Dental Emergencies and Urgent Care
If you or your little one experience a dental emergency, be sure to call our practice as soon as possible. If you need immediate attention after hours, call our emergency phone number and our on-call staff member will help you. If you are unable to reach our office during an emergency, dial 911.
We are here to help you at any time, on any day. When your or your child’s dental health is at risk, we will do everything we can to make sure you’re treated as soon as possible. While dental emergencies are rare, they can happen, and it’s vital to know how to take care of your teeth no matter what.
Causes of Tooth Pain
Causes of tooth pain encompass a wide range of clinical conditions, typically stemming from irritation of the nerves within the tooth's pulp or the surrounding gum tissue. The most frequent cause is dental decay that has penetrated the protective enamel, but discomfort can also arise from fractured teeth, dental abscesses, or thinning enamel that exposes the sensitive dentin. Additionally, non-decay factors such as bruxism (teeth grinding), gum recession, or even sinus congestion can create pressure and sensitivity that mimics a traditional toothache.
Progression of Decay
Progression of decay is the continuous advancement of tooth destruction starting from the outer enamel and moving inward to the soft pulp. This process begins with minor demineralization and progresses through the dentin until it reaches the nerve, ultimately leading to painful abscesses or tooth loss if the infection spreads into the supporting bone.
Trauma- Fractured Tooth (Complicated)
A complicated tooth fracture occurs when a traumatic injury results in a break that extends through the enamel and dentin, directly exposing the dental pulp—the living tissue containing nerves and blood vessels. Because the inner chamber of the tooth is open to the oral environment, this type of fracture often causes significant pain and carries a high risk of bacterial infection.
Recurrent Decay (Around a Restoration)
Recurrent decay, also known as secondary caries, is the formation of new cavities along the margins or underneath an existing dental restoration, such as a filling, crown, or bridge. This occurs when the seal between the restorative material and the natural tooth structure breaks down due to wear, age, or improper fit, allowing bacteria and food particles to seep into the gap. Because this decay is often hidden beneath the restoration, it can progress undetected until it reaches the sensitive inner pulp or causes the restoration to fail, often requiring a replacement or more extensive restorative treatment.
Trauma- Chipped Tooth
A chipped tooth is a common dental injury where a small piece of the enamel or dentin is broken off due to trauma, such as an accidental fall, biting down on hard food, or a sports-related impact. While often considered a cosmetic concern, a chip can also lead to sensitivity or sharp edges that irritate the tongue and cheeks.
Trauma- Fractured Tooth
A fractured tooth involves a crack or break in the tooth structure, often resulting from physical impact, biting on hard objects, or age-related wear. These fractures are clinically categorized by their depth—ranging from superficial enamel cracks to root fractures that extend below the gumline—and their orientation, such as vertical or horizontal breaks. Symptoms typically include sharp pain upon biting or sensitivity to temperature, and treatment varies from dental bonding and crowns to root canal therapy or extraction, depending on whether the tooth's internal pulp has been compromised.
Trauma- Horizontal Root Fracture
A horizontal root fracture occurs when a traumatic impact causes a break perpendicular to the long axis of the tooth root. Often invisible during a clinical exam, these fractures are typically diagnosed via X-rays and are characterized by tooth mobility or displacement of the crown. Treatment depends on the fracture's location; breaks near the root tip (apical third) have the best prognosis and may only require monitoring, while fractures closer to the crown (cervical third) often require stabilization with a splint or, in severe cases, extraction.
Root Resorption
Root resorption is the progressive loss of tooth structure caused by the body's own cells (odontoclasts) breaking down the cementum and dentin of the root. This process can be internal, originating from the pulp chamber, or external, occurring on the outer root surface due to trauma, orthodontic pressure, or chronic inflammation. If left untreated, resorption can weaken the tooth's structural integrity, potentially leading to tooth loss or the need for endodontic intervention.
Dental Tumor
A dental tumor, or odontogenic tumor, is an abnormal growth of tissue originating from the cells involved in tooth development. These tumors can be benign (non-cancerous), such as an ameloblastoma or odontoma, or malignant (cancerous), though the latter is rare. While they often grow slowly and may be asymptomatic in early stages, they can cause jaw swelling, tooth displacement, or bone destruction as they expand. Clinical diagnosis typically involves digital imaging like X-rays or CT scans followed by a biopsy, with surgical removal being the primary treatment to prevent further damage to the jawbone and surrounding structures.
