0208 245 7575
0208 374 0080
07436 809 977
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143 Durnsford Road,
London,
N11 2EL,
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EMERGENCY DENTIST Dental emergency

FAQ

As a dedicated 24 hour emergency dentist service, there’s not a lot we haven’t seen or been asked.
Here are some of the most common questions that we get asked.

Why does my root canal hurt?


If you have just had a root canal treatment procedure completed in the last 3 or 4 days and are experiencing some discomfort, then don’t be too concerned. Discomfort after a root canal isn’t uncommon. The process can lead to bruising around the tooth, leading to inflammation and discomfort. There may also be extrusion of some chemicals, dressing or debris from the treatment into the tissue around the root which may elicit an immune response and discomfort. Normally, the discomfort subsides within a few days and responds well to anti-inflammatory painkillers like ibuprofen. If you are developing a swelling immediately after a root treatment has been done, you need to let your dentist know, or to see an emergency dentist.

If pain is arising a few months after the procedure has been completed, this may be an indication of re-infection, in this case it is important to have the tooth assessed.

What are the signs and symptoms of a failed root canal treatment?

Generally, root canal treatment is a very predictable and highly successful treatment. Unfortunately, as with all medical procedures, there is an associated failure rate.

Common signs and symptoms can develop a few weeks or even years after a root canal treatment is performed.

  1. Pain is the most common initial sign. This can happen without any biting and chewing, and can be low grade or severe.
  2. Swelling. This can be beside the tooth in the gum, near where the roots of the tooth would normally be placed. Occasionally, the swelling may spread to the rest of the face on that side.
  3. Root canal treatments can fail without there being any obvious signs or symptoms. This is why it is important to see your dentist, who as part of routine dental examinations may review previous root treatments.

What to do for severe pain after root canal treatment?

First of all, don’t panic, the pain does not necessarily mean that there is a problem. You need to remember that you have had an operative procedure, and some discomfort is to be expected. Most discomfort arises as a result of inflammation in the tissues surrounding the roots of the tooth, and this type of pain should settle over a few days with anti-inflammatory painkillers. If you are having difficulty or pain on closing your mouth, the filling placed by your dentist may be a little “high” and may need adjusting. If your pain is not subsiding or improving after five days, you need to see your dentist to assess why this is the case.

Pain around the jaws is also not an immediate sign of a problem. It can arise due to the local anaesthetics given, and also due a prolonged period of keeping your mouth open.

How to find a dentist for an emergency root canal treatment?

Initially call your regular dentist as they may have emergency slots and/or advice available. If you are experiencing difficulty getting an appointment, you can always call our highly experienced root canal emergency dentist on 0208 245 7575

Is it normal to have a toothache after a filling?

Immediately after a filling is placed you may, in some instances, experience some discomfort or sensitivity. This is not always an indication of a problem and may be expected in some circumstances. Where there is doubt of complications following a new filling, the treating dentist will normally advise the patient and reassure them about what to expect and when to be concerned.

There are a few reasons why you may be experiencing discomfort following a dental filling:

  1. Pulp irritation following placement of the filling is more likely if the filling was particularly deep and close to the nerve. Temporary irritation normally subsides over a few days, and the tooth may be sensitive to temperature changes (normally cold). Your dentist would normally place a protective layer under the filling to help prevent this.
  2. The filling may have been placed too “high” such that the new filling make contact before your other teeth when you try to close your mouth. This can irritate the supporting tissues of the tooth, and can make the tooth tender to touch. The filling needs adjustment by a dentist.
  3. Pulp inflammation, or pulpitis, can also arise immediately after filling placement. This is much more likely in cases where the filling is exceptionally close to the pulp, direct exposure of the pulp during filling preparation (this is sometimes unavoidable), direct trauma to the tooth and pre-existing cracks under the filling or the natural tooth itself.

here are two types of pulpitis, reversible (the tooth will settle of it’s own accord and “heal”), and irreversible (there has been permanent damage done to the pulp, and it will not “heal”- a root canal treatment or extraction will be necessary in the long term).

Is it normal to have a toothache after a filling?

Immediately after a filling is placed you may, in some instances, experience some discomfort or sensitivity. This is not always an indication of a problem and may be expected in some circumstances. Where there is doubt of complications following a new filling, the treating dentist will normally advise the patient and reassure them about what to expect and when to be concerned.

