavity between the teeth, or a gap that has opened up, and it will keep happening until that is repaired.

What happens when you get there

Knowing the shape of the appointment makes it easier to call.

• The history first. When it started, what brings it on, what relieves it, whether it wakes you, whether anything is swollen. This is usually more diagnostic than the examination.
• Examination and tests. Tapping the tooth, testing the nerve with cold, checking how it responds to biting, and looking at the gum around it.
• A radiograph, where it will change the decision — it shows the bone around the root tip and the extent of decay or a fracture, neither of which is visible by looking.
• Getting you comfortable. Relieving the pain is generally the first job, before any decision about definitive treatment.
• A plan, with options and costs, for what happens next.

An emergency appointment is often about settling the problem rather than finishing it. Draining an abscess, opening a tooth to relieve pressure, placing a temporary dressing or splinting a loose tooth are all legitimate endpoints for the visit, with the definitive treatment booked afterwards.

If you are anxious, say so when you book, not when you sit down. It changes how the appointment is run. See Dental Anxiety.

What to bring, and what to say on the phone

Bring: any tooth or fragment (in milk), the crown or filling if you have it, a list of your medicines, your Medicare and health fund cards, and — for a child — someone who can consent.

On the phone, say these things in this order: whether there is swelling and whether you can swallow and breathe normally; whether a tooth has been knocked out and how long ago; how severe the pain is and whether it is keeping you awake; when it started; and whether there was an injury. That sequence lets whoever answers triage you in under a minute.

Cost, and the reason not to let it delay you

An emergency examination is quoted before anything is done, and you are entitled to know the cost of the treatment being proposed before it starts. Ask for the item numbers and the out-of-pocket figure — that is a normal request, not an awkward one.

Where cost is the barrier, say so rather than cancelling. Settling the pain and staging the definitive work is a legitimate plan, and it is a far better outcome than a tooth that becomes unrestorable while you wait. For children, the Child Dental Benefits Schedule covers examinations, fillings and extractions for eligible families. Public emergency dental care in Victoria is triaged by clinical urgency rather than by waiting-list position — say clearly that there is pain or swelling.

Preventing the next one

Most of what arrives as an emergency was visible earlier.

• A custom mouthguard for any contact or stick-and-ball sport. A knocked-out front tooth is a lifetime of dental work.
• Do not use your teeth as tools — opening packaging, holding pins, cracking shells. Most emergency fractures in adults are in teeth already weakened by a large filling.
• Treat the cracked tooth you have been putting off. A crack that hurts on biting becomes a split tooth, and a split tooth is often unsalvageable.
• Keep check-ups, which exist largely to find the things that become emergencies. See Emergency Dentistry for how urgent appointments are arranged, and What is considered a dental emergency? for the line between urgent and routine.

When you are not sure

Do not wait to find out. Call a dentist — many can triage over the phone, tell you whether it needs seeing today, and answer your concerns. A phone call costs nothing and settles the question.

Common questions

It has been more than an hour since the tooth was knocked out. Is it too late to put it back?

Almost certainly not, and this is the single most misunderstood point in dental first aid. A great deal of material in circulation gives a flat deadline of twenty or thirty minutes, after which people conclude the tooth is lost and throw it away.

What the clock is actually measuring is extra-oral DRY time — not total elapsed time. The International Association of Dental Traumatology sorts avulsed teeth by the state of the ligament cells: cells that may be viable but compromised, where the tooth has been kept in a storage medium such as milk, HBSS, saliva or saline ‘and the total extra-oral dry time has been <60 minutes'; and cells likely to be non-viable, where ‘the total extra-oral dry time has been more than 60 minutes, regardless of the tooth having been stored in a medium or not'. A tooth that has sat in milk for two hours has an extra-oral dry time of close to zero.

And even past that threshold, the IADT's position is unambiguous: ‘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.' The outcome in that situation is different — the guideline expects ankylosis-related replacement resorption rather than normal healing, and the goal becomes keeping the bone height and the appearance while other options are considered.

So: bring the tooth. Every time. The one absolute exception remains a baby tooth, which is never replanted.

Emergency department, GP, or dentist?

The hospital list at the top of this page is the whole of the hospital case — airway, spreading swelling, uncontrolled bleeding, major trauma. For everything else, an emergency department is generally not where the problem gets fixed, because hospitals do not routinely provide dental treatment.

