What is the purpose of this interview?
Hey, I'm Dr. Suess from Clackamass Smiles. I'm here to talk a little bit about dental emergencies. What's important, what's time-critical, what's really necessary to do when you have an emergency with your teeth or your mouth or your gums and you're at home, the office isn't open. What do you do? I'm here to answer all those questions for you.
What qualifies as a dental emergency?
I think the most obvious one is if your tooth is broken. If it was intact and something hit it, something bumped it, you bit down and part of the tooth broke away, that's a dental emergency. Something was there, and now it's busted. There's a couple of different things that you should do. One of the big ones is to identify, hey, is it just the top of the tooth that broke, or is it the whole root system? It's pretty obvious to tell if you have a whole tooth that's knocked out, that's much more time-critical. If it's just the top portion that's broken off, that might be either a fix-it issue or some other kind of issue, but if the whole tooth comes out, that one's much more time-critical, much more important because in some cases, those can actually be replaced.
What other signs indicate a dental emergency?
One of the next dental emergencies is if you feel swelling, if it looks puffed up, if it's red on the outside of your cheek or your gums, or if you have the taste or sensation of pus coming from one of your teeth. That's a clear indication that there's a dental infection. That pus is welling up, indicating that there's infection present, and the bacteria in that area is taking over and starting to damage that area. It can damage other things along with that single tooth and can spread throughout your body, making you much sicker than just a single tooth issue.
What about dental pain?
Finally, one of the last things to look for in a dental emergency or a sign of a dental emergency would be pain. If you're minding your own business and all of a sudden the tooth starts hurting, you get that ache, that deep-seated ache, and you're like, gosh, I know this is coming from a tooth, that's dental pain. Now those are a little more difficult to identify because you might look in there, and it's not for sure that you're going to see something. Those don't always come with outside symptoms, like it might not be red, it might not be broken, there might not be pus, but dang it, it sure can feel painful. So those are one of the hardest dental emergencies to track down because it's possible it could be from something else, not necessarily one of your teeth. So that's one that you really want to get in and get that checked out to make sure that this is pain that's coming from a tooth and something that can be remedied by a dentist versus pain coming from some other area that might not even involve your tooth whatsoever.
What should you do if a tooth falls out due to trauma?
So let's say I'm doing a sport or my kid's doing a sport and something happens, they get injured, there's some kind of trauma, and then a tooth comes out. If an entire tooth falls out, that's a time-critical issue. That tooth, in some cases, can be saved, it can be salvaged, and it can be replanted in that area, but really time is against you when that happens. For those things to happen, it has to still have that socket for the tooth to go into, the tooth has to be kept in good condition, it can't be cleaned off too aggressively or abraded, and it has to be kept hydrated. And that's easier said than done. Now you have to do all of this at the same time as getting in to see a dentist, usually within 30 minutes to an hour or two is the ideal time frame, but that's something that you should rush to contact a dentist and keep that tooth in good condition.
How should you preserve a knocked-out tooth until you see a dentist?
A lot of people say milk is a good container to keep that tooth in. You don't want to dry it off, don't brush it on your clothes, even if there's a little debris on it, you should either put it in some milk or what you can do is just keep it on the side of your cheek. So inside, right next to where your gums are, the saliva is adequate to keep it hydrated. None of these are ideal. It's ideal to be sitting in a dental chair when it's knocked out, but that's not always an option. So keep it in good shape, see that dentist as soon as possible, and then that's your best chance at being able to have something either salvaged or actually replaced.
What are the options for treating a broken tooth?
So if you have a tooth that's broken, you're going to be wondering like, what are my broken tooth treatments? Usually, that's an issue of rebuilding the top of the tooth. If the foundation's in good shape or it can be repaired, saved, or salvaged, we like to do that. That's our first preference. And then rebuilding the tooth on top of it is kind of like, let's say we have a good foundation, but the house needs some work, well then if we can rebuild or replace the house on top of a good foundation, that's what we'd like to do in dentistry as well. So if the root system's there, that's the foundation of the tooth. If we can replace the top of that one, rebuild the house on top of it, that's something that's going to usually be long-lasting, predictable, help control your costs, and be something that gives you a good lifespan with that tooth afterwards. You want to get it fixed, but then you want it to last a long time too. That's one of the best things that you can do.