There are a few reasons why you may be experiencing discomfort following a dental filling:

  1. Pulp irritation following placement of the filling is more likely if the filling was particularly deep and close to the nerve. Temporary irritation normally subsides over a few days, and the tooth may be sensitive to temperature changes (normally cold). Your dentist would normally place a protective layer under the filling to help prevent this.
  2. The filling may have been placed too “high” such that the new filling make contact before your other teeth when you try to close your mouth. This can irritate the supporting tissues of the tooth, and can make the tooth tender to touch. The filling needs adjustment by a dentist.
  3. Pulp inflammation, or pulpitis, can also arise immediately after filling placement. This is much more likely in cases where the filling is exceptionally close to the pulp, direct exposure of the pulp during filling preparation (this is sometimes unavoidable), direct trauma to the tooth and pre-existing cracks under the filling or the natural tooth itself.

here are two types of pulpitis, reversible (the tooth will settle of it’s own accord and “heal”), and irreversible (there has been permanent damage done to the pulp, and it will not “heal”- a root canal treatment or extraction will be necessary in the long term).

How long does it take for a new tooth filling to feel normal?

Placement of a new filling can take a few weeks to start to feel as normal as the rest of your normal teeth. There may be a slight difference in the textural feel, the bite, the smoothness and how your mouth closes- these all take time for your highly sensitive mouth with it’s lips, tongue, cheeks and millions of nerves to start to accept. The only time you need to be worried is if you are having prolonged pain, sensitivity or pain on biting beyond 2 to 4 weeks.

How long does it take for pain after a tooth extraction to go away?

It’s easy to forget that you have had a part of your body removed, and some discomfort and tenderness is to be expected. Normally, pain, tenderness and swelling should start to improve within 72 hours. You are much more likely to have pain and discomfort if the tooth was particularly difficult to extract or if it was removed surgically. You may find that any swelling or pain may generally increase before it starts to improve.

The only time you need to be concerned is if you are starting to develop the signs of a post-operative infection, like dry socket

Why does my tooth hurt on biting after a new filling?

This isn’t necessarily an immediate cause for concern. In most instances it is as a result of irritation to the pulp or supporting tissue (gums etc.) around the tooth and will settle in a few days. Placement of a composite (white resin) filling can generate heat, which can irritate the nerve tissue, this normally subsides, but on occasion can permanently inflame the pulp-if this is the case you may need root canal treatment.

If you are having pain on biting, it may also be as a result of the filling being too “high”. In this case a simple adjustment should resolve the issue.

Rarely, small cracks may form, or if they were present before they may propagate further and cause pain on biting. In cases like this, as long as the crack does not extend into the pulp, you may be able to prevent further damage by having a crown or partial crown placed.

Is it normal for other teeth to hurt after a dental extraction (removal of a tooth)?

Discomfort of adjacent teeth can occur, especially if the area has been traumatised during the extraction. This normally settles on its own within a few days.

Rarely, there may have been inadvertent damage to adjacent teeth during the extraction. Your dentist will take care to avoid this, but in rare circumstances it can still happen. More often than not, damage to adjacent teeth will consist of dislodged fillings rather than damage to the actual tooth. You should see an emergency dentist if you are concerned about this.

What is the best painkiller following a tooth extraction?

You should avoid aspirin (unless recommended by your doctor) following a dental extraction.

Painkillers work differently from person to person, but in general an alternating regime of ibuprofen and paracetamol works for most people.

Codeine combinations work better where there is bone type pain.

Remember, the first 72 hours following tooth removal tend to be the worst, and it is important to follow aftercare advice provided by your dentist.

What is a dry socket?

A dry socket is an infection of the bone that surrounded the tooth prior to extraction. The condition normally arises as a result of the natural clot from the wound being dislodged or not allowed to set properly. It is much more common in people who smoke, have an underlying illness that may affect healing, and in those who physically dislodge the clot by rinsing or exercise.

Dry socket tends to be a very severe and deep seated pain, and it normally arises a day or so after the extraction.

It requires a visit to the dentist for treatment. This normally involves cleaning the area and placing a dressing and possibly prescribing antibiotics.

What are the risks of a dental extraction?

Dental extraction is a relatively safe procedure. There are risks involved with all medical procedures, but the most common ones are:

  1. Pain, swelling, bruising and tenderness.
  2. Difficulty in opening your mouth.
  3. Post-operative infections like dry socket.
  4. Delayed healing.
  5. Temporary or permanent numbness of the soft tissues. This normally occurs with lower wisdom teeth, and risks of a permanent numbness of the lip or tongue, are very low.
  6. Damage to the sinus floor. This is a risk with upper molar teeth, and in most cases requires the extraction site to be closed with stitches to close the exposure.
  7. Fracture of the tuberosity. The tuberosity is piece of the bone behing your top molar teeth at the end of the upper jaw. Occasionally it may be removed with the tooth. In most instances this is not an issue and just requires wound closure and monitoring.