Dental Erosion
Dental erosion is the irreversible loss of tooth enamel caused by chemical dissolution from acids not produced by bacteria. Common triggers include dietary acids (such as citrus fruits or soda), gastric acid from acid reflux (GERD), or frequent vomiting. Unlike decay caused by sugar and bacteria, erosion thins the protective enamel across the entire tooth surface, leading to increased sensitivity, yellowish discoloration as the underlying dentin is exposed, and a rounded or "cupped" appearance of the biting surfaces.
Sensitive Teeth
Sensitive teeth, or dentin hypersensitivity, occur when the protective enamel wears down or gums recede, exposing the underlying dentin. This layer contains microscopic tubules that lead directly to the tooth’s nerve center; when triggered by hot, cold, sweet, or acidic stimuli, fluid movement within these tubules causes sharp, temporary pain. Common culprits include aggressive brushing, tooth grinding (bruxism), and acid erosion, with treatment typically involving desensitizing toothpastes, fluoride varnishes, or dental bonding to seal the exposed areas.
Vertical Root Fracture
A vertical root fracture (VRF) is a crack that begins in the root of the tooth and extends toward the biting surface, typically running along the long axis of the root. These fractures are often difficult to diagnose because they frequently mimic signs of periodontal disease or failed root canals, such as localized deep gum pockets or "J-shaped" bone loss visible on X-rays. Because the crack allows bacteria to infiltrate the bone and supportive tissues, the prognosis is usually poor, and extraction is often the only definitive treatment to prevent ongoing infection and bone destruction.
Crack Due to Large NCCL Filling
A crack due to a large NCCL filling occurs when a tooth is weakened by the restoration of a Non-Carious Cervical Lesion (a notch near the gumline caused by erosion or abfraction). Because these fillings are placed in the high-stress cervical area of the tooth, a large restoration can compromise the structural integrity of the "neck" of the tooth. Over time, the repeated mechanical stress of biting and chewing can cause stress fractures to propagate from the margins of the filling into the dentin. If the crack extends deeply, it can lead to persistent sensitivity, pulpitis, or even a full fracture of the tooth crown.
Periodontal Abscess
A periodontal abscess is a localized collection of pus within the tissues surrounding a tooth, specifically the periodontal pocket. Unlike a periapical abscess which starts inside the tooth, this occurs when bacteria become trapped in a pre-existing gum pocket or due to a foreign object (like a popcorn kernel) being forced under the gumline.
Root Surface Decay
Root surface decay, or root caries, is a cavity that forms on the root of a tooth rather than the enamel-covered crown. This occurs when gingival recession (receding gums) exposes the root's cementum, which is softer, thinner, and more susceptible to acid dissolution than enamel. It is particularly common in older adults and patients with dry mouth (xerostomia), as the lack of protective saliva allows plaque bacteria to quickly demineralize the root surface. Because root decay can spread rapidly and progress toward the tooth's nerve, it typically requires treatment with fluoride therapy for early lesions or composite/glass ionomer fillings for deeper cavities.
Posterior Wear
Posterior wear refers to the loss of tooth structure on the premolars and molars, typically occurring on the occlusal (biting) surfaces. This degradation is often the result of attrition from tooth-to-tooth contact (such as bruxism), abrasion from external objects, or erosion from chemical exposure.
Common Dental Emergencies and Immediate Steps
- Broken, Chipped, or Cracked Teeth Rinse your mouth with warm water to clean the area and apply a cold compress to the outside of the face to reduce swelling. Save any broken tooth fragments and bring them with you to the office as soon as possible.
- Knocked-Out Permanent Tooth Time is critical. Gently rinse the tooth without scrubbing the root. If possible, try to place the tooth back into the socket. If that isn't possible, keep it moist in a small container of milk or saliva and call us immediately for an emergency appointment.
- Severe or Persistent Toothache A sudden, intense toothache can indicate an infection or abscess. Rinse with warm salt water and use dental floss to ensure no food is trapped. Avoid placing aspirin directly on the gums, as this can cause tissue irritation; instead, contact us to find the underlying cause.