What should you do if you have a dental emergency after hours?
So let's say that it's after hours and you have a dental emergency. You're going to wonder, where do I call? Do I go to the emergency room? What about the ER? Are their offices open? This is when it really pays for you to already have a regular dentist, a place that you go to, that you know the name, you know the doctor, your chart is already open and active there, and they know what your dental condition is. We get these calls with some frequency where the patient of record that we know will call us up and say, Hey, I think something's going on. They can even describe the area. We'll look that up and we'll say, Oh, sure enough. I see something that might've been a problem. And we can help advise them in that situation. We might not always be able to come in in the middle of the night, but we're always available within about a one-hour timeframe to answer a return on an emergency phone call. But that's only eligible for patients who have already been here. If you're a new patient, you've never been here. We can't intake a new patient after hours and we can't offer those emergency services to people who are strangers to us. So that's one of the big advantages to being part of a practice already being established at a dental office, going for your regular treatment, your regular checkups, because your chart is active at that office and that can fast track you to accessing emergency care if you need to.
What are the alternatives if you can't reach your regular dentist?
If your dental office isn't closed, if they don't have that ability to take emergency messages after hours, you might have no choice but to be seen at an emergency dental clinic. If you are relatively certain that it's a dental emergency, you can call one of the 24-hour or open-hours emergency dental offices. It's hit or miss with those. Sometimes they're open, and they have the capacity, and they can take you. Other times it's less certain that they can be seen, or it's going to be someplace that's even out of town. Those are less good options if you have a dental emergency and you want to be seen quickly. If it's truly middle of the night and no dental office is available, then you might have no other choice than to go to the emergency room to address really severe pain if that was happening.
What should you do if you're experiencing severe pain after hours?
So if it is after hours and you're having a severe dental emergency, you have, let's say it's pain, you look in there and you can't see anything and it doesn't feel broken and there's not necessarily pus coming out, but it hurts, then in that case, what do you do? Well, the first thing that you should do is contact your dentist. Leave a message. Use your emergency contact information. That's why most offices have that and let them know that something's going on. That message will get passed to the person that needs to see it, and they'll be able to get back to you. But what do you do at home? If you are healthy enough and you don't have allergies or bad reactions to pain relievers, certainly try some over-the-counter pain relievers. Then as you get contacted by that dental office, if they talk through your symptoms and they find out that this might be something caused by bacteria or might be something caused by an infection process, in those cases, they can almost always prescribe or call in some antibiotics for you. Be careful that's not always the answer, and so we recommend patients who haven't gone through that screening, don't just take some old leftover antibiotics you have lying around unless you know that that's the issue and you've already had it addressed with that tooth previously.
Any final advice for dealing with dental emergencies?
One last piece of advice for dental emergencies. Most of the time dental emergencies happen to teeth that have already either had some work or teeth that are in need of some work that have been identified in the past. So don't get yourself in a situation where, hey, there's something that's going on, you know that it's back there, you've been told but you're choosing to neglect it, and then later on it blows up, it starts growing, it causes pain, it causes infection. Murphy's Law says it's going to be before you leave on vacation or Christmas Eve or some other time that's inconvenient for you. That's an insult to injury. We know that it's there. If you have something that hasn't been addressed that needs to be taken care of, do it. Get that thing fixed. Don't let a small problem become a large problem and then eventually an emergency, that's the wrong way to play it.
How can patients best prepare for potential dental emergencies?