How long does the hole after an extraction take to close?

This varies from person to person, and although you may feel a shallow depression, this doesn’t mean that the wound is not healing or closing. In a fit and healthy person, it is expected that at the 6-8 week mark, you should not be able to feel anything more than a depression where the tooth once stood.

What to do if your crown falls off?

Crowns can debond, leaving unsightly prepared tooth underneath exposed. The exposed tooth may be sensitive, and it is much weaker without the crown and liable to leak or break. It is important that you see a 24 hour dentist as soon as possible to minimise the risk of any complication.

You should keep the crown in a safe and clean place. If possible, you may be able to purchase over the counter temporary crown refixing kits, but in our experience these do not form an adequate and predictable seal and can be messy.

If you cannot see an emergency dentist soon, then try to keep the exposed natural tooth clean, and avoid biting directly onto it.

Please avoid using superglue or denture adhesive to refix debonded crowns.

Will it hurt if my crown falls off?

If the underlying tooth is still vital (it has not had root canal treatment), then you may experience some sensitivity and discomfort. More often than not, some of the adhesive remains on the tooth and can minimise this sensitivity, but it is better to see an emergency dentist sooner rather than later.

Can a crown be reattached?

As long as the crown has simply debonded, and has not been damaged, and the underlying tooth is not broken or rotting, then the simple answer is yes.

It is important to let your dentist see the underlying tooth to assess why the crown has debonded in the first place, to help minimise the chances of it recurring.

Is it normal to have pain after a crown is fitted?

Having a new crown fitted may cause some initial discomfort, but this should subside over the first few days. If it is not settling after a few day, you should see your dentist.

There are a variety of reasons why you may have prolonged sensitivity, including:

  1. The bite is too “high”. Your dentist will need to adjust this
  2. The crown does not fit as well as it should-this is not always immediately clear to the dentist. You may have gaps that allow air, liquid and food to be directly in contact with exposed tooth.
  3. Rarely, you may develop irritation or inflammation of the pulp and nerves in the tooth-you will need a dentist to assess this.

Why does my crown smell after it fell off?

This can happen due to two main reasons:

  1. There has been long term leakage around the margins of the crown, food and bacteria have been stagnating and have caused the odour.
  2. There has been persistent decay under the crown, and the smell is from rotting of the underlying tooth.

In both instances you need to see a dentist to assess and treat you appropriately.

Why did my front tooth chip?

Front teeth are much more likely to chip and break due to a few reasons. The most common are:

  1. Direct trauma to the tooth, like a trip, sporting injury or blow to the face.
  2. Gradual thinning of the tooth through natural wear and tear.
  3. Grinding, you may not even be aware that you do it!
  4. Erosion of the teeth leading to thinning and weakening. This is much more likely with frequent and high acid foods and drinks.

Fortunately, most broken and chipped front teeth can be quickly and easily repaired at your emergency dentist with composite bonding, crowns and veneers.

What to do if my tooth is knocked out?

Try not to panic.

See if you can find the tooth, check if it is 1 piece. If it isn’t, look for any other pieces that you can find.

Pick it up by the crown of the tooth (the part that looks like a tooth), taking care not to hold it by the root.

If it is dirty, gently rinse it under the tap-do not scrub or try to remove any debris with your fingers.

If it didn’t leave your mouth, you can try to replant it yourself until you get to an emergency dentist. If it fell out of your mouth, then you need to ensure that the tooth does not dry out-carefully place it in milk or contact lens solution.

It is important to try to get to a dentist ideally within an hour, the highest chances of successful replantation is within an hour. This is not always practical, which is why it is important to store the tooth in a moist media.

My tooth has been knocked out of position, what should I do?

A trip, a fall or blow can cause bodily movement of the tooth. This is normally backwards, such that you have difficulty closing your mouth, but sometimes it can be knocked forwards such that you look buck toothed.

Firstly don’t panic. You need to get to an emergency dentist as soon as possible to try and move the tooth back into its correct position. Delaying this can lead to permanent damage to the blood supply of the tooth and increase the risk of complications at a later stage.

The dentist will thoroughly examine your injury, and take x-rays to assess the extent of damage and to ensure no other damage to adjacent teeth or complications are present. Normally the tooth is manipulated into position, and splinted with a “brace” to help hold the injured tooth in position. The brace may need to be left from between 2 to 4 weeks, depending upon the type of injury sustained.

