Emergency

True dental emergencies may require immediate attention by a dentist, whereas other complaints can be handled at home.  Below are tips on how to handle various dental situations.

Inflamed or Irritated Gum Tissue

  • Sudden bleeding or swelling of the gums may be the result of food or foreign body impaction. (Locate if possible and remove the cause)
  • Red, swollen gums should be rinsed thoroughly with a warm salt water solution (1/4-2 teaspoons of salt in 8 oz. glass of warm water) for 15-30 seconds.
  • The child’s parent/caregiver should be contacted for referral to a dentist if the bleeding cannot be controlled within three days.

Objects Caught in Between Teeth

  • Try gently to remove the object with dental floss and avoid cutting the gums.
  • Do not try to remove object with a sharp instrument, as injury may occur.
  • If unsuccessful, please contact the parent/caregiver for referral of the child to a dentist.

Lip, Cheek or Tongue Injuries

  • Have child rinse repeatedly with warm water.
  • Gently clean the bitten area with a clean cloth.
  • Apply pressure to the bleeding area for at least five minutes.
  • Use cold compresses to reduce the swelling.
  • If the bleeding still persists after 15 minutes and cannot be controlled with pressure, immediately go to a dentist or hospital emergency room.

Tooth Aches

  • Rinse out the patient’s mouth with warm water.
  • Gently use dental floss or an interdental cleaner to make sure that there is no food or other object stuck between the teeth.
  • Check temperature and observe for respiratory distress.
  • If face is swollen, apply cold compress.
  • Never apply any other painkiller against the gums near the aching tooth because it may burn the gum tissue.
  • Look for localized abscess or gum boil.

Broken Tooth

  • Rinse the patient’s mouth out with warm water to clean the area.
  • Control any bleeding
  • Use cold compresses to keep swelling down.
  • Observe broken end of tooth for bleeding.
  • Try to locate broken fragments of tooth, if applicable and possible.
    – Keep tooth fragments in gauze moistened with water.

Displaced Tooth

  • If tooth has been pushed up into the socket or gum by the blow, control bleeding and be supportive.
    – DO NOT attempt to pull it out into position.
  • If the tooth has just been loosened, attempt to reposition the tooth to its normal alignment using a light amount of finger pressure.
    – DO NOT force the tooth back into position.
  • Have the patient bite down to prevent the tooth from moving.
  • Refer to dentist immediately as permanent damage to broken tooth may occur without care.

Knocked out Tooth

Permanent Tooth

  • TIME IS CRITICAL! Contact the parent/caregiver to arrange to have the child taken to a dentist immediately.
  • Hold the tooth by the crown and rinse the root off in water.
  • Do not scrub the tooth.
  • Be careful not to remove any attached tissue fragments.
  • If possible, gently insert tooth back into its socket.
  • If that attempt fails or is not possible, place the tooth in a Save-A-Tooth Kit, and have child take it with them to a dentist immediately.

Primary Tooth

  • DO NOT attempt to replace primary tooth in child’s mouth.
  • Control bleeding and check for other injury.
  • Contact parent/caregiver for referral to a dentist.

Lost cap/crown

  • May simply be a lost primary tooth – check inside cap for tooth fragments – if so, no action is necessary.
  • If due to poor retention, contact parent/caregiver for referral to a dentist – bring cap to dentist.

Tooth Eruption and Shedding Pain

Loose Primary Teeth

  • Normal problem – reassure child and encourage home removal.

Erupting Primary Teeth

  • Local discomfort is common with eruption and can be associated with cold, fever or diarrhea. Can use various treatments such as refrigerated teething rings or topical anesthetic.
  • Eruption site should be hard and blanched (white). If soft, may be an eruption cyst; refer to a pediatric dentist when convenient.

Erupting Permanent Teeth

  • Keep area clean with warm salt water.
  • No treatment necessary unless prolonged pain (over 24 hours) which is unusual; this may be caused by inflammation around an impacted or partially impacted tooth.
    – The parent should be notified for referral of the child to a dentist.

Orthodontics

General Discomfort and Irritation

  • It is perfectly normal for a patient to experience discomfort for a few days after braces have been adjusted, especially when eating.
  • An over-the-counter pain reliever such as acetaminophen or ibuprofen can be taken to lessen the pain.
  • Reassure students that pain is a normal side effect of wearing braces and recommend that they eat softer foods.
  • For general irritation of the mouth due to braces, apply a small piece of non-medicinal relief wax to act as a buffer between the

Mouth Sores

  • Mouth sores on the cheek, lips, or tongue due to braces are not considered true emergencies but can cause significant discomfort.
  • Applying a small amount of topical anesthetic directly to the ulcerated surface with a cotton swab can bring quick relief.

Protruding Wires

  • In the event of a wire working itself out of place and causing irritation to the student’s mouth, use a cotton swab to push the wire so that it rests flat against the tooth.
  • If the wire cannot be moved or bent back into place, cover it with relief wax.
  • In situations where the wire is causing extreme discomfort, use a folded tissue or gauze around the area.

Loose or Knocked-off Brackets

Brackets are generally attached to the center of each tooth with a special adhesive and can break off when children eat hard foods, or if their mouth is struck during gym or athletic play.

  • If a bracket is off-center, the adhesive may have failed.
  • Notify parents of the situation and recommend they contact their orthodontist immediately.