Smile Specialist

UK Dental Treatment Emergencies and Toothaches "Self-Help"

These general tips and dental treatments information for UK Dental Emergencies, toothaches, accidents etc, are NO substitute for seeking professional, personal advice from your Dentist or Doctor immediately. We emphasise the importance of getting Professional help/advice as soon as possible!
Everyone in UK can also get medical OR dental advice and help 24 hours a day from calling 0845 46 47 NHS Direct !
According to recent Parliamentary answers in 2005, Toothache is now the 2nd commonest reason for contacting NHS Direct for all possible advice and treatment nationally - this "Trend" continued over the Holidays Christmas 2006 to New Year 2007, with Dental pain and Toothaches occupying the 2nd and 4th top-ten spots for NHS Direct statistics ! Do you wonder why they split-up Dental Problem NHS Direct Statistics like this, rather than count all dental emergency problems together ?
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Toothache, lost fillings, broken teeth, gum swelling, facial pain, dental pain, abcess, fractured teeth, decayed roots, root canal problems, broken dentures, loose crowns, accidents, dental emergency, urgent dental treatment or advice, help line use, emergency appointments, self help treatment information, dental clinic contacts, phone numbers, dentists on-call, wisdom teeth problems, painful ulcers, trauma, fractured jaws, accidents etc, can all vary in advice, any treatment need and urgency. Your first point of call should be your own Dentist, but if you haven't been in 15 months then the government may have de-registered you off their computer if you were an NHS patient. About 50% of the population are not registered with a Dentist in the UK, so your Primary Care Trust ( Heath Authority/Board ) are responsible to help you access regular Dental Care and/or cover your Emergency treatment needs.
Always contact NHS Direct first for advice or emergency treatment provision - Tel : 0845 46 47 in the UK
However, if you have such a severe problem that it is threatening your general health, you may be advised to go straight to the nearest Accident and Emergency Dept. at Hospital - see some examples of these below, which is then followed by a section of "self-help" information that you may find useful after contacting NHS Direct, for Dental pain, Toothaches or inconvenient Dental problems.

Serious Dental Emergencies that could rapidly lead to a deterioration of General Health are fortunately rare, but do require IMMEDIATE MEDICAL or A+E Attention !!!
Urgent examples include the following, potentially dangerous conditions:

Fractured Jaws - affects speech, teeth may not meet together properly, swelling inside mouth, limited mobility, pain etc. Need bones resetting urgently!

Most commonly happens after an accident, blow to chin etc.

Uncontrolled Bleeding - Any bleeding that cannot be controlled by firm pressure from a pack for 10 minutes may need suturing to prevent bleeding to death.

Most commonly happens after extraction, due to infection or alcohol, asprin, drugs etc.

Loss of Conciousness - No matter how brief, anyone who was unresponsive may have suffered internal brain damage that could worsen if left without investigation!

Most commonly happens after a blow to the head or accident - don't confuse with epilepsy.

Swelling in Neck/Face -This can get rapidly larger and obstruct the airway and cause breathing problems!

Most commonly due to rapidly spreading infection or bleeding.

The pictures below show the rapid swelling distorting the face of a young child, who has a significant Dental Emergency and who needs treatment without delay, if they are not to suffer greatly or even die. Swelling can quickly spread to the neck and airway, or infection enter the blood and cause Septacaemia (blood poisoning). Fortunately, most Dental problems are not this severe and treatment can often be delayed without deterioration of general health, but always seek a Professional opinion first.

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The above facial picture shows the swelling distorting the face - the mouth view shows the abcessed rotten tooth!

All of the above Emergencies often need immediate medical assistance from Hospital A+E !!!
They will often contact their Specialist Oral Surgeon to treat any Dental causes or problems arising from the mouth - or you may ask them to do this too !

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Non Life-Threatening Dental Problems

