Emergency dentistry of one form or another may be necessary as a result of several situations, but regardless of the patient’s issue, at that moment of desperation, nothing may have a greater priority. Understanding that there are times when an individual may be in a state of dental urgency, our policy at the Miami Center for Cosmetic and Implant Dentistry, regardless of our schedule load, is to offer the patient an immediate appointment up to one hour before our office closing time.
Dental emergencies may result in varying degrees of pain, severe pressure, embarrassment, or simple frustration and desperation. Situations that can result in a dental emergency include:
- Broken or fractured teeth
- Severe facial or gingival (gum) swelling
- Wisdom teeth
- Gingival bleeding
- Missing tooth or teeth, or dental prosthesis
Teeth break or fracture due to different circumstances. They fall into three main categories: extensive decay, endodontic (root canal) treated teeth without crowns, and trauma to the tooth. Extensive dental caries (decay) is a result of a lack of personal dental hygiene, home care, and maintenance. Teeth that are not flossed and brushed regularly are susceptible to decay, which causes destruction of the tooth structure. The tooth is divided into two sections: the root, which is embedded in the jawbone and covered by the gums and the crown, which is the upper part of the tooth visible in the mouth. The crown is comprised of a thin outer layer of enamel that covers a thick layer of dentin. When a substantial amount of the enamel and dentin is destroyed and the tooth becomes weakened, it is susceptible to fracture. When this occurs, pain of varying degrees may result, depending on the severity of the fracture. When the fracture is too severe, restoration of the tooth may not be possible. However, when a tooth has been treated with root canal therapy it no longer has any nerve or blood supply and consequently may become very brittle and susceptible to fracture. Finally, trauma caused by a sharp blow to the tooth may cause it to fracture. In any of these situations where fracture has occurred and the remaining tooth structure is restorable, it is accomplished in one of two ways. When the fracture is relatively small, the placement of a dental restoration (filling) may be sufficient. However, when the fracture is large and a significant amount of tooth structure needs to be replaced, the tooth may need to be built up with a core of filling material and a crown fabricated to reconstruct the tooth. On the emergency visit, the goal at the Miami Center for Cosmetic and Implant Dentistry is to prepare the tooth and fabricate a temporary crown. Clearly, from a cosmetic standpoint, when a fracture occurs on one of the front teeth, it is critical that the patient leaves our office with the tooth restored sufficiently so they can engage in their normal routine.
Severe facial or gingival swelling occurs when infection is present. The usual cause of facial swelling is infection due to a dental abscess. The etiology of the swelling is infection caused by the tooth, which may not be salvageable. This infection must be immediately treated with antibiotics and extraction or a combination of both. Gingival swelling usually occurs as a result of poor dental hygiene. When a periodontal abscess occurs and results in severe swelling, the prognosis for saving the tooth is often very poor and extraction is the only resolution. However, if the infection is treatable, simple deep periodontal scaling, along with direct antibiotic therapy and good home care may resolve the situation.
Third molars, commonly referred to as wisdom teeth, are often the cause of dental pain. Many people have healthy, properly erupted wisdom teeth which remain asymptomatic their entire lives, however a large percentage of wisdom teeth do not properly erupt and can eventually cause severe pain and swelling. The tooth may be fully erupted, or fully or partially impacted (encapsulated by bone). There are also times when a wisdom tooth may become severely decayed. Under these circumstances immediate extraction will eliminate the pain and any accompanying swelling.
The most common cause of oral bleeding that we find in our office is due to gingival inflammation. This is usually due to poor dental hygiene and results in gingivitis (inflamed gums) and varying degrees of bleeding, which is treated by periodontal scaling and possible antibiotics. An extreme case of gingivitis is ANUG (acute necrotizing ulcerative gingivitis), commonly referred to as trench mouth. This condition is caused by poor oral hygiene, smoking, malnutrition, psychological stress, and immunosuppression. The main features are extremely painful and bleeding gums, which are best treated by antibiotics and debridement.
A missing tooth or teeth caused by an accident or a lost dental prosthesis often results in a patient being desperate for an immediate cosmetic resolution. At the Miami Center for Cosmetic and Implant Dentistry, we are very conscious of our patients’ cosmetic dental requirements. Certainly few people, regardless of their esthetic dental needs, want to be in public with visible spaces when they smile. Over the years, we have had countless patients come into our office on an emergency basis because of a lost tooth or teeth and leave not only the same day with a replacement, but a beautiful smile as well.
These are the most common reasons we treat patients on an emergency basis, but regardless of the situation, our goal is immediate resolution of the emergency and our patient leaving the office without pain and with a smile on their face.