- A permanent tooth that has come out whole is the one situation where the first minutes change the outcome. Everything else is sorted by pain, swelling and time.
- A dentist is who you want. A hospital emergency department can help with part of the problem and not the rest, and knowing where that line sits can save you a wasted night.
- Keep a knocked-out tooth moist, in milk or saline, never water. Do not let it dry out.
- Never put an aspirin on the gum or on the aching tooth, and use cold rather than heat.
- A baby tooth is never put back in. Take it with you and have the mouth looked at.
A tooth comes out at six in the evening, and the next few minutes decide how much of it can be saved. If you have ever typed “can the ER do anything for teeth” into a phone with one hand while holding a torch with the other, this article is written for that exact moment. Here is its shape. Find the tooth, or find the painkiller, or look at the swelling, and then phone somebody. What follows sorts the situations one at a time, so you can read only yours. Nothing here substitutes for being seen, and nothing here diagnoses anything.
The one with a clock on it: a permanent tooth that has come out whole
Do this first: find the tooth, and hold it by the crown, never by the root.
This is the only dental injury where the first minutes genuinely change the outcome, because a permanent tooth that is knocked out whole can be saved with immediate action. The steps, in order.
Stay calm enough to find the tooth, and pick it up by the crown, the part you would normally see. Do not scrape it, rub it, or try to remove any tissue fragments attached to it.
If it is dirty, rinse it in milk or contact lens saline. Not water, and not for long.
Replant it in the socket and bite down on a clean cloth to hold it in place, if you can manage that. If you cannot, keep it moist, and keep it moist in the right way: in milk or in saline, not in water. If the person it belongs to is old enough and calm enough to hold it safely, it can travel inside their mouth beside the cheek. If not, wrap it in cling wrap with a little saliva. The one outcome to avoid at all costs is a tooth that dries out.
Then get to a dentist immediately. The reason for all of this care is simple: the difference between a tooth that stays alive and one that does not is usually made before anybody reaches a clinic.
Two groups this section is not for, and they matter just as much. A baby tooth is never replanted, because doing so can damage the adult tooth still developing underneath; take it with you and have the mouth looked at instead. And if the person is not calm, not cooperative, or not fully conscious, do not put the tooth in their mouth at all, in any form.
One more thing is worth saying about this situation, because it is the one readers second-guess. The steps above are the same whether the accident happened at sport, at school or at the kitchen table. What changes is only how quickly you can get to a dentist, which is another way of saying that speed is the whole of the advantage.
A tooth that is broken, chipped or cracked
Do this first: keep the pieces, including the small ones, and rinse gently.
A cracked tooth has several possible futures and you cannot tell which one you are in by looking. So the useful work is care, not diagnosis. Keep whatever broke off, even the fine pieces, and take them with you; a dentist can sometimes use them.
Rinse the mouth with warm water to clear any debris. Use a cold compress on the outside of the face if it is swelling, and never heat. Avoid chewing on that side until someone has looked at it.
See a dentist promptly for anything that has exposed a sharp edge, anything that has opened the tooth, and anything that hurts when it should not. The cosmetic question, whether it shows and whether it should be bonded, is a later conversation with a normal appointment rather than part of the emergency. If the damage turns out to be permanent, the site’s what to expect before, during and after getting a dental implant sets out what that conversation involves.
A line that helps when the tooth looks worse than it feels, or feels worse than it looks: that mismatch is normal, and it is a reason to have the tooth seen rather than a reason to relax.
An abscess, or a face that is swelling
Do this first: look at the swelling, and be honest about what it is doing.
This is the section that needs to be unambiguous, because this is where a tooth problem stops being a toothache and starts being a medical one. The signs, named plainly: a toothache that will not settle, pus, red or swollen gums or face, a bad taste or bad breath, fever, sensitivity to hot and cold, swollen glands in the neck, a swollen upper or lower jaw, difficulty swallowing or opening the mouth, and nausea or vomiting.
Then the line this article exists to write. A swollen face with difficulty swallowing or breathing, or a swelling that is closing the eye or spreading down the neck, is a hospital matter. Go now. Do not wait for a dental appointment, and do not wait to see whether it settles overnight.
Anything short of that is a dentist matter, and it should be seen soon rather than watched. An infection inside a tooth does not drain itself. It does not respond to anything you can buy at a supermarket, and it does not get better because you have decided to be sensible about brushing. It needs a person with the right tools, and the sooner the better.
An infection can also be quiet for a long stretch and then stop being quiet, which is the pattern to treat with respect. A toothache that has been “settling down” for weeks is not settling. It is waiting.
A toothache with nothing visibly wrong
Do this first: warm water to rinse, and cold on the outside of the cheek.
This is the most common call and the least dramatic. Rinse with warm water to clear any debris. If there is swelling on the outside, a cold compress helps; heat does not, and heat can make it worse. For moderate pain, over-the-counter pain medication is reasonable.