The other thing that I could say is go ahead and establish as a patient in one of your local offices, pick a place that you trust, that's close by, that's convenient for you. Make sure that you're a regular there, get all of your preventative stuff done, make sure that they know you. So if something like this ever happened to you, you could be as close as a phone call away to that personalized advice, possibly calling in a prescription, possibly even after-hours appointments. We've had a couple of those even just this last holiday break, but they were patients who were already part of our practice. That unlocks that door for you to get that level of care is to have your record there, have your chart open, have people know who you are, and that way if you do encounter a situation like that, then it's easy to give you guys that help. That would be the single biggest thing besides just keeping things in good condition and hoping you don't have an emergency, leave yourself a backup plan, and that backup plan is already being part of an office.
Thanks for listening to this advice with dental emergencies and hopefully it gives you some idea of what you should do if you had something unlucky like a fractured tooth or infection or pain or swelling or pus, how to contact your office, what to do next, and what we might do to help you with that one. If you have any additional questions, reach out and contact us here at the office. Clackamas smiles. I'm Dr. Suess.
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What is considered a dental emergency?
A dental emergency is any time that there's pain, a fracture, a broken tooth, or something going on that you're just not sure what's happening, and you could be concerned long-term that it would be a problem for that tooth. Examples of dental emergencies could be a chipped or fractured tooth, a dental infection, or severe pain.
When should you see a dentist for an emergency?
If the pain is increasing, is severe, or if something that didn't used to be painful suddenly becomes very painful or uncomfortable, then you should call your dentist right away. The times when you should consider going to the emergency room is if the swelling is big, if it's spreading anytime that it impacts the lower jaw or the neck or any of the breathing, that's an emergency. Call 911.
If you suspect that your dental issue is related to a tooth and it's worsening, and you feel it's urgent to be seen, please pick up the phone and call us. Let us know what you're experiencing. We typically have emergency slots available to accommodate patients in such situations and address their needs promptly. In the rare event that it's after hours or in the middle of the night, it might be more appropriate to visit an emergency room. This is especially important to stabilize the area and rule out other concerns, such as complications involving the sinus, the floor of the mouth, or the airway. However, if you are fairly certain that the problem is tooth-related, do not hesitate to contact us. We can almost always arrange a prompt appointment for issues like these.
What are common types of dental emergencies?
One common dental emergency is a toothache, which typically begins with a tooth that was previously fine but gradually becomes painful. This pain can stem from various causes, ranging from simple sensitivity or acid irritation to more complex issues like fractures, infections, or abscesses. It's often challenging to diagnose the exact problem based on symptoms alone, so it's advisable to seek dental attention promptly.
Another urgent dental issue is an abscess, a type of infection often accompanied by swelling. This swelling can be localized to the affected tooth but may rapidly expand. Visible and palpable signs, such as redness or a warm sensation, indicate a serious emergency, necessitating immediate care at a dental clinic or emergency room if the dentist is unavailable.
Wisdom tooth pain is another concern. It can be a normal part of the eruption process, causing discomfort as the tooth pushes through the gum. This type of pain usually resolves on its own if there is sufficient space for the tooth. However, if the surrounding gum tissue becomes inflamed or infected, a condition known as pericoronitis, immediate dental attention is required.
Gum problems can also mimic toothaches. In many cases, the pain originates from the gums or bone surrounding the tooth, not the tooth itself. An examination, often including an X-ray, is essential to determine the exact cause of the pain.
What should I do about sensitive teeth?
In our dental practice, we frequently encounter patients with sensitive teeth. This condition can range from mild to severe, with some individuals experiencing discomfort from everyday activities like drinking ice water or eating ice cream. In extreme cases, even breathing in normal air can cause pain.
The causes of tooth sensitivity vary. It may be due to gums receding from the tooth, leaving the root more exposed and sensitive. Alternatively, the tooth itself might be damaged, for instance, from acid exposure or a chip or crack near the gum line. Understanding the specific cause of sensitivity in each case is crucial for effective treatment.
Fortunately, there are various ways to alleviate tooth sensitivity, often at minimal or no cost. These treatments are generally quite effective, bringing significant relief to our patients. If you're experiencing any form of tooth sensitivity, we encourage you to let us know. Addressing this issue not only improves your oral health but also allows you to enjoy your favorite foods and drinks without discomfort.
