Columns
February 21, 2019
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The Wealth of Health

George Malkemus
Dental emergencies
February 22, 2019

Accidents happen.  From a broken tooth to even a broken jaw, certain steps can be taken to lessen the pain and damage while seeking dental treatment.  First, it is important to remain calm and contact your dentist as soon as possible.  Keep a copy of your dentist’s after hour and daytime phone numbers in a convenient place or stored on your cell phone.   Many dental emergencies can be handled over the phone and then followed up with a dental appointment in the next few days.  Some emergencies need immediate attention by your dentist or at an emergency room.

Toothache

A toothache is usually the result of an infection from tooth decay or inflamed gums.  Rinse your mouth with warm water and gently use your toothbrush or dental floss to make sure there is no food impacted in or between teeth.   The pain can usually be controlled with Ibuprofen and Tylenol.  Placing an ice pack on your face over the area of pain will help. A bag of frozen peas works well for an ice pack and can be reused, but remember to mark the bag so you don’t eat the peas at a later date.  Your dentist will usually prescribe antibiotics and schedule appropriate treatment.  A toothache left untreated will worsen over time; the dental infection will spread becoming an abscess, affecting the jawbone and other teeth.  A dentist should be seen as soon as possible to prevent possible spread of the infection. 

Chipped Tooth

An injury resulting in a fracture to a tooth or teeth is a fairly common occurrence, especially during childhood.  If the tooth is not sensitive, then make an appointment with your dentist to check and repair the chipped tooth.  Watch for darkening of the tooth or a swelling in the gums, which are signs of nerve damage.  Seek help immediately if there is severe tooth pain to touch or air. 

A short-term trick to protect a fractured tooth is to cover the tooth with sugarless gum.  Don’t use sugar gum or it could worsen the area.  The sugarless gum coverage can keep your tongue from being cut while playing with a sharp tooth edge.  Also the gum coverage can help prevent temperature sensitivity on the fractured tooth. 

Children or adults who engage in contact sports such as soccer, basketball, football, or wrestling should wear a mouth guard for protection against injury to the mouth and teeth.  Custom fitted mouth guards can be fabricated in the dental office, while regular mouth guards are available in sporting goods store.  Mouth guards are an inexpensive way to prevent tooth injuries.

Broken jaw

Usually you will have pain and swelling in the joint area, ear or tongue.  Often you will not be able to close your jaw or get your upper and lower teeth to align properly.  Use an ice pack to control swelling and pain.  Stabilize the jaw, using a small towel wrapped beneath the jaw and tied on top of the head [like in the old Three Stooges comedy films].  The jaw needs to set by an oral surgeon referred by your dentist or a hospital emergency room.

Knocked out tooth

When a permanent tooth is knocked out of the mouth, it is essential that treatment be sought immediately to ensure the best possible chance of saving the tooth.   The tooth needs to be reinserted within the first hour after the accident. On the other hand, a knocked out, baby tooth should not be saved or placed back into the socket because it might damage the developing permanent tooth. 

Here are some important steps to follow if a permanent tooth is knocked out of the mouth:

Remain calm and bite on a clean cloth or gauze with pressure to control any bleeding.

Find the tooth and pick up the tooth by the crown only, do not touch the root surface. A ligament surrounds the outside of the root and can be easily damaged.

Rinse off any dirt gently with running water.  Do not scrub the tooth.

Gently try to reinsert the tooth into the socket and hold in place with firm pressure.

If the tooth won’t go into the socket, put it in saliva inside the lip of the mouth, or place in a glass of milk, or use Save-A-Tooth® for transfer to a dentist for reinsertion.  Do not let the tooth dry out.  [Save-A-Tooth® is a kit for preserving a knocked out tooth while transferring to a dentist for reinsertion. Save-A-Tooth® can be purchased at a local pharmacy or on-line and is a great addition to a first aid kit, especially for sports teams. In fact, most professional sports teams as well as the U.S. Olympic team use Save-A-Tooth®.]

Head to the dentist immediately.  For reinsertion, success is directly related to the amount of time from the accident to replacement. 

Tooth that is pushed out of place

Often times a tooth is pushed out of place but still remains in the boney socket from an injury. With a permanent tooth, it is important to place the tooth back into its original position.  

Gently push the tooth back into that position and hold it there.  Biting can also help push the tooth into its original position.  If seen soon, a dentist can numb the area and press the tooth back into position and then bond it into its original position until healing is completed.  The sooner you see the dentist, the better chance of positioning the tooth correctly.

Many years ago, I treated an 11-year–old boy who had a bicycle accident and damaged his upper front teeth.  One tooth was chipped which I repaired with a bonded filling.  A second tooth was fractured into the nerve, so root canal therapy was completed with a large tooth-colored filling. A third front tooth was knocked down and back, so I pressed it back into position. All three teeth were temporarily bonded together, which held them in place while the bone and gums healed.  After six months, I removed the bonding and smoothed the teeth, which were firm and looked good. When he was 17, after braces for teeth alignment, he had permanent cosmetic crowns and veneers.   He had a great smile for his senior pictures.   

ENJOY LIFE AND KEEP SMILING!

George Malkemus has a Family and Cosmetic Dental Practice in Rohnert Park at 2 Padre Parkway, Suite 200. Call 585-8595, or email info@ malkemusdds.com.  Visit Dr. Malkemus’ Web site at http://www.malkemusdds.com