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If you have a toothache, a broken or knocked-out tooth, swelling, or an injury to your mouth, call us at (305) 568-8899 as soon as you can. We try to see patients in pain the same day; when the pain starts late in the day, the first opening is often the next morning. If you are already a patient here, we have your records, which makes it easier to advise you, including by phone outside office hours. New patients need to be seen, because an examination is the only reliable way to find the cause.
What to tell us when you call
- Where it hurts, and for how long
- Whether anything makes it better or worse
- Whether there is swelling, fever or an injury
- Whether you can open your mouth normally
That lets us judge how urgent it is and prepare.
Problems we see every week
- Toothache, from a dull ache to pain that keeps you awake
- Cracked, chipped or broken teeth, and lost or broken fillings and crowns
- Teeth knocked loose or out after a fall, a sports injury or an accident
- Swelling of the gum or face, and abscesses
- Sensitivity to hot or cold that has become severe
- Gum pain and bleeding, and pain around an erupting wisdom tooth
- Jaw muscle tightness and pain
- Ulcers, sores and other lesions in the mouth
Comfort first
The first priority at an emergency visit is to get you comfortable. When the source is obvious, such as a broken tooth with a deep cavity that hurts when touched, we numb it first, let the pain subside, and then go through your options. When the cause is not obvious, we hold off on the anesthetic for a few minutes, because numbing the area makes it harder to tell which tooth is responsible, and run the tests that pinpoint it.
Finding the cause
Depending on the problem:
- X-rays of the tooth or the jaw, and a CBCT scan when a flat image is not enough
- A cold test to check the nerve
- Gentle tapping, and a bite test for cracks
- Probing of the gum
- A check of how your teeth meet
Pain is often felt in a different place from the tooth causing it. Occasionally the picture is not clear at the first visit; then we relieve the symptoms and arrange further testing rather than treat the wrong tooth.
What can be done at the first visit
- Step 1 of 5 Relief
Local anesthesia when the source is clear, and treatment of the immediate problem so that you leave more comfortable than you arrived.
- Step 2 of 5 Diagnosis
Examination and the tests above, and an explanation of what we found, what it means for the tooth and what the choices are.
- Step 3 of 5 Treatment, definitive or temporary
Where it is possible and sensible, the final treatment that day: a filling, smoothing or rebuilding a chip, starting a root canal, recementing a crown, or an extraction when the tooth cannot be saved. Otherwise a temporary measure that stops the pain and protects the tooth until a planned visit.
- Step 4 of 5 Medication and instructions
Whatever prescriptions the situation calls for, what to expect over the next days, and when to call us back.
- Step 5 of 5 Follow-up
A planned appointment to complete treatment, or further testing if the diagnosis is still open.
Pain that is not coming from a tooth
- Tight, sore jaw muscles from clenching can feel like a toothache across a whole side.
- A blocked sinus can make the upper back teeth ache and feel tender to bite on.
- Pain can be referred from one tooth to another, or from the lower jaw to the ear.
- Some symptoms are never dental: jaw or arm pain with shortness of breath, sweating or chest pressure is treated as a possible heart problem and belongs in an emergency room.
Part of the examination is sorting these out.
After the visit
- You will know what we found, what was done, what to expect over the next few days and when to call back.
- Some soreness after an extraction or the start of a root canal is normal and settles with the pain relief we recommend.
- Swelling that increases after the second day, a fever, or pain that gets worse rather than better is a reason to call us.
- If you left with a temporary filling or crown, it protects the tooth for weeks, not months, and the planned visit to finish the treatment is what solves the problem.
Call before the pain is severe
A tooth that has been hurting badly for days develops a severely inflamed nerve, what dentists call a hot tooth, which is harder to anesthetize fully. That is where the reputation of the emergency root canal as a painful procedure comes from. Treated early, the same tooth is numbed easily. We can still make a patient who has waited comfortable; it is harder work for everyone.
First aid while you arrange care
A permanent tooth knocked out. Pick it up by the crown, not the root, and do not scrub, wipe or soak it: the film on the root holds the cells that let it reattach. If it is dirty, clean it gently with saliva, or rinse it for a few seconds under cold running water. Put it back in the socket right away if you can and hold it in place with your fingers; if not, keep it moist in milk, in a little saliva in a cup, in Hank’s Balanced Salt Solution or inside the cheek, never dry and never in water. Come straight in or go to an emergency dentist; the longer the tooth is out, the lower the chance of saving it. Never put a baby tooth back.
A broken or chipped tooth. Rinse your mouth with warm water, keep any piece you find, and cover a sharp edge with sugar-free gum or dental wax if it is cutting your tongue.
A lost crown or filling. Keep the crown; it can often be recemented. Avoid chewing on that side.
Swelling. A cold compress against the cheek, twenty minutes on and twenty off. Swelling that grows, or any difficulty swallowing or breathing, means the emergency room.
Pain. An over-the-counter pain reliever as directed on the label, if your doctor allows it. Nothing placed on the gum itself.
Prevention
Apart from injuries, many dental emergencies could have been prevented. The cavity that reaches the nerve had been there for a long time without hurting, and the wisdom tooth had been grumbling for weeks before it flared. Regular exams and cleanings catch those problems while they are small and painless.
Frequently asked questions
Do you see new patients for emergencies?
Yes. New patients need to come in so we can examine you, take any X-rays or tests we need and find the cause; we cannot advise someone we have never seen over the phone. Call as soon as you can and tell us what is happening.
Are you open on weekends or Wednesdays?
The office is open Monday, Tuesday, Thursday and Friday from 9 am to 5 pm. Outside those hours, established patients can call the office number; because we know your mouth and have your records, we can often advise you by phone and arrange the first available visit. New patients with a true emergency outside our hours should seek urgent care.
Will you pull the tooth the same day?
If the tooth cannot be saved and extraction is the right treatment, often yes. But a painful tooth is not automatically a lost tooth. Many emergency visits end with the tooth saved, by starting a root canal, placing a temporary filling or adjusting the bite. We tell you the options before anything irreversible is done.
What should I do about pain at night before I can be seen?
Take an over-the-counter pain reliever as directed on the label, unless your doctor has told you not to. Keep your head raised, avoid very hot, cold or sweet food on that side, and a cold compress on the cheek helps with swelling. Do not put aspirin on the gum; it burns the tissue. Then call us first thing in the morning.
Will antibiotics fix my toothache?
Usually not on their own. Most dental pain comes from inflammation inside the tooth or around it that antibiotics do not reach; the cause has to be treated. Antibiotics have a place when there is spreading infection, swelling or fever, and we prescribe them when they are indicated, but a prescription without treatment only delays the problem.
How much does an emergency visit cost?
The emergency examination, including any X-rays needed to find the cause, is a set fee, and we quote any treatment before doing it. Most PPO plans cover emergency exams and X-rays.
Sources
Professional guidelines and peer-reviewed reviews this page draws on.
- Lockhart PB, Tampi MP, Abt E, et al. Evidence-based clinical practice guideline on antibiotic use for the urgent management of pulpal- and periapical-related dental pain and intraoral swelling. Journal of the American Dental Association. 2019;150(11):906-921. DOI
- Fouad AF, Abbott PV, Tsilingaridis G, et al. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth. Dental Traumatology. 2020;36(4):331-342. DOI