What is the best course of action if a tooth is broken or fractured?
If you have a broken or fractured tooth, whether it's still in place but cracked, it's crucial to treat it promptly due to its delicate nature. For example, a young person might fall off their bike and break a front tooth. Immediate treatment is necessary in such cases.
Similarly, adults often experience this with molars, possibly with existing fillings. If you bite down and hear or feel a crack, followed by pain, this indicates a need for urgent dental care. The goal is to prevent further damage. A chipped or cracked tooth is weakened and more susceptible to damage from chewing, food particles, and bacteria. Neglecting it can exacerbate the problem.
Immediate attention not only prevents further harm but also opens up the possibility of saving the tooth. If the tooth can be stabilized and repaired, that's the best outcome. However, if the damage is extensive and the tooth is significantly compromised, considering replacement options early on is crucial for optimal results. Therefore, it's vital to seek dental care as soon as possible for a broken or fractured tooth. Early intervention can make a significant difference in the health and longevity of your tooth.
What is the best course of action if a filling is broken?
Fillings are a routine part of dental care, but it's important to remember that nothing manmade lasts forever. This applies to dental fillings as well; like natural teeth, they don't last indefinitely. Over time, fillings can wear out, chip, or even start leaking. When we notice such wear and tear early, we advise patients to replace these fillings promptly. Proactive replacement is often the best approach to prevent further dental issues.
However, there are instances where a filling might fracture suddenly and without warning. Generally, these situations are manageable, and the repair process is quite successful, often restoring the tooth to a pain-free state. The situation becomes more complex if the fracture extends into the central portion of the tooth or reaches the root system. These cases are more challenging and are handled on an individual basis. It's crucial to address such issues as soon as they are noticed.
Ignoring a cracked filling or tooth can lead to more severe problems. Continuing to chew on a damaged tooth might escalate the issue from a repairable condition to an irreparable one, which can be much more difficult to manage. Therefore, it's important to seek dental care immediately if you notice any irregularities with your fillings or if you experience a crack in your tooth. Prompt attention can often save the tooth and prevent more complicated procedures.
What is the best course of action if a denture is fractured?
Occasionally, we encounter patients whose dentures have accidentally fallen and fractured, either by hitting the ground or being dropped in the bathroom. In such cases, our advice is to refrain from using any household adhesives to repair them. The adhesives available at home are not suitable for effectively bonding the broken pieces of a denture.
If the denture has a clean break and hasn't shattered into multiple pieces, we can often repair it using the same type of material from which it is made. This repair usually requires a dental lab, and in some instances, we can perform it on-site. However, the key to a successful repair is the condition of the broken edges. If adhesive has already been applied, it compromises the cleanliness of the edges, making it challenging to achieve a proper repair.
Therefore, if you experience a denture fracture, whether it's a simple chip, crack, or even if a tooth pops out, it's important to bring it to us immediately. Prompt attention to such issues typically results in a successful repair, which is not only cost-effective but also allows you to quickly resume using your familiar denture. Repairing a denture is considerably more affordable than replacing it, making it a practical and efficient solution.
What would I do if my crown, veneer or crown came off?
If you find yourself in a situation where a crown has come off, a veneer is loose, or a dental bridge is becoming detached, it's important to address this issue promptly. These dental fixtures are designed to be securely fixed and reliable, so if they become loose or fall out, immediate action is needed.
Firstly, it's crucial to handle the detached piece carefully and bring it to the dental office as soon as possible. In cases where both the tooth and the dental appliance (crown, veneer, or bridge) are undamaged and still fit well together, we often can simply reattach it. This is an ideal outcome, as it saves both time and expense, avoiding the need to create a new piece.
However, the situation becomes more complicated if the tooth is damaged, the crown is broken upon detachment, or if the piece is lost. The longer the time elapses from when the piece detaches to when it is treated, the more problematic it can become. Therefore, it's crucial to visit the dentist immediately after noticing any issues, such as a feeling of looseness or discomfort, even if the dental appliance hasn't completely fallen off yet. Prompt attention ensures the best chance for a successful reattachment and overall dental health.