You will need regular monitoring of the tooth to ensure no complications are developing.

Can a traumatised tooth heal?

The short answer is yes, but it depends on a variety of external factors:

  1. Extent of injury
  2. Time taken to get emergency dental attention
  3. If the tooth was left to dry out for a prolonged period of time
  4. Whether the root of the tooth was physically damaged during the injury

With traumatic injuries, it is best practice to have regular reviews at your dentist so that any complications can be diagnosed and treated at an early stage.

What happens if a baby tooth is knocked out?

You need to see a dentist to assess whether there have been any other injuries. If a baby tooth is knocked out, it is generally not replanted, but a dentist needs to monitor the development of the succeeding adult tooth.

I knocked my tooth and it feels weird

You need to be assessed but, generally if the tooth has not been knocked out or out of position, then you may have a concussion type injury. You may experience some discomfort on touch and with sensitivity to hot and cold. This normally subsides over the course of a week, but still needs to be monitored by your dentist for complications, which can sometimes arise years after the initial injury.

What does wisdom tooth pain feel like?

Wisdom teeth are located at the back of the mouth. You may initially feel a mild gum discomfort as the teeth start to “poke” through. The overlying gum may become red and tender and you may have difficulty opening or closing your mouth at a later stage as the gum starts to swell. At a later stage, you may also start to feel difficulty opening your mouth, swallowing and a swelling in the cheek.

How long does wisdom tooth pain last?

What normally causes irritation of wisdom teeth is food impaction around the gum, normally once this is washed away discomfort should start to fade away within 48 hours. If you have suffered a full-blown wisdom tooth infection, then you may require antibiotics, and these take 3 to 5 days to start to relieve the symptoms.

Is my wisdom tooth infected?

If you have any of the following signs and symptoms, then there is a good chance you have a wisdom tooth infection:

  1. Pain and swelling/reddening of the overlying gum
  2. Swelling of the cheek
  3. A salty discharge and/or bad smell from the mouth
  4. Difficulty in opening the mouth
  5. Difficulty in swallowing

What is the best pain relief for a wisdom tooth pain?

Wisdom teeth infections are normally inflammatory based infections. A good anti-inflammatory type painkiller, like ibuprofen, will help with the pain and associated swelling. Ideally, you will still seek emergency dental advice to ensure that you do not require further medication or intervention. A good antimicrobial mouthwash, like corsodyl, will also help.

Is my wisdom tooth infected?

Most UK dentists will follow the NICE guidelines for extraction of wisdom teeth:

  1. Recurring episodes of wisdom tooth related infections.
  2. Gross caries.
  3. Impaction contributing to decay of teeth in front or making their repair difficult.
  4. If they have associated cysts or pathology associated with them.

How to find an emergency dentist near me?

Your first port of call should be to call or check the website of your regular dentist-they may be able to provide you with their own out of hours emergency arrangements. If this is not possible, you are welcome to call our private emergency dental service to see if we can help.

You may also find alternative emergency dentist services by searching on the internet and checking alternative directories for a 24 hour dentist.

Generally, hospitals do not deal with routine dental emergencies, you may call NHS 111 to see if you fit the criteria to go to hospital.

How do I get an emergency dental appointment?

Try calling your own dentist first, to see if they can help. If they are closed, follow their out of hours dental emergency advice. Alternatively, please call our emergency dentist service.

Can you go to hospital accident and emergency for an emergency dentist?

Very few hospitals in the UK now have emergency dentist care available. You can check by calling them directly, but generally they will only deal with severe emergency situations where there is a risk to life, like uncontrollable swelling, uncontrollable bleeding or difficulties in breathing.

Further advice for finding an emergency dentist can be found by calling 111, speaking to your insurance provider (if you have one), or by searching for a private emergency dental service clinic.

When should you see an emergency dentist?

This is very subjective and one person’s minor cosmetic issue may very well be a major dental emergency for someone else. Generally, anything that stops normal function, or left unattended to has the prospect of worsening or causing further complications, is a true dental emergency.

Below are some of the most common reasons patients attend our 24 hour dentist service in North London:

  1. Severe and uncontrollable tooth and jaw pain.
  2. Worsening dental pain.
  3. Swollen face.
  4. Direct trauma to the teeth.
  5. Knocked out teeth.
  6. Uncontrollable bleeding following an extraction of a tooth or oral surgery.
  7. Lost fillings and lost crowns that affect you eating or drinking.
  8. Severe sensitivity and pain from teeth with holes and deep fillings.
  9. Cracked and broken teeth.
  10. Pain and infection after a tooth extraction.
  11. Dental abscess.
  12. Root canal treatments.
  13. Infected wisdom teeth

Why is my face swollen?

