Emergency Care

Soft tissue injuries in the mouth don't usually bleed excessively — although blood mixing with saliva may make any bleeding appear worse than it actually is. To assist someone with this type of injury, you should first try to rinse the mouth with a dilute salt water solution. If a wound is visible, it can be cleaned with mild soap and water; if that isn't possible, try to remove any foreign material by hand, and rinse again.

Bleeding can usually be controlled by pressing damp gauze (or, if unavailable, another clean material) directly to the site of the injury, and keeping it there for 10-15 minutes. If the bleeding doesn't stop, immediate medical attention will be needed. Try to see a dentist within 6 hours of the injury for evaluation and treatment. This usually involves determining the extent of the damage, performing initial restorative procedures, and occasionally suturing (stitching) the wound. An antibiotic and/or tetanus shot may also be given.

Occasionally, foreign objects may become lodged in the space between teeth and gums, causing irritation and the potential for infection. There are a few foods (such as popcorn husks) that seem especially prone to doing this, but other items placed in the mouth — like wood splinters from toothpicks or bits of fingernail, for example — can cause this problem as well.

If you feel something stuck under the gum, you can try using dental floss to remove it: Gently work the floss up and down below the gum line to try and dislodge the object. Light pressure from a toothpick may also help work it free — but avoid pressing too hard or pushing the object in deeper. If that doesn't work, see a dentist as soon as possible. Special tools may be needed to find and remove the object, and you may be given medication to prevent infection.

Sometimes called a gum boil, an abscess is a pus-filled sac that may form between teeth and gums. It is caused by an infection, which may have come from food or other objects trapped beneath the gum line, or from uncontrolled periodontal disease. Because pressure builds up quickly inside them, abscesses are generally quite painful. Symptoms may include a throbbing toothache which comes on suddenly, tenderness and swelling of the gums or face, and sometimes fever. Occasionally, pus draining into the mouth through an opening in the sac relieves the pressure and pain, but may cause a strange taste.If left untreated, abscesses can persist for months and cause serious health problems, including infections that spread to other parts of the body. That's why it is important to see a dentist right away if you experience symptoms. He or she will find the location of the abscess and treat it appropriately. Treatment usually involves draining the pus and fluid, thoroughly cleaning the affected area, and controlling the infection.

Constant, severe pain and pressure, swelling of the gums, and sensitivity to touch indicate an infection in the tooth, possibly accompanied by an abscess (inflamed, pus-filled sac) in the surrounding gum and bone tissue. In this case, it's important to see a dentist or endodontist right away — not only to relieve the pain, but also to save the tooth while it's still possible. Treatment may include a root canal to remove diseased or dying pulp tissue, and/or periodontal procedures to drain the abscess and stop the infection.

Lingering pain after eating hot or cold foods usually indicates disease in the pulp tissue deep inside the tooth. Deep decay or physical trauma to the tooth may have allowed bacteria to infect the pulp tissue or compromise the pulp vitality. As nerves inside the pulp tissue die, the pain may go away, but the infection won't — in fact, it can spread and cause significant damage. Make an appointment to see a dental professional as soon as possible; a root canal may be needed to ease the pain and preserve the tooth.

Sharp pain when biting down on food can be caused by severe tooth decay, a loose filling, a crack in the tooth, or possibly by damaged pulp tissue inside the tooth. It should be evaluated by a dentist as soon as possible. Depending on the cause, treatment may involve filling, bonding, root canal therapy, or other procedures.

Occasional or momentary sensitivity to hot or cold foods may be caused by a tiny area of decay, a loose filling, or a small amount of gum recession that has exposed the roots of the teeth. To alleviate the symptoms, you can try using a soft brush and toothpaste formulated for sensitive teeth, for a couple of weeks. If that doesn't help, call the dental office to schedule and appointment. Dental treatment itself sometimes causes temporary sensitivity, which can often be relieved by the same methods. If pain persists or grows worse, however, be sure to seek treatment.

A severe sinus headache or congestion from colds or flu may cause you to experience symptoms such as a dull ache or pressure in the upper teeth and jaw. When the illness goes away, the dental distress should cease too. Tooth clenching or grinding (bruxism) has also been known to cause this type of discomfort. If you have these habits, you may want to have a nightguard made at the dental office to protect your teeth and jaws from too much force.

No matter what type of tooth pain or discomfort you are experiencing, it is important to seek treatment if it persists.

Americans of all ages love playing sports — so much so that participation in high school sports has been increasing for 24 consecutive years, according to one survey. Yet to gain the very real benefits that sports offer, it's necessary to accept — and prepare for — the risk of injury.

Chipped teeth are the most common dental injury, according to the American Association of Endodontists. If teeth have been chipped or fractured, or if they are loose or tender to the touch, make sure to see a dentist within 12 hours. Try to locate any pieces of the tooth that have come off, as it may be possible to reattach them to the crown with tooth-colored bonding material.

If a permanent tooth has been knocked out of its socket (avulsed), immediate attention is required. First, recover the tooth — and if it's dirty, gently clean it off with water. Try not to touch the root portion of the tooth. Next, if possible, place the tooth back into its socket (making sure it is in the proper orientation), and apply gentle, sustained pressure to the area for five minutes. You can use a wad of wet tissue or gauze to help grasp and hold the tooth in place. Get emergency dental treatment as soon as possible afterward, and be sure to check whether a tetanus shot or booster is needed.If it isn't possible to replant the tooth, have the patient hold it between his teeth and cheek, or place it into a plastic bag with the patient's saliva, or into a cup of cold milk. Control bleeding from the tooth socket by applying pressure to the area (use gauze if possible), and get the patient and the tooth to an emergency treatment center as soon as possible. Primary (baby) teeth, however, don't usually need to be replanted.

If teeth are driven into or pushed partially out of the jaw, or if they are out of alignment, the patient should see a dentist or oral surgeon within six hours of the accident. A careful examination of the mouth (plus x-rays if needed) should reveal the extent of the damage, and indicate what restorative treatments are likely to be required.

In addition to the teeth, dental injuries often involve damage to the gums, the tongue, and the inside of the mouth. When these soft-tissue injuries occur, it's best to take the following immediate actions, and then see a dentist as soon as possible: Wash and rinse the area with soap and water if possible, or remove debris and foreign material by hand. Bleeding can usually be controlled by applying direct, gentle pressure to gauze pads placed on the wound. If it can't be controlled after about 10 minutes, go to an emergency room.

Don't hesitate to call the dental office for more specific information about handling a traumatic dental injury.