In a Dental Emergency

A&E or the Dentist?

For almost every dental problem, a dentist is the right person to see, because we can work out what's causing it and treat it there and then. Hospital emergency departments generally can't repair or treat a tooth. Dial 999 or head straight to A&E if:

• A swelling is making it hard to breathe or swallow, or you can barely open your mouth
• The swelling is growing fast, or creeping up towards your eye or down into your neck
• Bleeding carries on after 20 minutes of steady, firm pressure
• You've had a heavy blow to the face or jaw, lost consciousness, or think your jaw may be broken

Anything else, such as a tooth knocked out or broken, a crown that has come off, toothache or a swelling that is staying put, is ours to deal with. Ring 020 8788 6688; if you call before 9.30am, Monday to Saturday, we'll see you that day, patient or not. Unsure whether it counts as urgent? Call anyway and we'll advise you.

If an Adult Tooth Is Knocked Out

Speed is everything. The sooner the tooth goes back in, ideally inside an hour, the better its chance of reattaching.

• Pick it up by the white biting end, never by the root
• If it has dirt on it, give it a quick rinse in milk, or water if you have no milk. Don't scrub it or wrap it in tissue, and never let it dry
• If you can, slide it back into its socket facing the right way, then bite softly on a clean handkerchief to keep it there
• If it won't go back, store it in a little milk. An adult who is confident they won't swallow it can hold it inside the cheek instead
• Phone us at once so we can see you within the hour

Never replant a baby tooth, as it can harm the adult tooth developing beneath it, but a child who has knocked a tooth out should still come in the same day. Teeth that have been loosened or pushed out of line, without coming out, are just as urgent: we need to ease them back into position and splint them while they heal.

A Broken Tooth or a Filling That's Come Out

Save any fragments and rinse with warm water. Where the gum is bleeding, hold a clean cloth firmly against it. A jagged edge can be covered with a piece of sugar-free gum or some orthodontic wax from the chemist, so it doesn't catch your tongue or cheek. Steer clear of anything very hot, cold or sugary, which an exposed tooth will feel, and chew on the opposite side for now.

We can usually smooth a small chip or rebuild it with bonding at a single visit. A bigger break, or a filling that has fallen out, is normally sealed with a temporary filling at £70 to calm the tooth, followed by a permanent filling, onlay or crown. If the fracture has exposed the nerve, root canal treatment may be needed to keep the tooth. See our broken tooth page and our guide to fillings, onlays and crowns.

When a Crown Comes Off

Put the crown somewhere safe and bring it to your appointment. Resist the urge to stick it back with superglue or any household adhesive: it harms both the crown and the tooth, and a crown seated at the wrong angle can crack the tooth beneath. If the exposed tooth is sensitive, smear some toothpaste for sensitive teeth over it. Until your appointment you can shield it with sugar-free gum, or with a temporary repair kit from a chemist, following the instructions in the box.

Where the crown is undamaged and the tooth under it is healthy, we can normally clean it and cement it back on the same day, at £70. If decay or a fracture has developed underneath, a replacement will be needed, and we'll go through your choices and their fees before doing anything. A loose bridge, onlay or inlay is handled in exactly the same way.

Bad Toothache

Take over-the-counter painkillers exactly as the packet says, without going over the stated dose, and never hold a tablet against the gum, as it causes a chemical burn. Avoid very hot, cold or sweet things, prop your head up on an extra pillow at night and rinse gently with warm salty water. Then ring us for an appointment.

When you come in, we examine the tooth and take an X-ray where needed to find the source, and our goal is to have you out of pain before you leave. That usually means a dressing, a temporary filling, draining an infection or beginning root canal treatment. Antibiotics on their own won't cure toothache, as they leave the underlying problem in place; we prescribe them only when an infection is spreading or you're unwell. For pain at night or on a Sunday, see our guide to toothache at night and weekends.

Facial Swelling or a Gum Abscess

A lump on the gum, or a small pimple that weeps when you press it, is most often an abscess caused by an infected tooth or gum pocket. It needs treatment, but it rarely needs an ambulance. Ring us that day. Meanwhile, hold something cold against your cheek to reduce the swelling, sleep with your head raised and leave the lump alone rather than squeezing it. Painkillers and warm salt-water rinses both help.

Don't wait for a dental appointment if the swelling is spreading quickly, is starting to interfere with breathing, swallowing or your vision, or you've developed a fever and feel ill: go to A&E or dial 999. Dental infections can travel into the face and neck, and at that point they need hospital care. Our dental abscess page explains how we treat them.

Bleeding That Won't Settle

A little oozing for a few hours after a tooth has been taken out is expected. If it's heavier, fold a clean, damp gauze square or tissue, place it over the socket and bite down hard for 20 minutes while sitting up. Don't rinse, spit or explore the area with your tongue. If it's still bleeding after that, or you find yourself swallowing blood, ring us. A cut to the lip, gum or tongue from a fall normally stops with a few minutes of firm pressure; if it doesn't, or the wound is deep or its edges pull apart, head to A&E, because stitches may be needed.

Same-Day Appointments and Out-of-Hours Help

Phone 020 8788 6688 from 8.30am, Monday to Saturday. Call before 9.30am and we'll see you the same day, whether you're one of our patients or not. The emergency appointment is £70 and includes any X-rays and medication you need; it's free for dental plan members. If you need more treatment, for example a temporary filling or the opening stage of root canal treatment, we'll explain it and give you the fee before we start.² You can also book online, but for pain, phoning is quickest.

We're open Monday to Saturday, 8.30am to 5.30pm, and the practice is about ten minutes' walk from North Greenwich station, so Canary Wharf is a short Jubilee line hop away. Out of hours, members of our dental plans have emergency access included. Anyone else with dental pain at night or on a Sunday should call NHS 111. Please phone, not message, about pain or swelling, because WhatsApp is answered in opening hours.

Questions

This guide explains the options in general terms. Only an examination can tell you which of them suits your own teeth.