The Dental Emergency – True or False?
“Beep, beep, beep… ” my pager pierced as I was preparing for bed. Who’s calling at this time of night, I thought, warily eyeing the number. Not recognizing the digits, I dialed it anyway.
“Hello, this is Dr. Yang,” I began.
“It’s Mackenzie,” the caller announced, like Michelangelo or Beyoncé, with no last name. Resisting the urge to say, “Mackenzie who?” because I knew who she was.
“I have a flossing emergency,” she said.
“OK, well, at least you’re flossing.”
“But my gum is bleeding so bad and I can’t get it to stop. Is this normal?”
Recommending she put some pressure on the area, I assured Mackenzie that she would be fine, and just “baby it.” No one had ever died of a flossing emergency.
“I know you’re scared,” I said. “But you’ll be fine. Call me tomorrow morning and let me know how you’re doing.”
As a dentist, I uphold an ethical obligation to provide after-hours emergency care for my patients. It’s not a legal mandate, but it’s the right thing to do. But how many flossing emergencies can I be expected to manage?
Some practitioners had answering services who screened the calls. Pre-cell phone, others gave out their home phone numbers. The drug pusher and I had this in common: the beeper and a means to supply pills. While the drug dealer’s beeper might display a number that was secret code for “Drop confirmed at the usual spot,” mine showed phone numbers that could have been loyal patients – or complete strangers. There was no way to know.
Often a voice I didn’t recognize would say, “I was in your office nine months ago and I just broke my tooth. It really hurts! I need help.”
“What’s your name?” I would ask. Strangers always told their story before telling their name; when prodded, it would be something common, like David Lee or Jim Johnson.
“Think,” I told myself, not wanting to embarrass either of us, “who is Jim Johnson?”
“Doc, I know it’s the weekend and I just need something for the pain. It’s killing me.” Jim Johnson wasn’t embarrassed; he knew what he was after.
The female callers were usually more inventive. “I had a prescription for Norco, but on the way to the pharmacy, my car was totaled. Oh My God, I’m fine though, miraculously. Not so with the prescription, it’s in pieces now. I tried to call the doctor who wrote it, but he’s out of town. I’m desperate. Can you please call in a new one for me?”
I fell for this charade once or twice, phoning in a prescription for Vicodin, asking Jim Johnson if he had any known allergies, warning him not to drink alcohol with the pills, telling him to come in Monday morning – suspecting he probably would not. Eventually I learned to ask these Jim Johnsons so many questions that they would hang up and move on to the next dentist in the phone book.
The opioid crisis put an end to these calls. Before issuing a prescription, I was required to check a database for the drug history, write it in triplicate, and hand it over in person. (Today the rules are even more stringent.) Often I couldn’t help feeling that dentists - and the entire medical establishment - might have contributed to Jim Johnson’s predicament by overprescribing in the first place, or believing a drug rep over a chicken dinner lecture, or thinking that pain could only be exclusively managed through a pill. For years I kept a supply of Percocet in the family emergency kit, leftover from one of my kids’ wisdom teeth extractions.
It turns out that ibuprofen and acetaminophen are just as, if not more, effective than narcotics. Recently the makers of Advil introduced Advil Dual Action, a marriage of those two medications in one pill, like mixing salt and pepper into one bottle.
Most patients, though, simply wanted information – and reassurance. A chipped tooth didn’t mean the entire tooth would crumble like stale cheese. It was normal for a fresh break to sting when cold water or air touched it, just as it was normal for the patient not to know this fact and be alarmed by the pain. When my children were sick, I harbored the same uncertainties. After the third visit to the pediatrician, the doctor finally said, “Trust me, you’ll know when she has the chicken pox.”
So what are some legitimate dental emergencies?
My tooth got knocked out!
This is perhaps the most urgent dental emergency because time is of the essence. You have approximately one hour to get the tooth reimplanted into the mouth. It can be the result of a fall, a sports injury, a car accident, or similar. Do the following:
Determine if it’s a permanent or baby tooth. Baby teeth do not require any treatment.
Get to the dentist. Any dentist.
Gently rinse any debris off the tooth. Do not scrub it.
Store the tooth in one of three solutions:
o Pasteurized milk
o Hank’s balanced salt solution
o The patient’s own saliva. With an adult, the tooth can be placed inside the cheek while traveling to the dentist’s office.
Even if reimplantation is successfully done, the prognosis will remain guarded. Often the tooth will require a root canal.
My mouth is swelling.
Swelling can be caused by anything from a wayward popcorn kernel to a life-threatening infection. Contact your dentist if you’re unsure. A potentially serious infection may include:
Difficulty breathing
A high fever
Difficulty swallowing
Eye partially swollen shut
I have a toothache.
It’s rumored that the pain of a toothache is worse than that of childbirth and, like childbirth, a toothache can happen at an inopportune time. Call your dentist if you’re in severe pain. An emergency procedure can generally be done to provide relief. Occasionally, if the tooth is infected, the infection must be treated first prior to working on the offending tooth.
Your dentist may not be happy if you’ve interrupted his Saturday night plans and the toothache is the result of treatment recommendations that were ignored. The priority, though, is to take you out of pain.
I was in an accident and now my teeth don’t touch like they used to…
Your jaw may be broken. Contact your dentist or an oral surgeon right away as this requires timely treatment.
My tooth broke/ my filling fell out.
Unless you’re in profound pain, this situation may be better handled during business hours. The treatment may even turn out better with the help of an assistant who won’t be present while the office is closed.
It’s normal for the tooth to feel sensitive, particularly to cold liquids or air. Try to chew on the other side. Chances are the tooth will feel rough to your tongue as well.
My crown or temporary crown fell out.
This can also wait until the next business day. Again, the tooth may be sensitive since it’s no longer covered and protected. Avoid chewing on that side. Never use Krazy or Gorilla Glue to recement the crown yourself.
A picture is worth a thousand words.
Clear photographs are useful tools to help your dentist assess the urgency of the situation and whether it is best handled in their office or that of a specialist.
Inasmuch as nobody likes emergencies, they do sometimes happen and your dentist has a professional obligation to assist you. Cultivate a collaborative and consistent relationship with your dentist to ensure that emergencies are kept to a minimum. Do your part by seeing your dentist regularly for examinations and practicing good oral hygiene habits at home.