- Objects Caught Between Teeth If an object is stuck, try to gently remove it with dental floss. Never use a sharp or pointed tool, such as a needle or pin, as this can damage the enamel or cut your gum tissue. If floss does not work, please call our office.
- Broken or Dislocated Jaw This is a serious injury that requires immediate attention. Apply a cold compress to control swelling and head to the nearest emergency room or call our office immediately. If you are having trouble breathing or swallowing, dial 911.
- Lost Filling or Crown While not always painful, a lost restoration leaves the tooth vulnerable to further damage. Keep the crown if you have it, and try to keep the area clean until you can get to our office to have it recemented or replaced.
Cracked Teeth and Hidden Risks
Because we live longer and more stressful lives today, we are exposing our teeth to many more years of potentially damaging habits such as clenching, grinding, and chewing on hard objects.
These habits make our teeth more susceptible to cracks. Our office may treat a cracked tooth to prevent further damage to the tooth structure and tissue.
Cracked teeth do not always show any visible signs of damage, but may present a variety of symptoms, including erratic pain when you chew with them, and pain or sensitivity to heat and cold. In many cases, the pain may come and go, making it difficult for us to locate the source.
Why Cracked Teeth Hurt
When the outer hard tissues of the tooth are cracked, chewing can cause movement of the pieces, and the pulp becomes irritated. When biting pressure is released, the crack can close quickly, resulting in a momentary, sharp pain. Irritation of the dental pulp can be repeated many times by chewing.
Eventually, the pulp will become damaged to the point where it can no longer heal itself. The tooth will not only hurt during chewing but may also become sensitive to extreme temperatures.
In time, a cracked tooth may begin to hurt all by itself. Extensive cracks will lead to infection of the pulp tissue, even spreading to the bone and gum tissue that surround the tooth.
Types of Cracked Teeth
There are many different types of cracked teeth. The treatment and outcome for your tooth depends on the type, location, and extent of the crack.
- Craze Lines: Craze lines are tiny cracks that affect only the outer enamel. These are extremely common in adult teeth. Craze lines are very shallow, cause no pain, and are of no concern beyond appearance.
- Fractured Cusp: When a cusp (the pointed part of the chewing surface) becomes weakened, a fracture sometimes results. The weakened cusp may break off by itself or have to be removed by an endodontist.
When this happens, the pain will usually be relieved. A fractured cusp rarely damages the pulp, so root canal treatment is seldom needed. Your tooth will usually be restored with a full crown by our team.
- Cracked Tooth: Some cracks extend from the chewing surface of the tooth vertically toward the root. A cracked tooth may not be completely separated into two distinct segments. Because of the position of the crack, damage to the pulp is common. Root canal treatment is frequently needed to treat the injured pulp.
We can restore your tooth with a crown to hold the pieces together and protect the cracked tooth. At times, the crack may extend below the gingival tissue line, which requires extraction.
- Split Tooth: A split tooth is often the result of long-term progression of a cracked tooth. The split tooth is identified by a crack with distinct segments that can be separated.
A split tooth cannot be saved intact. The position and extent of the crack, however, will determine whether a part of the tooth can be saved. In rare instances, endodontic treatment and a crown or other restoration may be used to save a portion of the tooth.
- Vertical Root Fracture: Vertical root fractures are cracks that begin in the root of the tooth and extend toward the chewing surface. They often show minimal signs and symptoms and may therefore go unnoticed until the surrounding bone and gum become infected.
Treatment may entail extraction of the tooth. However, endodontic surgery is sometimes appropriate if a portion of the tooth can be saved by removal of the fractured root.
Preventing Cracked Teeth
Though cracked teeth are not completely preventable, you can take some steps to make your teeth less susceptible to cracks.
- Don’t chew on hard objects such as ice, unpopped popcorn kernels, or pens.
- Don’t clench or grind your teeth.
- Wear a mouthguard or protective mask when playing contact sports.
Early Detection is Essential
Early diagnosis is important. Even with high magnification and special lighting, it can be challenging to determine the extent of a crack. A cracked tooth that is not treated will progressively worsen, and eventually result in the loss of the tooth. Early diagnosis and treatment are essential to saving these teeth.