Then the warning that needs to be said plainly, because it is still done. Do not put an aspirin on the gum or against the aching tooth. It burns the soft tissue. It was advice once, and it was wrong.
The honest limits are worth knowing too. A toothache that wakes you at night, or one that gets worse with heat, is usually the pulp rather than the surface, and no amount of brushing, salt water or clove oil is going to change that. It needs a dentist, and a painkiller is a way to get there rather than a way to avoid it. Pain that a painkiller settles is still pain, and it will be waiting when the effect wears off. If you do not already have a practice to ring, this is a normal reason to find one, and a general practice such as a dental practice with clinics in Wanneroo and Mount Lawley is where most of these end up. The site’s sensitive teeth: what causes them and what actually helps covers the milder version of a tooth that complains, if that is closer to what you have.
One line on what this section is not. If the pain is in the jaw or the ear rather than the tooth, and especially if it comes with chest symptoms, that is a different emergency and it is not this article.
When the tooth is not the problem: a bad knock, a jaw, a bitten lip
Do this first: stop any bleeding with firm pressure and a clean dressing.
These are the situations people do not search for, because they assume the mouth will sort itself out. Sometimes it does, and sometimes it needs a person.
A hard knock to the mouth where the teeth look fine but the bite feels wrong. A jaw that will not close normally. A lip or cheek that will not stop bleeding. A tongue bitten through. The guidance is short and the same in every case: control bleeding with firm pressure and a clean dressing, use cold rather than heat, and get medical attention for anything involving a break, a wound that will not stop, or a bite that has changed. The mouth heals well, and it also gets infected well. That combination is exactly why it is worth having someone look.
The same applies to a knock that seems to have done nothing. If the bite feels different afterwards, that is the detail to mention.
One sentence belongs here for children and sport, because it prevents most of what this whole section describes: a fitted mouthguard is the one piece of equipment that reliably stops the injury happening in the first place.
What a hospital can and cannot do for a tooth
Do this first: work out whether this is a danger or a damage.
This is the question people ask in four different ways at two in the morning, and it deserves a straight answer. A hospital emergency department can help with the things that are medical: severe swelling, difficulty breathing or swallowing, uncontrolled bleeding, a facial injury, and pain that cannot be managed at home. The Queensland Government’s emergency dental guidance states that where a dentist cannot be seen, an emergency department may be able to provide the treatment needed to save the tooth, which is worth knowing rather than assuming.
What an emergency department is not is a dental surgery. The definitive dental work, the treatment that fixes the tooth itself, is done in a dental chair with a dentist’s equipment. So the honest rule of thumb is this: a hospital for danger, a dentist for damage.
That split answers the question almost everyone is really asking, which is whether a hospital will solve it for them tonight. Sometimes it will, when the thing that needs solving is the emergency around the tooth. Sometimes it will keep the situation safe and send you to a dentist, and that is a good outcome rather than a wasted trip. What it will not do is replace the dental appointment you are going to need regardless.
One practical note for that trip: bring the tooth, or the pieces, if there are any, and a quick note of what happened and when. The first questions anyone will ask are about the injury itself, and those details are easiest to give while they are fresh.
Do not ignore it, and do not wait for it to settle
Do this first: ask the one question that sorts waiting from going.
Is this getting better on its own, or is it getting worse? That question decides almost everything in this article, and it is one you can answer honestly in the bathroom mirror.
A weekend of waiting is a reasonable and common choice for a sore tooth. It is a bad choice for a swelling. An infection inside a tooth does not quietly resolve, and a tooth that has been knocked out and left to dry does not come back. If you cannot reach a dentist, there are routes built for exactly that moment: healthdirect, the national health advice service, runs an advice line and an online symptom checker, and the public dental service in your state runs its own emergency stream on its own eligibility rules. Both are worth knowing about before you need them rather than while you are searching.
Public dental care deserves one more paragraph, because it is the route some readers will actually take. Every state and territory runs its own service, with its own emergency and general streams, its own eligibility arrangements and its own way in, and none of it is uniform. The details depend on where you live, so the starting point is your own state’s service rather than a national summary.
Once it has settled, the natural sequel is the check-up you promised yourself, and the site’s what actually happens at a dental check-up (and what the numbers mean) explains that appointment before you sit down in it.
If it happens tonight, in order
- Find the tooth, or find the painkiller, or look at the swelling.
- Deal with any bleeding using firm pressure and a clean dressing.
- Cold, never heat.
- No aspirin on the gum or on the tooth.
- Keep a knocked-out tooth moist: milk or saline, never water, never dry.
- Do not put a baby tooth back, and take it with you.
- Call a dentist, and if you cannot reach one, work out whether this is a hospital thing or a Monday thing.
- Keep the pieces.
Most of these end with a dentist and a plan rather than a disaster. The reason to read this page is so that the ones which do not are the ones you went to hospital for.
This is general information and not a substitute for being seen. Anything that is getting worse needs a person rather than a page.
Sources consulted: Queensland Government emergency dental information; healthdirect health advice and symptom checker.