Emergency
in Petaling Jaya

A dental emergency includes severe toothache that keeps you awake, a swelling of the gum or face, or a knocked-out or broken tooth. It also includes a crown, bridge or filling that has come off, bleeding that does not stop after an extraction, a locked jaw, a broken denture you rely on, or an injury to the mouth. If a swelling affects breathing or swallowing, spreads towards the eye, or comes with a high fever, go to a hospital emergency department first.

A knocked out adult tooth is one of the few genuine time critical emergencies in dentistry. The cells on the root surface that let the tooth reattach to the bone start dying within minutes of drying out, and once they are gone the tooth will eventually be resorbed and lost even if it is put back. Putting the tooth into its socket within the first half hour gives it the best chance by a wide margin, and doing that yourself at the scene beats travelling to us with it in a tissue.

If you cannot face replanting it, the storage medium is what matters. Milk is the practical choice because it is available and its salt concentration and pH are close enough to the body's own to keep the cells alive for a few hours. Your own saliva, held inside the cheek, is the fallback where the person is old enough not to swallow it. Plain water is the one to avoid, because the cells burst in it.

Once we have it back in the socket it is splinted to the neighbouring teeth for a period, and the tooth almost always needs root canal treatment afterwards. That is expected rather than a complication.

A dental abscess is a collection of pus under pressure inside bone. Antibiotics travel in the blood, and the inside of an abscess has almost no blood supply, which is why antibiotics alone frequently take the edge off without curing anything and why the pain returns when the course finishes. What resolves it is drainage and dealing with the source, either through the tooth by starting root canal treatment or by removing the tooth.

Antibiotics have a real place alongside that, where the infection has spread into the surrounding tissues, where there is fever or spreading facial swelling, or where a patient's medical history calls for cover. What they are not is a way to keep postponing the appointment. Repeated courses for the same tooth drive resistance and let the bone loss continue quietly underneath, and it remains a matter for the dentist seeing you rather than a request that can be filled over the counter.

• Take the medication exactly as prescribed and finish any course of antibiotics.
• Soft food, a cold compress for swelling, and no smoking while the area heals.
• Keep the follow-up appointment for the definitive treatment even if the pain has gone.
• Return or call if swelling, fever or bleeding gets worse rather than better.