FAQ

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.

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.

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.

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

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).

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).

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.

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

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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

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.

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.

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.

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.

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.

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

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

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

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.

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.