Most dental problems can wait until morning. A few cannot, and one of them has a sixty-minute window that decides whether you keep the tooth. Worth knowing the difference before you need it.
Go to an emergency room, not a dentist
These are medical emergencies where the dental cause is secondary:
- Facial swelling that is spreading, especially toward the eye or down the neck
- Difficulty swallowing, breathing, or opening the mouth
- Fever with a dental infection
- Trauma with suspected jaw fracture, or loss of consciousness
- Bleeding that has not stopped after 20 minutes of firm continuous pressure
Infections in the floor of the mouth or the deep spaces of the neck can compromise the airway, and they progress faster than people expect. MedlinePlus dental health lists the same red flags. If you are weighing it up at 2am, the correct choice is the emergency room.
Knocked-out permanent tooth: the sixty-minute window
- Find it and pick it up by the crown, the chewing surface. Never touch the root.
- If dirty, rinse briefly in milk or saline. Not water, not for long, and do not scrub. The cells on the root surface are what reattach.
- Reimplant it immediately into the socket if you can, correct way round, and bite gently on a clean cloth to hold it.
- If you cannot reimplant, store it in cold milk. Saline or the patient's own saliva in a cup are next best. Never store dry, never in tap water.
- Get to a dentist within an hour. Survival odds fall sharply after that.
Baby teeth are the exception: do not reimplant a knocked-out primary tooth, because it can damage the permanent tooth developing behind it. The American Academy of Pediatric Dentistry's parent resources cover child dental trauma specifically.
The rest, ranked by urgency
| Problem | Do now | Timeframe |
|---|---|---|
| Abscess, localised swelling, no fever | Warm salt rinses, ibuprofen, do not apply heat externally | Same or next day |
| Cracked or fractured tooth with pain | Rinse, cold compress outside, avoid chewing on it | 24 to 48 hours |
| Lost crown | Keep it, temporary cement from a pharmacy, never superglue | Within a week |
| Lost filling | Temporary filling material, keep it clean | Within a week |
| Broken orthodontic wire poking the cheek | Orthodontic wax over the end, tuck with a pencil eraser | Next working day |
| Bleeding socket after an extraction | Firm bite on gauze for 30 minutes, no rinsing, no straws, no smoking | Call if it persists past an hour |
On painkillers: for dental pain, ibuprofen outperforms paracetamol alone, and the two combined outperform either. Do not place aspirin against the gum. It burns the tissue and does nothing for the tooth.
Dry socket, days later
Severe throbbing pain starting two to four days after an extraction, often radiating to the ear, with a bad taste, usually means the blood clot has been lost. It is not an infection and antibiotics do not fix it. The dentist packs the socket with a medicated dressing and the relief is close to immediate. Smoking and using a straw in the first 72 hours are the main causes, which is why every post-extraction sheet says the same two things.
If you have no dentist and no insurance
Hospital emergency departments can drain an abscess and prescribe antibiotics but generally cannot treat the tooth, so you will still need dental care afterward. Federally qualified health centers provide urgent dental care on a sliding fee scale and can be found by ZIP through the HRSA health center locator. Dental school clinics often run emergency walk-in sessions at a fraction of private fees. Our guide to low-cost dental care lists both routes, and the directory will show you what is nearby.