These are the more common toothaches, broken dentures, chipped teeth, lost fillings, loose crowns etc. that are usually very inconvenient socially, with any pain being controlled with over the counter painkillers or remedies from the local Chemist or Pharmacy. Even good Dental treatments can result in complications/problems, if the tooth was badly decayed or had many problems in the past. This is why regular Dental Care and early dental treatment and prevention is ALWAYS best !
The 50% of the Population in the UK who are registered with a Dentist, will have access to their own Practice Emergency contact number. Unfortunately, the UK Government system removes you from NHS Family Dentists list if you haven't been back within 15 months - so you are not then entitled to use that NHS Dentist's Emergency services and their NHS list may then be full if you try to register again later! In short, don't miss your regular (6 monthly etc.) check-ups, both to stay as healthy as possible as well as not become de-registered by default! Currently unlike NHS Medical Practices, you are not registered continuously and must renew Dental registration regularly.
(Please note: this is due to change for NHS patients from 1st April 2006, where in order to increase Access to anyone, they will be droping the concept of registration, so no-one will be registered and no-one will have priority over anyone else. Thus previous regular attenders on the NHS will be "competing" with irregular attenders for the same, limited availability!
This does NOT affect Private patients who will continue to be registered and seen by THEIR same Dentist. )
The Government has had to set up Dental Access Centres (DAC's) in some parts of the Country to give Emergency Dental Advice and Treatment to the People Government has deregistered amongst the other 50% of the population who rarely see a Dentist until they have big problems or pain. In other areas, Dentists from abroad have to be "imported" and properly funded for their wages and premises so people can get even basic NHS Dental care.

Remember, pain is often a poor health signal as it's usually a LATE sign of trouble!

Anyone though can call NHS Direct 0845 46 47 for Dental or Medical Advice, UK, 24 hours!

But be warned, if you say to NHS Direct that you are registered with a Dentist, they may "not offer emergency treatment" saying you must go back and try to contact your own Dentist for emergency care. If you say you haven't seen a Dentist in the last 15 months, they will be obliged to give you advice and arrange for any emergency treatment needed. Be sure you don't say you are registered if you've lapsed more than 15 months!
(Again from the 1st April 2006 the NHS will change Dental Emergency definitions to those that are serious or "life-threatening" (eg:at the top of the page, uncontrolled bleeding etc,) so out of hours Dental treatment will be reduced for the NHS, waiting perhaps 48 hours before being seen somewhere, depending upon NHS Access for "urgencies", as they will be known!)

This is important because many times the NHS "patient" thinks they are "still" registered, but they are actually no longer - NHS Direct says contact your "own" Dentist, who may then have to say you are not a "registered" Patient anymore and as much as this Dentist would like to help, they are already struggling to look after their over-full list, made up of the many patients who have stayed registered, turned up for regular check-ups, followed their dental advice etc.

Clearly, the best solution is for you and your family (even babies) is to register with your Dentist AND keep going for your regular Check-ups and personal advice! Prevention is always better than cure, so don't delay registering with a Dentist, whether NHS or Private, get registered!
Remember also, Private patients cannot be taken off Dentists lists by Government, only NHS patients are taken off their Dentist's list by Government systems automatically!

It also makes sense to visit your Dentist to get your Oral health checked out before any major trips, summer holidays, important events, Christmas time etc. Remember to do this earlier than needed, because most Dentists appointment books are very busy and booked up at these times too.

Unfortunately, even registered patients get occasional problems too, so the following general guide is given for everyone as an "adjunct", additional to the personal Professional advice that you should seek immediately in the first place.

This does NOT substitute for your Dentist, NHS Direct, Specialist or Professional advice !!!

Some Pharmacies and larger Supermarket Chains Sell temporary cement or toothache kits, read all instructions and get professional advice before using.

Temporary Toothache remedies

Toothache is either caused by the nerve in the tooth root being alive, inflamed and sore, such that it reacts badly to hot and cold or sweet things, or by the nerve dying and making an abcess at the end of the root. The dead nerve doesn't feel hot or cold or sweet (though other teeth might nearby). Both need Professional Dental treatment as soon as practical.

Also remember that the Large Supermarket Chains may have a number of Pharmacies within them, that often stay open late, Bank Holidays, Sundays etc. (eg: Sainsbury's, Asda, Tesco's etc.).

Possible remedies -

Please remember - Always read and follow the instructions on any medicines, tablets or remedies before use!

PAINKILLERS such as Ibuprofen (Nurofen) are good for toothaches, because it is anti-inflammatory as well. However, asthmatics are not supposed to take these, so try paracetamol or ask your chemist for an alternative. Children under 12 years old should avoid Asprin (Reye's Syndrome), with liquid paracetamol (Calpol) a good alternative. Codeine makes you drowsy, so unless you want to sleep better at night, don't take during the day, otherwise you can't drive safely, might hurt yourself, need someone to accompany you etc. Never exceed maximum recommended doses! This is dangerous and will not work any better than the recommended dosage would anyway!

OIL OF CLOVES is available from most Chemists/Pharmacies and is useful to apply on cotton wool on a tooth with a "live" nerve toothache. The helpful effect is only temporary though as it gets washed away by saliva easily.

