What to do right now
Call 911 first if there is trouble breathing or swallowing. Go to an emergency room for a head injury, an eye injury, bleeding that will not stop with firm pressure, or a jaw that no longer closes correctly. For a knocked-out permanent tooth, hold it by the crown, keep it in milk, and be seen within the hour. For everything else, call us.
Outside 16:00–21:00 the line reaches the on-call service, which pages the surgeon.
Go to an emergency room, or call 911
These need a hospital rather than a dental office. Going to the right place first is faster than being sent on.
- Any difficulty breathing or swallowing — call 911.
- Swelling that involves the eye, or that is spreading under the jaw or into the neck.
- Bleeding that will not stop after 20 minutes of firm, continuous pressure.
- Loss of consciousness, vomiting or confusion after a blow to the head.
- A jaw that will not close together properly, or a bite that has changed after an impact.
- Numbness of the lip or chin following facial trauma.
- Fever above 101°F together with facial swelling.
- Any injury to the eye, or a change in vision.
Call us for these
Call us and we will get you seen. If we are closed, the on-call service pages the surgeon.
- A knocked-out permanent tooth — call while you are on your way.
- Pain that was improving after an extraction and has sharply worsened, typically day three to five. This is the pattern of a dry socket.
- A tooth broken below the gum line, or a fragment left in the lip.
- Swelling at the back of the jaw around a partly erupted wisdom tooth.
- A suture that has come loose, or a socket that has started bleeding again.
- Numbness that has not started to improve in the days after surgery.
A knocked-out permanent tooth, in the first hour
Time out of the socket is what determines whether the tooth survives. Do these four things in order.
Pick it up by the crown
The crown is the part you normally see. Do not touch the root — the cells on its surface are what allow the tooth to reattach.
Do not scrub it
If it is dirty, rinse briefly in milk or saline. Not tap water, and never with a brush or cloth. Cleaning the root surface is what makes reimplantation fail.
Put it back if you can
Into the socket the right way round, then bite gently on a clean cloth to hold it. If you cannot, keep it in milk — the inside of the cheek works if there is nothing else and the person is fully alert.
Be seen within the hour
Call us on the way. A baby tooth is not put back — leave it out, and still be seen.