Dental emergencies: what to do in the first hour

Dental emergencies rarely happen at a sensible time. It is a hockey elbow on a Saturday, a popcorn kernel on a Friday night, a toothache that becomes unbearable at two in the morning.

What you do in the first hour genuinely matters, particularly with a knocked-out tooth. This guide walks through the most common situations and the right immediate response for each. Save the page or bookmark it, because the worst moment to start searching is when it has already happened.

If you need us now, call (416) 755-4336.

A knocked-out tooth

This is the one where minutes count. A permanent tooth that has been completely knocked out can often be saved, but the chance of success drops sharply with time.

Do this, in order:

1. Find the tooth and pick it up by the crown. The crown is the white chewing part. Do not touch the root, the pointed part that sat in your gum. The root is covered in living ligament cells, and those cells are what allow the tooth to reattach.

    

2. If it is dirty, rinse it briefly. Use milk, saline, or your own saliva. Do not scrub it, do not use soap, and do not dry it off.

    

3. Try to put it back in the socket. This is the best possible outcome. Position it the right way round, push gently, and bite down on a clean cloth to hold it in place. It feels alarming to do, but it is the correct step.

    

4. If you cannot replant it, keep it wet. Milk is the best everyday option. Saliva works too, and you can spit into a clean container and place the tooth in it. Saline is fine. Water is a poor choice, but it is still better than letting the tooth dry out.

    

5. Get to a dentist immediately. Call us on the way.

    

Why the clock matters: after about 30 minutes of dry time outside the mouth, most of the ligament cells on the root are no longer viable. The first hour is the meaningful window. Do not wait until morning to see whether it settles.

One important exception. If it is a child’s baby tooth, do not try to put it back. Replanting a primary tooth can damage the permanent tooth developing underneath. Keep your child comfortable, control any bleeding with gentle pressure, and call us to be seen.

A chipped or cracked tooth

Less urgent than an avulsion, but still worth same-day attention.

Rinse your mouth with warm water. If there is bleeding, apply gentle pressure with clean gauze. Use a cold compress on the outside of your cheek to limit swelling. If you can find the broken fragment, bring it with you, because it is sometimes usable.

Avoid chewing on that side, and steer clear of anything very hot or very cold, since exposed inner layers of the tooth can be sharply sensitive to temperature.

Do not ignore a crack because it does not hurt. A crack can extend into the nerve over time and turn a simple repair into a root canal. Getting it sealed early is nearly always cheaper and simpler.

Severe toothache

A toothache that wakes you up, throbs steadily, or does not respond to painkillers is usually telling you that infection or nerve inflammation has reached a point that needs treatment.

In the meantime: rinse with warm salt water, floss gently around the tooth in case something is lodged there, and take over-the-counter pain relief following the label directions. A cold compress on your cheek can help.

Do not put aspirin directly against the gum. It is an old piece of advice that circulates, and it burns the tissue rather than helping.

See a dentist urgently if the pain comes with facial swelling, fever, or a bad taste in your mouth, or if swelling starts to affect your eye or your throat. Those signs point to a spreading infection. Swelling that makes breathing or swallowing difficult is a hospital emergency, not a dental one, so go to the nearest emergency department.