TOPICAL ANAESTHETIC gel available at Pharmacies again. Useful for gum ulcers around wisdom teeth, loose baby teeth tugging painfully on a child's gum, or soft tissue injuries and accidental bites. Not much good for teeth problems though.

ANTISEPTIC MOUTHWASH for gum infections around wisdom teeth, gum diseases, multiple mouth ulcers etc. Chlorhexidine (Corsodyl) is good, so is Betadine, Eludril etc. Most Supermarket own brands of "Antiseptic" mouthwash are nothing more than a cheap version of a Fluoride mouthwash, so read the contents label carefully to be sure it's useful. Keep in the mouth for a FULL minute, so it soaks into the gums!
DIFFLAM spray (antiseptic and anti-inflammatory) is useful too.

SALT MOUTHWASH is good for post-extraction healing, Denture rubs and mouth ulcers if you cannot get to a Chemist for a good antiseptic mouthwash. A "teaspoon" of salt in a tumbler of warm water works well. Rinse around 4 times daily or as needed.

ANTIBIOTICS only work for "dead" nerves and gum infections. They are essential for infection that causes swelling, but you need to see a Dentist or Doctor to prescribe these. You will still need Dental Treatment later as Antibiotics cannot get inside a dead tooth, so the infection will return if left untreated ! This is a common mistake: Tooth Abcesses nearly Always need dental treatment later if they are not to come back twice as bad!

AVOID the things that make toothache worse, drink through a straw, eat soft foods on the other side etc.

DO NOT take Alcohol or Asprin, these make you bleed more, which is bad news if you need a tooth out later on. Choose a safer alternative, such as paracetamol or ibuprofen. Remember, Codeine makes you "drowsy", so you shouldn't drive, operate machinery, boil water etc, get someone else to help you if you take these - always read the labels for warnings etc !

Loose Crowns, Bridges etc.

Rarely cause pain that stops one sleeping, but are very socially inconvenient. If the cement came loose, just mix some flour and water into a paste, place inside the crown hollow and press onto the tooth. This will not make any difficulties for your Dentist, but gives enough grip short-term.

You can also use "Polygrip" or other water soluble Denture adhesives to stick items back in with, until you can get to your Dentist. Otherwise store in a "soap box" to protect any items and prevent their loss!

However, loose items should be removed before sleep so you don't accidently inhale or choke on these items!

NEVER use super-glue in the mouth. It is poisonous and sets so fast that some people have ended up with their finger glued to their mouth!!!

Other glues have nasty chemicals in them too which apart from poisoning you, may also turn a simple Dental Treatment into a Complex one.

SOME LARGER CHEMISTS actually have emergency dental kits with temporary cement to use, and may stay open late too, such as in Supermarkets or Shopping Centres etc.

Fractured Dentures

Whilst it may be possible to glue removable Dentures outside the mouth, unless the Fractured pieces are a perfect fit, You are likely to ruin it, meaning it may not be repaired later. The commonest reason for a Denture fracturing is due to the Gums shrinking more and more, so that the denture flexes too much and eventually "cracks" with use. You will need another denture then anyway. Should you attempt repair with super-glue, ALWAYS wear gloves (eg: the vinyl ones free at garage diesel pumps) and make sure the two pieces are NOT twisted out of line (the banana effect) when they are pressed firmly together, or it won't fit.
Other causes are simply too much wear and tear or accidently dropping it whilst cleaning it at home.
HOME INSURANCE may cover the damage costs of replacement Dentures, if these were accidently damaged in the home - it is worth reading your policy small print! Always clean Dentures over a towel or bowl of water etc, to prevent damage if dropped.

Tooth Knocked out ?

INFORMATION PAGE titled Acute Trauma and Fractured Teeth, has full details: Remember, if the person was unconcious at all, you must get medical attention immediately as there could be bleeding in the Brain (eg: call 999, go to A+E etc) -

ONLY second teeth that have been knocked out whole, with it's root intact, can be re-implanted at all. Not first (baby) teeth or those where the Crown has broken and the root left behind, just whole second Teeth with root intact.

Greatest Success of re-implantation is acheived if done within the Hour.
Store the tooth in Milk or tucked in the person's cheek. If greater than 24 hours has passed, then there is little chance at all of re-implantation working.

DO NOT scrub or touch the root (even if dirty) and hold it by the Crown part. Rinse under water to remove gross dirt.
Get Professional help immediately. Make sure the tooth is re-implanted into the socket facing the right way around!

These general tips and guidance are NO substitute for seeking professional, personal advice from your Dentist or Doctor immediately.

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