Minutes matter
A permanent tooth has been knocked out
Pick it up by the crown, the part you normally see when you smile. Do not touch the root, and do not scrub it or dry it off. The root is coated in a thin layer of living ligament cells, and those cells are what allow a replanted tooth to reattach. Handling strips them.
If it is dirty, rinse it for a few seconds in milk, saline, or your own saliva. Avoid plain water. Water has almost nothing dissolved in it, so those cells draw water in until they burst, and once they are gone the tooth typically cannot take hold again.
The best place for it is the socket it came from. If you can ease it back in the right way round, do that and bite gently on a clean cloth to hold it there. If you cannot, put it in a small container of milk. Saliva is the next best thing. A tooth carried dry in a tissue is the worst option there is.
Then call us. The first thirty to sixty minutes matter most, and after roughly an hour out of the mouth and dry, the chance of the tooth taking often drops sharply.
One exception: a knocked-out baby tooth should not be put back in. Pushing it into the socket may damage the permanent tooth forming above it. Keep your child comfortable, bring the tooth if you have it, and call us.
Protect what is left
A tooth is cracked, chipped, or broken
Save every piece you can find and keep them damp. Rinse your mouth with warm water, and hold a cold compress against the outside of your cheek rather than against the tooth.
Cover any sharp edge with dental wax from a pharmacy, or a piece of sugar-free gum, and stop chewing on that side. A broken edge can cut your tongue and cheek badly in a single day.
The reason this is worth a call even when it does not hurt: a crack that reaches the soft tissue inside the tooth lets saliva bacteria in, and the longer that stays open, the less of the tooth there often is to work with.
Do not wait it out
A toothache, or a suspected abscess
Rinse gently with warm salt water and floss carefully around the tooth in case something is trapped. A cold compress outside the cheek can help. Over-the-counter pain relief taken as directed on the label is fine. Never hold aspirin against the gum — it burns the tissue and does nothing for the tooth.
Swelling near a tooth, pain on biting, a bad taste, or a small pimple-like bump on the gum can all point to infection. Do not try to squeeze or lance that bump, and do not put heat on a swollen face. Call us.
The part people get wrong: a tooth that has throbbed for days and then suddenly goes quiet has usually not healed. The nerve inside it has died, so it has stopped sending the signal. The bacteria that killed it carry on into the bone at the root tip. If the pain stopped on its own, that is still a reason to call, not a reason to relax.
Keep the piece
A filling or crown has come out
What is underneath is unprotected. The inner layer of a tooth is threaded with microscopic tubes running to the nerve, which is why cold air and cold drinks may suddenly feel sharp.
Keep the crown if you have it and bring it with you. Temporary dental cement from a pharmacy can hold it in place for a few days. Never use household or superglue: it is not safe in the mouth and it typically ruins any chance of the original crown being cemented back properly.
Chew on the other side and call us. Left open for weeks, an unprotected tooth often chips further and the teeth on either side drift into the gap, so a crown that came out intact may no longer fit by the time it is looked at.
Pressure, not checking
Bleeding after an extraction
Fold clean gauze into a firm pad, place it over the socket, and bite down steadily for twenty to thirty minutes without lifting it to look. Every check restarts the clock, because the clot is torn away each time.
A damp black tea bag works well in place of gauze. The tannins in tea help the blood clot.
For the first day, no rinsing, no spitting, no straws and no smoking. Suction pulls the clot out of the socket, which is what leaves the bone exposed and typically makes day three far worse than day one.
If the bleeding is still heavy after an hour of steady pressure, call us. If it is pouring rather than oozing, treat it as the hospital list above.
Gently
Something is stuck between two teeth
Floss is the tool for this. Ease it down beside the object and pull it out sideways rather than snapping straight through, which tends to drive the object further in and can bruise the gum.
Never use a pin, a needle, a knife tip or a toothpick fragment. Metal against the gum causes an injury on top of the original problem, and a splinter of wood left behind is its own infection.
If it will not come out, leave it and call us. Something that keeps catching in the same spot every day is often a sign of a broken filling or a gap that needs looking at anyway.
Bring the pieces
A denture, retainer, or aligner has broken
Do not glue it. Household adhesives are not food safe, and they typically distort the fit enough that a proper repair is no longer possible. Bring every fragment in, even the small ones.
Stop wearing anything with a broken edge. Sharp acrylic will ulcerate the gum underneath within a day or two.
If a clear aligner has cracked, keep the previous set and wear that instead until we speak. Teeth begin drifting back within days of nothing being worn, and losing that ground often costs more time than the breakage itself.