Dental Emergency

You have about 30 minutes for the best chance of re-implantation. After 60 minutes the chance drops sharply, and after a few hours the tooth usually cannot be saved.

1. Find the tooth. Pick it up by the crown (the part you normally see in your mouth), not the root. Touching the root damages the cells that allow re-attachment.
2. Rinse the tooth gently with milk, saline (contact lens solution), or saliva for a few seconds. Do not scrub it, do not use soap, do not use tap water for more than a quick rinse.
3. If you can, put the tooth back in the socket. Have the person bite down gently on a clean cloth or gauze to hold it in place.
4. If you cannot re-insert it, store it in:
   • Best: milk (the closest household liquid to natural mouth chemistry)
   • Also good: the person’s saliva (in a small clean container, or held under their tongue if the person is conscious and won’t choke)
   • Last resort: saline solution
   • Avoid: water for storage; dry storage
5. Call us at 604-282-3800 immediately and tell us a tooth has been knocked out. If after hours, call HealthLink BC 8-1-1 for the nearest dentist on call.
6. Get to a dentist as fast as possible. If you cannot reach a dental office within 60 minutes, go to a hospital ER instead.

1. Rinse your mouth gently with warm water to clear blood and debris.
2. Save the broken piece if you can find it. We can sometimes bond it back. Store it in milk or saliva.
3. Apply a cold compress to the outside of your face near the injury to reduce swelling.
4. Take an over-the-counter pain reliever (ibuprofen or acetaminophen) following package directions. Do not put aspirin directly on the tooth or gum. It can burn the tissue.
5. Call us at 604-282-3800 the same day. Most broken teeth do not need an ER visit unless there is also a cut lip that won’t stop bleeding, a tooth pushed up into the gum, or you suspect a jaw fracture.
6. If the break exposes the inner pink or red tissue (the pulp), the tooth needs prompt attention to prevent infection and possibly avoid a root canal.

1. Call 9-1-1 first if any of these are true: loss of consciousness (even briefly), suspected neck or spine injury, deformed face or jaw, can’t close the mouth, heavy bleeding, severe headache, vomiting, confusion.
2. Do not try to assess the teeth first. A possible head, neck, or jaw injury takes priority over the teeth. Save the teeth if you can do so quickly and safely (see knocked-out instructions above), but the medical assessment comes first.
3. Trauma centres in the Lower Mainland: Royal Columbian Hospital (New Westminster) is the closest Level 3 trauma centre to Burnaby. Vancouver General Hospital is Level 1 (the most severe cases). BC Children’s Hospital handles pediatric trauma.
4. After medical clearance, follow up with us as soon as possible. Many bike or sports impact injuries that affect the jaw or alveolar bone (the bone that holds the teeth) require bone grafting and dental implants later. The earlier we plan the restoration, the better the long-term result.
5. Document the injury. If anyone took photos at the scene, save them. Insurance claims and possibly ICBC (if vehicle-related) will need them.

For a child with a major head injury, broken jaw, or any sign of concussion: go to BC Children’s Hospital ER (4480 Oak Street, Vancouver) or call 9-1-1.

Knocked-out baby tooth: Do not re-implant a baby tooth. Re-inserting a primary tooth can damage the permanent tooth bud growing underneath. Save the tooth and bring it with you, but do not try to put it back. Call us so we can check that no fragments remain and that the underlying permanent tooth is not affected.

Knocked-out permanent tooth (children 6 and older): Same protocol as adults (see the knocked-out tooth section above). Time is critical.

Mouth cut from a fall: Apply firm pressure with clean gauze or cloth for 10 to 15 minutes. If bleeding does not slow, go to the ER. Small cuts in the lip or tongue usually heal without stitches, but the dentist or doctor should check for embedded debris.

Toothache in a child: Rinse with warm salt water, give age-appropriate pain reliever, and call us. Toothaches in children often indicate infection that needs treatment within 24 to 48 hours.

Tell the dentist or any medical staff that you are pregnant at the very first contact, including how many weeks along you are. This changes which medications, X-rays, and procedures are appropriate.

What is safe during pregnancy:

• Most emergency dental treatment, especially in the second trimester
• Local anaesthetics like lidocaine
• Dental X-rays with a lead apron and thyroid collar when clinically necessary
• Antibiotics from the amoxicillin family

What we avoid or postpone:

• Elective procedures during the first trimester
• Tetracycline-class antibiotics (can stain developing baby teeth)
• Nitrous oxide

An untreated infection or severe pain is more risky to a pregnancy than careful dental treatment. Do not delay calling us out of caution. Call 604-282-3800 and tell reception you are pregnant; we will adjust the visit accordingly.

A throbbing toothache that wakes you up, gets worse with hot or cold, or comes with facial swelling usually means an infection that needs prompt treatment, often a root canal or extraction.

Right now:

1. Rinse with warm salt water (about half a teaspoon of salt in a cup of warm water).
2. Take ibuprofen and acetaminophen alternating every 3 to 4 hours if you can take both (ibuprofen helps with the inflammation; check with a pharmacist if you have any conditions).
3. Apply a cold compress to the outside of your face for swelling.
4. Do not apply heat to a swelling. It can make an infection spread.
5. Call us at 604-282-3800 the same day.

Go to a hospital ER right away if: swelling spreads toward your eye or down your neck; you have trouble swallowing or breathing; you have a fever over 39 °C; or you start to feel generally unwell, dizzy, or confused. These can signal a spreading infection that needs IV antibiotics.

Usually not a same-day emergency, but call us soon (within a day or two) to schedule a repair.

1. Save the crown or bridge if you have it. Keep it in a clean container.
2. If the exposed tooth is sensitive, drugstore temporary cement (sold as Dentemp or similar) can re-seat the crown for a few days while you wait. Do not use household glue.
3. Eat soft foods and chew on the other side until you can see us.
4. Call us to schedule a permanent fix. A tooth left without its crown for too long can shift or develop further decay.

Not an after-hours emergency. Wait until our next open hour and call us.

• Broken wire poking into the cheek: cover the end with orthodontic wax (sold at any pharmacy) or a small piece of cotton ball. Do not try to cut the wire yourself.
• Loose bracket: leave it in place; tape it down with wax if it is irritating your mouth.
• Lost or broken retainer: stop wearing it; teeth can shift within days. Call us for a replacement appointment.