When might I need an emergency tooth extraction?
If a tooth has a significant issue, such as an abscess at the root tips or a fracture that extends through the entire tooth, there may be cases where saving the tooth is not possible. In scenarios where bacteria are growing, an abscess is forming, and the tooth is causing pain and discomfort, it may be necessary to remove the tooth.
It's crucial to seek dental attention as soon as possible to determine the appropriate course of action. The dentist will need to assess whether the infection should be treated with antibiotics first or if the tooth needs to be removed immediately to help drain the infected material at its root tips. Each case is unique, and a professional assessment is needed to decide the best treatment plan.
I've encountered both scenarios in my practice. The key is to be seen by a dentist as soon as possible and to start the appropriate treatment promptly, whether that involves beginning a course of antibiotics or proceeding directly with the extraction procedure. Prompt action is vital to begin the healing process and improve your dental health as quickly as possible.
Do I need to have my wisdom teeth removed?
Parents and young people often have many questions and concerns about wisdom teeth. Common inquiries include whether they can keep their wisdom teeth, if there's enough room for them, the process of removal, the length of recovery, and precautions to take post-surgery. There's a lot of confusion surrounding this topic.
The simplest way to approach wisdom teeth is to consider the space available in the jawbone. If a wisdom tooth is emerging and there's insufficient room, it can cause several problems. It may push against and potentially damage other teeth, leading to pain, infection, and discomfort as it breaks through the gum tissue. Additionally, improperly positioned wisdom teeth can affect your overall bite, potentially causing crowding and displacing other teeth.
Traditionally, wisdom teeth are evaluated in the mid to late teenage years, around 13 to 15. One key factor is the development stage of the tooth's root system. If the roots haven't yet grown into the nerve, the extraction is generally more successful and carries fewer risks. Therefore, it's advantageous to remove them at this stage if necessary.
The readiness for extraction can vary; some may be suitable for removal as early as 13-15 years, while others might require more time to develop. However, we can only determine this by examining the teeth, typically through an X-ray, to assess their development stage. Each case is unique, with early, regular, or late-developing wisdom teeth all requiring different treatment timelines. Generally, it's better to address wisdom teeth early, preferably before pain or discomfort arises, as this is the safest stage for extraction. Ultimately, a dental examination is necessary to determine the specific situation and the appropriate timing for any potential removal of wisdom teeth.
What can I expect from the tooth extraction process?
When a regular tooth needs to be extracted due to reasons like a fracture, being too costly to repair, or simply being irreparable, the procedure typically involves numbing the tooth and then removing it. If the extraction leaves behind infection or abscess material, it's routine for us to clean and wash out the area during the procedure.
It's important to consider tooth replacement options after an extraction to prevent future dental problems. Not replacing a tooth can lead to issues like other teeth leaning into the space, creating crowding, or the opposing tooth moving out of position. The two generally accepted options for tooth replacement are a dental implant or a bridge. After a tooth extraction, the jawbone can undergo atrophy, meaning it can diminish in volume. This bone loss can create a poor foundation for a future dental implant. If an implant is a considered option for the future, it's important to think about getting a bone graft at the extraction site. Bone grafting helps to preserve the jawbone, preventing it from thinning and creating a solid foundation for a future implant.
The best time to preserve the bone is immediately when the tooth is removed. Routinely, the tooth is extracted, the infection is cleaned out, and then bone particles are added back into the socket. This process aids in quicker and more effective healing, resulting in a denser and thicker bone ridge, which is ideal for placing a dental implant in the future. By doing this, you keep the option of a dental implant open for the future.
What anesthesia options are available to me?
Modern dental anesthesia has significantly evolved, providing highly effective and nearly pain-free options. This advancement means that the numbing you receive at the dental office can make procedures almost entirely comfortable. The anesthesia used today is not only effective in minimizing pain but also lasts a considerable duration, ensuring patient comfort throughout the procedure.