NSW Health's Agency for Clinical Innovation says so in its own clinical tool for emergency departments: ‘Routine dental care should be provided in the community rather than by hospitals, except for patients with chronic illness that may be impacted by dental caries, e.g. cancer, cardiac disease, immunodeficiency, bleeding disorders, special needs, or where general anaesthetic is required.' The same tool states that ‘once a dental abscess or infection has formed, extraction or root canal therapy is usually required to remove the source of the infection', and that ‘definitive treatment of the carious tooth will still be required after treatment of pain and infection'.

The scale of the problem is measurable. The Australian Institute of Health and Welfare reports roughly 88,600 potentially preventable hospital admissions for dental conditions in Australia in 2023–24, a rate of about 3 per 1,000 population, up from a low of 2.6 per 1,000 in 2019–20. A separate peer-reviewed review states that ‘dental infection is the leading dental-related cause of potentially preventable hospitalisations in Australia'. Those two figures come from different sources with possibly different inclusion rules, so we are not drawing a single trend line between them — but the direction is not in dispute.

The practical rule: if you can breathe, swallow and open your mouth, and the swelling is not spreading, a dentist is the faster route to the thing that actually ends it.

Can I just get antibiotics and sort the tooth out later?

No — and the reason is blunter than most people expect. The Royal Australian College of General Practitioners states it in one sentence: ‘Antibiotic treatment without dental treatment to remove the cause always fails.'

That is not an argument that antibiotics are never appropriate. The NSW Health clinical tool gives the indication in a single line: antibiotics ‘if systemic infection, immunocompromise, or delay to more definitive treatment'. What they do is control spread and buy time. What they cannot do is remove a source of infection that sits inside a tooth or in a periodontal pocket.

Which medicine, at what dose, for how long, is a matter for the practitioner who assesses you — this page will not name one. What we will say is that a course that settles the swelling and is then never followed up is not a cure; it is a postponement, and it is one of the commonest routes to losing the tooth.

There is swelling but no fever, and I feel fine otherwise. Does that mean it is not serious?

No. The absence of a fever is not reassurance, and the NSW Health tool says so directly — in its list of signs of an abscess it notes that ‘fever and systemic symptoms may be absent'. What it lists alongside that is more useful to watch for: trismus (not being able to open the mouth), redness and cellulitis of the facial skin over the tooth or under the jaw or around the eye, and tender gum swelling.

Where the infected tooth sits changes which direction the trouble travels, and this is worth understanding once. The RACGP describes two routes. From the lower back teeth, infection can spread under the jaw and into the neck; where it involves the whole neck on both sides, that is Ludwig's angina — and the RACGP notes that ‘angina' here means ‘choking', which tells you what the risk is. From the upper front teeth and premolars, infection can travel the other way, via the veins around the eye toward the cavernous sinus, and the RACGP explains why that route is so unforgiving: ‘spread is facilitated as these veins have no valves'.

So the things to act on are anatomical, not thermometric: swelling that is spreading rather than static, swelling under the jaw or toward the eye, a changing voice, difficulty swallowing, or not being able to open your mouth. Any of those is a hospital, today.

What tests should I expect, and what should I not expect?

Less than people often assume, and that is appropriate. The NSW Health clinical tool's position is that ‘blood tests are not required unless systemic symptoms present', and that a practitioner should ‘consider orthopantogram to assess for evidence of abscess' — the wide single film that shows both jaws.

What does most of the work is the history and the clinical tests, which is why the questions on the phone and in the chair matter more than they sound. An x-ray is justified where it will change the decision, not as a routine part of every emergency visit; see How safe are dental x-rays?

It is entirely reasonable to ask what a proposed test will change. If the answer is nothing, that is a good reason not to have it.

Practical details

Smile Solutions accommodates emergency dental appointments at short notice.

The statements attributed above to NSW Health's Agency for Clinical Innovation, the Royal Australian College of General Practitioners, the Australian Institute of Health and Welfare and the International Association of Dental Traumatology are from those organisations’ own published material and remain the primary source.

Specialist registration can be verified on the AHPRA register, or by calling 1300 419 495.

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.

Related pages: Emergency Dentistry, Tooth Pain and Ache, Chipped and Cracked Teeth, Root Canal Treatment, Endodontists, Oral and Maxillofacial Surgeons, Children's Dental Emergencies, Dental emergencies explained.

Published 13 July 2017. General information only; it does not replace advice from your treating practitioner. Any medicine mentioned here is a matter for your treating practitioner to decide. In a life-threatening emergency call 000.

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