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Dental Emergencies

What to do when a dental emergency strikes and your dentist is MIA

There is nothing worse than being on your honeymoon, in-flight, on a camping trip, or a long car ride when it strikes – an unrelenting toothache so severe you feel like you want to die. Toothaches and other dental inconveniences occur regardless of the fact that it may be 2 AM or that your dentist is away on a Caribbean vacation. Knowing what to do can prevent major discomfort. Toothaches can range from a distressing inconvenience to an intense, miserable experience. Severe, emergency dental pain may be as unrelenting as kidney stones or even labor contractions. Fortunately, the chance of an unforeseen dental crisis can usually be prevented by early detection and treatment of dental disease. When dental disaster does strike, (and it always seems to be at the most inopportune time) knowing how to alleviate the pain is invaluable information everyone can use.

A toothache is any pain or soreness within or around a tooth, indicating inflammation and possible infection. Generally, a toothache occurs if tooth decay is very close to or has penetrated the pulp chamber that contains nerves and tiny blood vessels. Ideally, it’s best to undergo dental treatment at once. Dr. Jonathan Abenaim is a cosmetic and restorative dentist in New Jersey. Throughout his many years in practice, he has heeded the call of many a patient in dental distress. Dr. Abenaim has developed an arsenal of at-home tips to help patients with toothaches and other emergencies until they reach his dental chair. “If your toothache is caused by trapped food, you should rinse the area with warm water and swish it about. Floss between the teeth this should dislodge the food or it may loosen whatever is causing the pain.

There are many over-the-counter (OTC) pain relievers to cure toothaches that you can choose from. Most common are paracetamol, aspirin, and acetaminophen. If you feel that a small swelling has occurred, you may take non-steroidal anti-inflammatory drugs (NSAID) for their inflammatory components, like ibuprofen, (Advil, Aleve) and mefenamic acid. However, those with a history of ulcers as well as pregnant women need a doctor’s recommendation before taking NSAID and aspirin. “Rubbing aspirin on your gums to numb an aching tooth isn’t a good idea. In fact, it’ll do more harm than good,” says Dr. Abenaim. He adds, “Aspirin contains salicylic acid, which can burn and damage gum tissue. For general pain relief, it’s a better idea to simply swallow the aspirin. Or stop by a pharmacy for pain-relieving gels like Anbesol or Orajel.” There is also something that a patient can buy called Dentemp. It’s over the counter and can be used to cement a temporary or permanent crown until the person gets to his/her dentist. It could also be used to caulk or fill a hole in case a filling breaks.

Other home remedies for a toothache include rinsing your mouth with salt water or dabbing some clove oil directly on the bad tooth. Clove oil has bacteria-slaying properties, along with a remarkable numbing effect. “We’ve used clove oil in dentistry for years,” Abenaim says. “Clove oil is responsible for that stereotypical dental office smell. Years ago, we would dab clove oil over a tooth before putting a filling in it, but now we have better ways of decreasing the sensitivity.” For another home remedy, there is numbing power in cooled peppermint tea. Swish, then swallow if you like the flavor. “People can try putting some ice on the area, but the temperature of the ice could send them over the edge,” cautions Dr. Abenaim. “Most challenging are toothaches that stem from inside a tooth,” he adds. But in cases where a lost filling or a broken tooth is causing the pain, “caulking” the sore tooth with softened chewing gum can ease the pain – covering the sensitive area until it can be repaired.

Dr. Abenaim also receives frequent complaints about canker sores. He suggests that people with frequent canker sores check to see if their toothpaste contains sodium lauryl sulfate, or SLS. SLS is a foaming agent that in some studies has been linked to the development of canker sores. “Toothpaste that doesn’t contain SLS usually makes a big deal about it by saying ‘SLS free’ on its label,” says Dr. Abenaim. An additional remedy for both canker sores and gum pain is tea tree oil. Tea tree oil should be applied directly to the infected site and can even be purchased in mouthwash form to soothe inflammation. Another preventive measure for canker sores is to avoid eating chips and other jagged foods that can cause tiny cuts and scrapes, which can be an entryway for a virus to set up shop in your mouth. Besides that, stay away from foods that trigger canker sores. Potential troublemakers include whole wheat, rye, barley, shellfish, pineapple, chocolate and tomatoes, as well as salty or citrus fruits. There is a remedy of 1/3 Mylanta, 1/3 Benedryl, and1/3 viscous Lidocaine. This will ease the discomfort of canker soars.

“About 80 percent of our population deals with gum problems – from gingivitis all the way up to losing teeth,” according to Dr. Abenaim. Ginseng can be used to alleviate the pain associated with irritated gum tissue. A ginseng tonic can be directly applied to the gum to promote circulation and speed healing. An additional home remedy suggestion is to use a wet tea bag for tooth or gum pain. Tea contains astringent tannins, which have the power to shrink swollen tissue and stop bleeding. No toothache will heal on its own. A toothache is a dental problem that needs to be treated as soon as possible.

What should you do if you’ve knocked out a tooth – whether from a blow, a fall or accident?

Shake off debris (rinsing or scrubbing could remove important periodontal ligament), place it in a container of milk or back in its socket and try to reach the dentist within 30 minutes. “Unfortunately, not all teeth can be saved,” cautions Dr. Abenaim. Alternative methods, such as a bridge or implants, may need to be considered.”

What should you do if you’ve broken a tooth?

Again, if you’ve lost the broken piece, just get to the dentist. “If you have it, gently shake off surface dirt and definitely keep it,” says Dr. Abenaim. “Even if the piece can’t be bonded back to the original tooth, it can be used to help re-create the look of that tooth.

If something (food, other foreign matter) is wedged between your teeth, should you try to dislodge it?

Gentle flossing or brushing is fine, but if the object does not respond to that treatment and the surrounding gum begins to swell, make an appointment with your dentist. A bit of broken filling or chipped enamel can throw your bite off and make you panic. Popcorn husks are one of the worst problems and occasionally need to be removed by a dentist.

What should you do if you lose a filling or crown?

If you lose a filling, it’s not worth saving. However, just cover the hole with temporary material, do not try to put the old filling back in the tooth. If you lose a crown, you’ll want to try and salvage it (you can use Temparin or Dentemp, available in pharmacies, to put the crown back in place until you can reach a dentist). “In either case, visit the dentist as soon as possible,” says Dr. Abenaim. “Many people don’t realize that when a filling falls out, there’s a reason for that, whether it’s a cracked tooth or more severe. You need to see a dentist.”

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