There are many reasons why you may suddenly develop a swollen face, but the most common is due to a dental infection of some kind. You should always see a dentist in the first instance to exclude a dental cause, unless you are experiencing symptoms like breathing difficulties, dizziness palpitations, wheezing or numbness of the limbs. There are a variety of non-dental causes for a swollen face too.

  1. Dental abscess
  2. Allergic reactions
  3. Medication side effects
  4. Angioedema
  5. Cellulitis
  6. Oral Surgery, like after a tooth extraction
  7. Direct trauma
  8. Salivary gland blockage

What causes cheek swelling?

We can divide cheek swellings into dental/oral and medical causes.

Dental causes:

  1. Dental abscess
  2. Pericoronitis
  3. Direct trauma
  4. Salivary gland disease

Non-dental (medical) causes:

  1. Anaphylaxis
  2. Mumps
  3. Hypothyroidism
  4. Steroid use
  5. Cushing syndrome
  6. Cellulitis
  7. Some kinds of cancers

Will a tooth abscess go away with antibiotics?

Antibiotics are most often reserved for certain types of dental abscess, or in certain conditions. Normally, you will require further assessment and possibly treatment to prevent the situation arising again. You may be advised in some instances to have active treatment in addition to the antibiotics, so that you are treating the underlying cause.

What is the treatment for a tooth abscess?

This really depends upon the cause, the severity and the location of the abscess.

There are 4 main ways of treating a dental abscess in an emergency situation, and occasionally you may be advised to have a combination of the options to help with speeding up recovery.

  1. Incise and drain- if there’s pus, let it out. Normally we prefer to do this from inside your mouth, especially if the swelling has collected beside the tooth. Occasionally the swelling may enter the deeper tissues of the head and neck, in which case direct drainage would only be achievable externally-this is avoided due to the risk of scarring and is reserved for cases where there is a risk of further life threatening complications.
  2. Extirpation of the pulp. This is where your dentist may try to achieve drainage through the roots of the tooth, by drilling a hole in the affected tooth and leaving it open to allow drainage to occur. Ideally, the drainage hole should not be left open longer than 24 hours.
  3. Extraction of the tooth. Removing the tooth in question is a great way to allow drainage to occur. It may not always be possible to do, especially if the abscess is causing difficulty in opening the mouth, or if adequate anaesthesia may be difficult to achieve due to the size of the swelling.
  4. Prescribing antibiotics. This may be offered as a stand-alone treatment, or in combination with any of the above.
Our location and transport links allow us to provide emergency dentistry for London, North London, Hertfordshire, Essex
What is your dental emergency?

This is a genuine dental emergency, especially if it is uncontrollable and after a dental extraction. Call immediately to arrange an appointment. You may require sutures or special gauze placement to help control the bleeding. Please bring a list of any medication that you may be taking.

Problems with braces can include:

  • Broken braces (brackets)
  • Broken wires
  • Loose bands
  • Loose braces
  • Wires sticking out
Call and discuss the problem with your dentist. You may need to visit right away, especially if the broken/loose item is causing trauma to your cheeks, gums or tongue. If the problem with your braces was caused by an injury (such as a blow to the mouth), seek help right away.

Teeth may break for a variety of reasons including:

  • Trauma
  • Dental decay
  • Biting on hard foods
Treatment is dependent upon the degree of the break, how much tooth is broken and how much remains. Most teeth can have treatment to help save them, but a thorough assessment is required.

Dentures can break due to a variety of reasons, including:

  • Wear and tear
  • Poorly fitting dentures
  • Dentures that have loosened over time
  • Accidental dropping of the denture
Most dentures can be repaired, but will require you to bring as much of the denture to the dentist. In some instances, the dentist may be able to repair the denture for you there and then. If the break is particularly severe, your denture may require to be sent to a laboratory to be repaired- this can take a few hours. We do not recommend trying to repair the denture with superglue.

A dental abscess is a collection of pus that can form in the teeth or gums as a result of a bacterial infection.
Bacteria are found in plaque (a by-product of food, saliva and bacteria in the mouth). Plaque damages teeth and gums and can eventually infect the soft tissue inside a tooth or gums, forming an abscess.
There are two types of dental abscess:
periapical abscess (the most common type), when bacteria infect the inside of the tooth as a result of dental decay periodontal abscess, when bacteria infect the gums Dental abscesses can be very painful and tender and can make a person feel unwell.

