Tooth on the Pavement: A Calm Ten-Minute Plan for Dental Emergencies

It is 9.12pm on a Sunday. The tooth is in your hand, the crown is on the bathroom shelf, and your cheek is doing something it definitely was not doing at lunchtime. The practice is shut, the pharmacy is shut, and the internet is giving you three contradictory answers at once.

Most dental emergencies are not life-threatening. But a handful of them are genuinely time-sensitive, in the sense that what happens in the first ten minutes shapes what is possible afterwards. A knocked-out adult tooth is the obvious one: the delicate cells on the root surface start to fail quickly, and no amount of skill in the chair can bring them back. So this is not a guide to becoming your own dentist. It is a guide to not wasting the window while you wait for one.

First, work out which door you are knocking on

There are really only three routes, and picking the right one saves you hours.

Your dental practice, or its out-of-hours line. This covers most of it: a lost filling, a chipped tooth, a crown that has come off, a dull ache that has become a sharp one, a bit of bleeding after an extraction.

NHS 111. In England, Scotland and Wales this is the route to urgent dental advice when your practice is closed, including bank holidays. Have your postcode ready, and be honest about the symptoms rather than downplaying them because you feel like a nuisance.

A&E or 999. This is for a swelling that is closing your eye or spreading down your neck or under your jaw, difficulty breathing or swallowing, bleeding you cannot control with pressure, or a facial injury with a possible broken jaw or head injury. Those are medical emergencies first and dental problems second.

What A&E generally cannot do is fix a tooth. Most emergency departments do not have a dentist on site, cannot reimplant a tooth or place a filling, and will dress the problem and send you onwards. Turning up there with a broken molar usually costs you four hours and a taxi fare. Turning up there with a swelling that is threatening your airway may save your life. Know the difference before you need it.

A tooth that has come out completely

This is the one where minutes genuinely count. Aim to be seen within an hour, and do not spend that hour deciding.

• Pick it up by the crown, not the root. The root is covered in living cells you cannot see and cannot replace. Touching it is like handling the wrong end of a photograph.
• Do not scrub it. Not with a brush, not with a cloth. If it is gritty, rinse it briefly — a couple of seconds — in milk or saline, not under the tap.
• Adult tooth: try to put it back. Rinse it, slide it gently into the socket the right way round, and bite down on a clean handkerchief to hold it there while someone drives you in. If it will not sit comfortably, do not force it.
• If it will not go back, store it. Full-fat or semi-skimmed milk is ideal and almost always in the fridge. Contact lens saline works. So does your own saliva, held in the mouth beside the cheek — though not for a child who might swallow it. A lidded pot of milk beats a dry tissue every single time.
• Baby tooth: do not reimplant it. Putting a milk tooth back can damage the adult tooth forming underneath. Store it in milk and ring the dentist for advice.

Tap water is the enemy here. It is the wrong salinity for those root cells and it is the reason a lot of otherwise saveable teeth are lost.

A crown that has come off, or a chunk of tooth that has gone

Less dramatic, still worth handling properly. Keep the crown — in a pot, dry, not in your pocket where it will get sat on. Clean it gently and try a temporary dental adhesive from a pharmacy, but never superglue, which fuses to gum tissue and turns a simple re-cement into a surgical problem.

For a broken tooth, keep any fragments in milk and avoid that side of your mouth. Hot, cold, sweet and acidic things will all make themselves known. A temporary filling material from the pharmacy can cover a sharp edge for a day or two; it is a bridge, not a repair. If the break is bleeding from the middle of the tooth, that is the nerve exposed, and it wants seeing promptly rather than eventually.

Swelling that is getting worse

Use a cold pack wrapped in a tea towel, ten minutes on and ten off. Do not apply heat, which encourages the infection to spread. Do not squeeze or pop anything. Sleep with your head slightly raised, drink plenty of water, and take paracetamol or ibuprofen if you can safely take them, following the packet rather than memory.

The watch-and-wait rule is: swelling that is stable and tender can usually wait for the next working session. Swelling that is spreading, feels tight and hard, is pulling your eye shut, or is affecting your breathing, swallowing or voice is a call now, not in the morning.

Bleeding that will not stop after an extraction

Roll a clean handkerchief or gauze into a pad, place it over the socket and bite firmly for a full twenty minutes without lifting it to check. Sitting upright and staying still matters more than people expect. No rinsing, no spitting, no straws, no hot drinks, no smoking and no gym for the rest of the day.

If bleeding is still heavy after twenty minutes of uninterrupted pressure, or you take blood thinners, ring the practice or 111 rather than repeating the same thing for an hour.

The drawer that stops the panic

None of the above is easier to do if you are hunting through a cupboard. Put these in one small box, somewhere you can find it in the dark:

• Sterile gauze swabs and a small lidded pot
• Two 20ml pods of contact lens saline
• A temporary filling or crown kit from the pharmacy
• Dental wax for a rough edge
• Paracetamol and ibuprofen, in date
• A small torch and a mirror
• Your practice's number and the out-of-hours route, written on card

The mistakes that actually cost people a tooth

Scrubbing a root. Storing a tooth in tap water or a dry tissue. Superglue. Putting an aspirin against the gum, which burns it. Waiting out a spreading swelling because it is inconvenient. Pulling a wobbly adult tooth that might have been splinted and saved. And the most common of all: doing nothing at all until Monday, because you were not sure whether it counted as an emergency.

If in doubt, ring. A receptionist or a triage line would far rather talk you through a false alarm at 9pm than see you on Tuesday with something that has become much harder to fix.