In Case Of A Dental Emergency

           Unfortunately, dental emergencies can and do occur. Furthermore, they often happen at the most difficult times when help is not immediately available. You may be traveling far from home or inclement weather may make traveling even just to Dr. McArdle's office forbidding. Your phone line may be out of service or you can't wait for Dr. McArdle to return your call. There are certain steps you can take in these cases to help yourself when Dr. McArdle isn't readily accessible to help you.

           Dental emergencies can be categorized as cosmetic, functional or symptomatic with varying degrees of overlap among these three classifications. Cosmetic emergencies in and of themselves are not sensitive, but they are unsightly and can be quite embarrassing when they happen just prior to important social occasions. Examples of purely cosmetic emergencies would be chipping an upper front tooth or losing a bonded filling from one when you experience no discomfort, but these can be easily seen while you speak or smile. Functional emergencies may hinder speech or mastication and can be quite annoying such as when a fractured but asymptomatic tooth causes you to lisp or prevents you from chewing on one side. Symptomatic emergencies result in varying degrees of pain ranging from a howling toothache to momentary but intense temperature sensitivity to vague feelings of pressure and everything in between. Many dental emergencies will have features of more than one of these types as in the case of a chipped front tooth that is bothered by breathing in cold air and is obvious when you speak or smile.

           There is not much that you can do for yourself in the case of purely cosmetic dental emergencies involving the tips of your natural teeth. If you lose a bonded filling from one of your front teeth that is totally or almost totally surrounded by the rest of your tooth, you may be able to replace it with one of the temporary filling compounds (DenTemp or Tempinol) obtainable over the counter at most drug stores with a passable esthetic result. Fractures at the edges or corners of your front teeth are almost impossible for you to repair with these products and if you are away from home when this happens, it is best to visit a local dentist and have a temporary filling placed until you can be seen by Dr. McArdle. Do not try to secure retrieved fragments of your natural teeth back in place with super glue as its active ingredient (cyanoacrylate) is quite toxic and can kill the nerve in your tooth.

           If you are a denture wearer and one of your denture teeth becomes dislodged, you can temporarily reattach the tooth if it is not hopelessly broken with super glue. However, cyanoacrylate is dissolved by your saliva in a relatively short period of time so it will be ultimately necessary to have Dr. McArdle reattach your denture tooth to its base professionally. There are some denture repair kits available over the counter, but these require the mixing of acrylic liquid and powder into a paste which can be quite messy and produce oppressive fumes so it is best to use super glue as a temporary measure. You should never try to use one of these kits to repair a natural tooth (as you may try to do with DenTemp or Tempinol) or recement a cap because their acrylic paste expands significantly on setting and could split your tooth like a wedge if used as a temporary filling material or shatter a metal-free crown. The safest way to temporarily recement a cap (also called a crown) lost from one of your front teeth is to use denture adhesive and be careful not to bite into food with it until it can be recemented by Dr. McArdle.

           You can often deal with functional emergencies yourself on a temporary basis with satisfactory results. Fillings lost from your back teeth that allow food to be trapped while you chew can be replaced temporarily using DenTemp or Tempinol as mentioned above until you can get to Dr. McArdle's office. If you are a partial denture wearer and one of its clasps (the hooks that anchor it to your remaining natural teeth) should break off, using denture adhesive on the partial's base should help stabilize it until Dr. McArdle can replace the clasp. A lost crown can be replaced with denture adhesive, but be aware that chewing your food can easily dislodge the crown again with the risk of you swallowing it, especially at back teeth.

           Symptomatic emergencies are usually the most urgent because they can involve pain or discomfort, sometimes of great intensity. Any sensitivity you may experience in such instances can be divided into two groups, spontaneous or provoked. Provoked symptoms arise from some activity on your part with the most common examples being eating and drinking. If the discomfort occurs only when the activity does and subsides immediately thereafter, that is provoked sensitivity. Pain from mechanical stimulation such as when you bite together or chew, soreness from exposure to extremes in temperature (meaning a significant difference from body temperature) and tenderness when you eat even body temperature sweet or spicy foods are all representative of provoked discomfort. Spontaneous pain, on the other hand, may occur at any time and come and go without warning. It can often be accompanied by swelling or a bad taste in your mouth.