Outlook

Without dental treatment, a dental abscess will get worse and may lead to the destruction of surrounding bone and other serious health problems.

A dental abscess occurs when bacteria infect and spread inside a tooth or your gums.

The bacteria responsible for this are found in plaque, which also contains food particles left over from eating combined with saliva.

Periapical abscesses are much more common than periodontal abscesses.

Causes of a periapical abscess

When a periapical abscess occurs, plaque bacteria infect your tooth as a result of dental caries (tiny holes caused by tooth decay) that form in the hard outer layer of your tooth (the enamel).

Dental caries break down the enamel and the softer layer of tissue underneath (dentine) and eventually reach the centre of your tooth (pulp). This is known as pulpitis. The dental pulp in the middle of the tooth dies and the pulp chamber becomes infected.

The bacteria continue to infect the pulp until it reaches the bone that surrounds and supports your tooth (alveolar bone), where the periapical abscess forms.

Causes of a periodontal abscess

A periodontal abscess occurs when plaque bacteria affect your gums, causing gum disease (known as periodontitis).

Periodontitis causes inflammation (redness and swelling) in your gums, which can make the tissue that surrounds the root of your tooth separate from the base of your tooth. This separation creates a tiny gap known as a periodontal pocket, which can be very difficult to keep clean and allows bacteria to enter and spread. The periodontal abscess is formed by the build-up of bacteria in the periodontal pocket.

Dental abscesses require immediate treatment, as left untreated they can cause severe pain, cause facial swellings and disrupt your day to day life.

It is important to arrange an emergency appointment to avoid the potential spread of infection. Treatment is dependent upon the severity and type of abscess, but may include root canal treatment, antibiotics, deep cleaning or extraction of the tooth.

Playing football, rugby, cricket or on a set of rollerblades, sports injuries can range from minor chips of a tooth to severe cases where teeth have been knocked out, loosened or displaced. It is important with any dental trauma to arrange an assessment straight away, especially if you have disrupted the position of the tooth or knocked it out. Studies show that the highest success rates can be achieved within the first two hours.

Gum pain can arise from a variety of causes, and maybe the result of something relatively minor (for example trapped food) to something that may require active treatment (periodontal abscess). It is important to arrange an appointment immediately as often this pain may escalate and may very well be the initial signs of an underlying problem.

Treatment is dependent upon the cause, but can vary from debridement of the area and antibiotics to specialist periodontal treatments.

Gum disease refers to inflammation of the soft tissue (gingiva) and abnormal loss of bone that surrounds and holds the teeth in place. Gum disease is caused by toxins secreted by certain bacteria in "plaque" that accumulate over time along and under the gum line. This plaque is a mixture of food, saliva, and bacteria. An early symptom of gum disease is gum bleeding without pain. Pain is a symptom of more advanced gum disease as the loss of bone around the teeth leads to the formation of deep gum pockets. Bacteria in these pockets cause gum infection, swelling, pain, and further bone destruction. Advanced gum disease can cause loss of otherwise healthy teeth. Gum disease is complicated by such factors as poor oral hygiene, family history of gum disease, smoking, and family history of diabetes.

Treatment of gum disease always involves oral hygiene and removal of bacterial plaque and tartar (hardened plaque). Moderate to advanced gum disease usually requires a thorough cleaning of the teeth and teeth roots called "scaling and root planing" and "subgingival curettage." Scaling and root planing is the removal of plaque and tartar from exposed teeth roots while subgingival curettage refers to the removal of the surface of the inflamed layer of gum tissue. Both of these procedures are usually performed under local anaesthesia and may be accompanied by the use of oral antibiotics to overcome gum infection or abscess. Follow-up treatment, if necessary, may include various types of gum operations. In advanced gum disease with significant bone destruction and loosening of teeth, teeth splinting or teeth extractions may be necessary.

What are Wisdom Teeth?

Wisdom teeth are the last molars on each side of the jaws. They are the last teeth to emerge, or erupt, usually when a person is between 16 and 20.

Since wisdom teeth are the last permanent teeth to come through, or erupt, there is often not enough room left in your mouth to accommodate them. This can lead to impacted wisdom teeth - teeth that are trapped beneath the gum tissue by other teeth or bone. If teeth are impacted, swelling and tenderness may occur.

Wisdom teeth that only partially emerge or come through crooked may also lead to painful crowding and disease. Since teeth removed before age 20 have less developed roots and fewer complications, consult your dentist to have your wisdom teeth evaluated to see if they need to be removed.