The goal of using anesthesia in dentistry is not to complicate your day or induce unnecessary sedation, but rather to make the experience as trouble-free and comfortable as possible. Often, the simplest approach is the best one. By thoroughly numbing the area and, in many cases, completing the procedure in a single visit, patients experience minimal discomfort and inconvenience. This approach to anesthesia and dental procedures represents a significant advancement from the stories many of us have heard from our parents' experiences. It makes the process of having a tooth removed, or undergoing other dental procedures, much more comfortable in today's modern dental practices.
When might I need an emergency root canal?
When it comes to emergency root canals, this usually involves a scenario where the tooth has become infected, with bacteria infiltrating the inner chamber of the tooth. This infection leads to swelling and the formation of pus, which creates significant pressure and results in intense pain around the affected tooth.
If the tooth has a solid bony foundation, is still considered valuable for keeping, and is deemed fixable or savable, one of the most effective treatments is to perform a root canal. This procedure involves removing the bacteria from the inside of the tooth, effectively addressing the source of the infection and pain. The course of treatment may vary depending on your specific situation. In some cases, antibiotics may be prescribed to reduce the infection, or other treatments might be used to shrink the infection. However, the gold standard for treating this type of dental issue is still to remove the bacteria via a root canal.
By undertaking this procedure promptly and initiating the healing process—sometimes involving medication placed inside the tooth or completing the full root canal treatment—patients generally experience the best outcomes. The primary goals of this treatment are to eliminate pain, eradicate the infection, and ultimately save the tooth, allowing it to remain a functional and aesthetic part of your smile.
Do you offer same-day care?
Yes, whenever our clinic is open, we offer same-day care. We are fortunate to have the facilities and a dedicated dental team capable of accommodating almost all emergency cases on the same day. One crucial step for patients is to call us as early as possible to inform us about the emergency. This early communication allows us to adjust our schedule accordingly and make the necessary space for your urgent needs. Dental emergencies are exactly that – emergencies that require swift and immediate attention.
Our clinic is structured precisely to handle such situations. By letting us know early in the day and giving us an idea of what's happening, you enable us to prepare and provide the best possible care. So, please reach out to us, inform us about your situation, and we will take a look and determine the best course of action to help you.
Do you offer late appointments?
Our dental clinic understands that scheduling can be a challenge for many, which is why we offer both early and late appointments to accommodate different needs. On Mondays and Wednesdays, we start our appointments as early as 7:00 AM, catering to those who need to visit us before their workday begins.
On most days, our clinic operates until 5:00 PM, and we even extend our hours until 6:00 PM on one day of the week. This schedule is designed for those who might find it difficult to visit during regular working hours and need more flexibility. If you have an urgent dental need but require an appointment time that's a bit out of the ordinary, we've got you covered. Whether you need an early morning or a late evening slot, just give us a call. Let us know your preference, and we'll do our best to accommodate your schedule.
This service is especially critical for our regular patients, such as a child with a fractured tooth or any other urgent dental issue that requires prompt attention. We strive to ensure that we're available for our patients when they need us, regardless of the time of day.
Do you offer weekend appointments?
Our dental practice is committed to providing comprehensive care to our established patients, even outside regular office hours. We understand that dental emergencies can occur at any time, including weekends, and we're prepared to respond to these situations for patients already in our practice.
If you are an established patient and encounter a dental emergency over the weekend, you should call our emergency line. Once you get in touch with us and describe the issue, we'll assess whether it's something that can wait a bit or if it requires immediate attention. In cases of true emergencies, especially when they involve children, we are willing to come in on weekends to address the issue. Our goal is to stabilize the affected tooth, alleviate discomfort, and ensure both the patient and their family can have peace of mind. We prioritize urgent needs to ensure our patients receive the necessary care to make them feel better as soon as possible.
If you have any further questions or if you're ready to take action regarding your dental health, the best way to reach us is by giving us a call. You can contact us at 503-786-3000. Our team is ready to assist you with any inquiries or to help you schedule an appointment. We're here to support you with your dental care needs.