           Of the two types, spontaneous distress tends to be the most serious because it is a strong indicator of dental abscess (infection) and needs to be treated promptly. You will need to have medication prescribed (an antibiotic and a pain reliever) to eliminate the abscess and its cause identified before your condition can be definitively treated. You should call Dr. McArdle at the first sign of spontaneous pain or swelling in your mouth. In extreme cases where puss from the abscess has accumulated to dangerous proportions, the abscess will need to be drained surgically as well as managed with antibiotics. If you experience swelling in your mouth that impairs your ability to breathe or swallow, you must go to the nearest hospital emergency room so that you can be evaluated by an oral surgeon at once!  Do not wait to be seen by Dr. McArdle in a case like this as he would refer you to an oral surgeon in any event. Such swelling, which can block your windpipe and cut off your airway (termed Ludwig's Angina), is potentially life threatening and must be attended to immediately. If you suffer severe trauma to your mouth or face such as lacerations or dislodged teeth as may occur in an automobile accident, attempt to control any bleeding with pressure and go to the nearest hospital emergency room right away. You may try to reimplant a dislodged tooth yourself in some situations. Ask Dr. McArdle for more information about this or check his web site for a discussion of the subject.


           Other, less serious, causes of spontaneous discomfort in your mouth include inflammation that may occur as the result of irritation from extensive fillings or difficult extractions done in the very recent past, sores on your gums from wearing dentures and TMJ problems attributable to bruxism (grinding your teeth). These situations can be handled with anti-inflammatory medications, simple mechanical adjustments or protective treatments. Only Dr. McArdle can do the latter two, but you can do something about the former by taking over the counter products containing ibuprofen (Advil, Nuprin etc.), an ingredient that has been proven to be more effective against dental pain than Tylenol with codeine. Ibuprofen should be the first pain reliever you try, unless you are allergic to it, for any spontaneous dental pain until you can be seen by Dr. McArdle or at a hospital emergency room. Try naproxen sodium (Alleve)in the case of an allergy to ibuprofen. These are usually more effective than aspirin-based products. If your spontaneous pain cannot be relieved by these medications and you cannot readily contact Dr. McArdle, an emergency room physician should be able to prescribe something that will be helpful.


A severe case of Ludwig's angina requiring hospitalization.

           Provoked sensitivity can be triggered from anything as harmless as the roots of your teeth being exposed by gum recession to their fracture caused by trauma and many things in between. Instances of provoked discomfort are usually less detrimental in the short run, but still need timely attention from Dr. McArdle. Lost fillings can cause temperature sensitivity if the inner layer of your tooth is exposed as a result. Using DenTemp or Tempinol as described above will relieve this discomfort. Drinking cold drinks through a straw and avoiding cold foods will also help under these circumstances if temporary replacement means are unavailable. If you are an orthodontic patient and the sharp end of a wire is scraping your cheek or tongue, wax or chewing gum can be used to cover the offending edge. This technique is also some times effective when the sharp tip of a broken tooth is causing the same problem. If chewing or just biting down creates a problem for you, especially on release, this may indicate a crack in your tooth. Avoid chewing with the affected tooth and limit yourself to a soft diet until you can be evaluated by Dr. McArdle in these cases. If your pain lingers significantly after you stop chewing or biting, this may be evidence of an early abscess and should be dealt with as described earlier. Sensitivity to heat that is markedly more severe than to cold or lingers and is relieved by cold is a probable sign of impending nerve death that can lead to an abscess. Avoid consuming anything heated and see Dr. McArdle as soon as possible should this situation arise. Certain lesions in your mouth can trigger provoked pain on eating or even during simple movements such as yawning or smiling. Cold sores or raw tissues at the corners of your mouth (termed angular cheilosis) are examples of such lesions. In certain instances, Dr. McArdle can prescribe medications to ease these conditions. Until you can see him, over the counter medications such as Orabase or Gly-Oxide can soothe and protect these lesions during normal function.





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Dr. Barry F. McArdle, D.M.D. ~ 118 Maplewood Avenue, The Captain Moses House, Suite B-7, Portsmouth, NH 03801

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