Wisdom tooth pain

Food impaction and bacterial plaque accumulation may set off an infection. This may very quickly spread and become very painful. Symptoms of a spreading infection may include difficulty in mouth opening, and swallowing. This may or may not, be accompanied with a facial swelling. There is usually a significant amount of pain also which may radiate to the ear..

It is very important to arrange an appointment immediately, and you will probably require antibiotics to control the infection in the first instance, unless it is clinically appropriate to remove the offending tooth.

We follow the NICE guidelines for the extraction of wisdom teeth.

How are Wisdom Teeth Removed?

A tooth extraction is a relatively routine procedure. Your dentist or a dental specialist, called an oral surgeon, will recommend either "going to sleep" using general anaesthesia, or numbing this area in your mouth with local anaesthesia.

After the tooth is removed, you may be asked to bite down softly on a piece of gauze for a certain period of time, to limit any bleeding that may occur. Some pain and swelling may occur but it will normally go away after a few days; however, you should call your dentist if you have prolonged or severe pain, swelling, bleeding or fever.

Removal of wisdom teeth due to crowding or impaction should not affect your bite or oral health in the future.

If a tooth is completely knocked out, it should be quickly rinsed off with water, but never scrubbed. The tooth should be held by the crown (top), not the root, so you do not damage the ligaments. In a cooperative adult, the tooth should be put back in the socket.

Many people may be uncomfortable re-implanting the tooth on their own. If this is the case, be sure to transport the tooth to the doctor or dentist in saline, milk, or saliva.

You may also place the tooth between the cheek and gum line of either the person who lost the tooth or any willing adult. The mouth is the best place for the tooth because it protects the root by keeping it moist and providing protection against bacteria.

Do not transport the tooth dry. This will cause damage within minutes. Transporting the tooth in water is also not recommended.

It is important to see a dentist as soon as possible if you are unlucky enough to lose a filling or a crown. You may or may not have pain or sensitivity, but the longer you leave a tooth without a protective covering, the higher the chances of you possibly developing a problem, or exacerbating an existing problem. The loss of a filling or crown may also have occurred as a result of an underlying problem, for example dental decay.

If there is no decay, then your existing crown can normally be cemented back straight away. Lost fillings will usually require replacement of the filling, you may have the option of a temporary or definitive filling being placed.

Following dental extractions, there is likely to be some discomfort, but this should subside within 24 hours and should respond well to painkillers. If persistent pain is occurring after this period, then there is a chance that you may have developed a post extraction infection. This is much more likely if you are a smoker.

It is important to arrange an appointment to see a dentist, as left untreated these can become quite painful. Treatment normally consists of stopping smoking, irrigation of the extraction site, placement of an antiseptic dressing and use of antibiotics.

Swelling after an extraction is entirely normal, and is the body's natural response. It should normally start to settle down within three days, but if it persists after this, then it is best to arrange an appointment.

The crown of the tooth is made up of the hard, white, enamel layer and a thicker dentine layer. Both these hard layers protect the innermost soft tissues of the tooth called the pulp. The dental pulp contains blood vessels and nerves within and extends from the crown to the tips of the root or roots.

Root canal treatment involves the removal of the pulp tissues from the tooth in the event that it gets infected or inflamed. The pulp can be infected or inflamed due to either deep decay or an extensive restoration that involves the pulp, cracked or fractured tooth due to trauma, excessive wear of enamel and dentine exposing the pulp, and sometimes as a result of severe gum disease.

Signs of pulp damage may include pain, prolonged sensitivity to heat or cold, discoloration of the tooth, swelling, tenderness of the overlying gums or a bad taste in the mouth. On the other hand, there may be no symptoms at all. If pulp inflammation or infection is left untreated, it can eventually cause pain, swelling and loss of the supporting bone.

What Are The Advantages Of Root Canal Treatment?

Root canal treatment saves teeth that would otherwise have been extracted.

After root canal treatment the tooth is pulp-less i.e. it has no vital tissues within. However, there are vital tissues surrounding the root e.g. the gum, periodontal membrane and supporting bone. A root canal treated tooth can function normally and can be maintained with routine dental care and oral hygiene measures.

How Is Root Canal Treatment Carried Out?

