First Aid for Your Mouth

Tooth Knocked Out

Find the tooth. Handle the tooth by the top, not the root portion.  Make sure that you do not touch the root of the tooth with your hands.  The root is the portion of the tooth which is usually embedded in the gum and not normally seen.  You may carefully rinse the tooth in cool water, but DO NOT clean or handle the tooth unnecessarily, DO NOT scrub it or clean it with soap -- use just water!. Try to reinsert it in the socket. Hold the tooth in place by biting on a clean gauze or cloth. If you cannot reinsert the tooth, transport the tooth in a cup containing milk. The tooth should not be wrapped in tissues, handkerchiefs, or gauze.  Call IMMEDIATELY!  Time is a critical factor in saving the tooth.  The faster you act, the better your chances of saving the tooth - if replanted within 30 minutes it has the best chance of survival.

Once the tooth is replanted, it should be splinted. The tooth should be re-examined within a week to 10 days for possible removal of the splint. Two of the most common complications of replanted teeth that have been knocked out are:  1) nerve of the tooth dying, and 2) the root dissolving.  Treatment for both of these is a root canal. For several weeks after the accident, the tooth or teeth should be monitored in how they appear and what shows on x-rays weekly.  If signs and/or symptoms that the nerve is dying or the root is dissolving are evident, a root canal should be started, if it had not already been done.

Prognosis is variable. It may not be possible to judge the success of reimplantation for many years. If the root continues to dissolve after root canal, the tooth will most likely be lost. Then, a bridge, partial denture, or an implant will be needed to replace the missing tooth to prevent problems associated with missing teeth.

Toothache

Clean the area around the sore tooth thoroughly and gently by brushing, flossing and rinsing. Rinse vigorously with warm salt water or use dental floss to dislodge trapped food or debris. DO NOT place aspirin on the gum or on the aching tooth. If your face is swollen, apply a cold compress. Take a pain reliever and call as soon as possible if the toothache does not subside.  Click here to see more about whether you may require a root canal.

Filling Out

Fillings typically don't "come out" unless there is decay present to compromise them, still you're left with a void that can be both sensitive and annoying until you can get in to have it treated.  A great help is orthodontic wax to fill such a void.  Orthodontic wax is soft and moldable, and is generally available in most drug store dental sections.

Chipped Tooth

If there is pain or sensitivity in the affected tooth that persists, call immediately as this indicates the tooth nerve may be injured.

If no pain or sensitivity is experienced the situation is not as critical. You should call to double check, but in most cases, you can simply schedule a future appointment to replace the lost portion of the tooth.

For comfort where a tooth is rough, you can gently use an emery board to smooth the tooth until it is no longer bothersome to the tongue.  This serves two purposes, one for comfort, the other to lessen the chance of continual chipping where the tooth is rough.

Something Stuck Between Teeth

Sometimes something gets stuck between teeth.  It could be a piece of floss, or food, or something else.

If after trying flossing normally the item is not removed, try putting a knot in the floss.  With the knot in the floss, place the floss between teeth normally by gently sliding it back and forth past the tight spot, then carefully pull the knot through.  This will often catch what is stuck.

If despite your best efforts you cannot dislodge the item, try this.  Teeth have the capability to move just slightly, that is for safety and gives teeth just a little "cushion".  Take a toothpick and put it in between the teeth where the item is stuck.  Push firmly on the toothpick and let it stay in place for a couple minutes.  The teeth will slightly move.  Again push on the toothpick, allowing the teeth to move a little further.  After a few more minutes remove the toothpick and try flossing the item out. The teeth will move back together shortly.

Mouth Sores

A great over the counter treatment for mouth sores and irritations is Orabase Sooth-N-Seal, available in the drugstore.

Fever blisters, also called cold sores (caused by the herpes simplex virus) occur usually on the lower lip, but can also occur on the upper lip.  These always occur in the same place on the lip.  These often appear during stress, sick times with cold - flu - other, pregnancy,  but also with prolonged exposure to sun or cold  These are contagious and if the blister breaks, direct contact with other people should be avoided to prevent transmitting the virus that causes the sore until it is healed.  Keeping the sore area covered with an ointment until healing is completed will make things more comfortable.  For regular cold sore sufferers there is a prescription cream that works very well: Denavir.  Another and significant option for regular cold sores is preventively taking Famvir tablets before you will most likely be in a situation that usually will bring out the sore/blister.  Ointments also include aloe vera or medicated vitamin E.  Abreva is an over-the-counter cream available (about $15).  It speeds healing time only about 1 day according to the company's research, compared to placebo.

Canker sores (aphthous ulcers) occur inside the mouth usually not right next to teeth, but under the tongue or between the gums and cheek.  These often occur during times of stress, and some people feel that acidic foods bring them on (oranges, tomatoes, etc.).  Once the canker sore appears, it will take about a week to heal, but in the meantime one of the best over the counter treatments is called Kanka - available in the drugstore.  Applied directly on the sore, it makes it more tolerable until healing is completed.  For regular canker sore sufferers there is a prescription cream that works very well:  Aphthasol.

Other different sores can occur, but these are the two most common.  Mouth sores should heal within two weeks, and if they don't call for further evaluation.

Denture irritation spots and retainer sore spots can be treated like canker sores, but you will usually need to call for an adjustment to prevent the sore spot from continuing or re-occurring.

Cut

Apply firm but gentle pressure with a clean gauze or cloth. If bleeding does not stop or slow after 15 minutes or it cannot be controlled by simple pressure call or go to the emergency room.

Bleeding After Baby Tooth Falls Out

Fold and pack a clean gauze or cloth over the bleeding area. Have the child bite on the gauze with pressure for 15 minutes. This may be repeated. It is normal to have bleeding after a baby tooth falls out, and it is generally not necessary to do anything - unless it makes you feel or your child feel better.

Prevention - Mouthguards

Mouthguards are highly recommended for any contact sport where there are high incidents of serious injuries to the teeth, and prevention is the key.  Not only do mouthguards protect teeth but they also protect lips, gums, and cheeks as well.

Commonly there are two types of mouthguards.

Semi-formable mouthguards, also known as boil and bite mouthguards, are available in sporting good stores and in many drug stores. Often these mouthguards can be boiled to fit allowing them to sit snugly against the teeth. These are best used when baby teeth are still present, due to the cost of the custom mouthguards.

Dentist-made mouthguards are custom made.  A mold of the mouth is used to create the mouthguard, and consequently, these mouthguards fit more securely against the teeth affording the best protection.  This type is ideal also for sports requiring communication, since they stay in place better when trying to yell across the field or court.  These are available with a strap.

See more about custom made mouthguards that I prescribe (Playsafe), click here.