  • Removal of the infected or inflamed pulp is the first step in saving the tooth. Under local anaesthetic an opening is made in the crown of the tooth to get access to the infected or inflamed pulp within.
  • Using small, specially designed hand or rotary files, the root canals are cleaned and shaped to a form that can be sealed. Debris within the canals is removed by flushing with an anti-bacterial solution.
  • The canals are finally filled or sealed with an inert material called gutta-percha. The tooth should be restored to full shape and function by either a permanent filling or a crown, depending on how much of the tooth is left. This should be done as soon as possible as there could be a risk of tooth fracture due to biting forces.
  • All root canal treatment procedures are performed by isolating the tooth with a rubber dam to provide a clean and saliva-free environment. Root canal treatment may be done in single or multiple visits depending on the complexity of the tooth. In between treatment appointments, medicaments may be placed within the canals and the tooth is covered with a temporary filling.
  • Often, X-rays are taken to determine the length of the root and to monitor the various treatment stages.

Is Root Canal Treatment Painful?

Root canal treatment procedures are relatively comfortable and often painless as the tooth is anaesthetised during treatment. After treatment, the tooth may be sensitive or tender for a few days due to inflammation of the surrounding tissues. This discomfort can be relieved by taking mild analgesics or painkillers available over the counter at the pharmacy. However, if the pain persists and is severe, or a swelling occurs, you should contact your dentist.

Care Of The Root-Treated Tooth

As far as possible, avoid chewing or biting on the tooth being treated until you have it permanently restored with either a filling or a crown. Excessive pressure at this stage may crack or fracture the tooth. Therefore, it is very important to restore the tooth properly as soon as possible. Most endodontically treated teeth last as long as natural teeth following permanent restoration.

Practise good oral hygiene, including brushing and flossing at all times, as root-filled teeth are as prone to decay as natural teeth. It is also important to have your treated tooth reviewed regularly by your dentist.

Facial swellings are usually a sign of a severe infection. Pus has formed and has entered the space between tissues. This may or may not be accompanied by pain, but it is very important to see a dentist straight away to assess the cause, and start any appropriate treatment. Left untreated, swellings may cause hospitalization, especially if they spread to the neck region and start to cause difficulties in breathing.

Treatment may include drainage of the swelling if appropriate (either by a small incision, or by making a small hole in the tooth) and the use of antibiotics. Sometimes, if appropriate and if clinically feasible, the offending tooth may be removed.

I had a sudden toothache on one tooth. The gums are slightly swollen. I feel the tenderness when I touch it. After a few days it subsided and I ignored it. A few days later, I had the same toothache. What can I do about this?

Sudden excruciating pain or toothache may indicate the deep spread of decay in the tooth. Often, root canal treatment is necessary. If you note mild symptoms on the teeth, a check-up with your dentist will help prevent a bigger problem from occurring.

Features:

  • may start with sensitivity to hot or cold drinks and food
  • sudden pain from tooth or jaw usually of moderate to severe intensity
  • pain may last a few days or longer
  • pain can be related to one tooth or over a wide area
  • painkillers may provide temporary relief
  • swelling could occur

Causes:

  • decayed teeth
  • history of trauma to teeth
  • cracked teeth from excessive wear, chewing on hard foods

Management depending on cause:

  • remove decayed area and protect tooth with filling
  • root canal treatment if decay is extensive and has affected nerve of the tooth
  • drainage of swelling
  • antibiotics for swelling
  • extract tooth if not restorable

We deal with all manner of dental trauma, from accidental trips and falls to sports injuries and assaults.

Treatment really is dependent upon the extent and degree of trauma.

Knocked out and displaced teeth can normally be replanted and splinted. If the tooth has been knocked out, it is important to care for it appropriately- keep it clean, don't scrub the root, try to keep it in the socket if possible or in milk/contact lens solution. The important thing is not to let it dry out, and to avoid further damage to the root. It is ideal to see a dentist within two hours of the incident, but sometimes this is not possible-as long as the tooth has been cared for, it may still be replanted.

Splinting takes the shape of a piece of wire bonded onto the tooth surfaces to hold the teeth in place during the healing period, which may be between two to four weeks. You will require regular assessments during this phase in order to diagnose any infections or complications that may occur, so that they are dealt with appropriately and at the earliest time possible.

Minor cracks and chips can be restored by either bonding the fractured portion back to the tooth or restoring the missing part with some composite filling material.

This can be particularly distressing for anyone unfortunate enough to experience it. A full examination is required to ascertain likely causes. Dental infections can cause radiating pain, such that it is difficult for the patient to pinpoint where the pain is coming from.

Once the source of the pain has been diagnosed, appropriate treatment may be started to relieve your pain.

On rare occasions, you may be suffering from a pain of non-dental origin which may require referral to a specialist for further assessment.

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