What will the er do for a toothache

Anyone who has ever suffered through tooth pain knows the warning signs – a bit of sharp pinch when biting down, a dull ache after drinking a cold liquid, a throb after chewing gum. But in the midst of COVID-19, when does dental pain mean you should call for an appointment or head to the emergency room?

To help navigate through the decision, The University of Texas Health Science Center at Houston (UTHealth) School of Dentistry has set up a dental information hotline at 713-486-4000.

“Unexpected dental problems can and do occur but, for some patients, they have nowhere to turn for help,” said John Valenza, DDS, dean of UTHealth School of Dentistry. “During this difficult time, in addition to serving any urgent needs for patients of record, we wanted to be a resource for the community who need information or guidance.”

The American Dental Association (ADA) has provided examples of elective versus urgent and emergent treatment. Dentists are advised to defer non-urgent care, but continue to see patients for acute dental issues to keep them out of emergency rooms when possible.

Life-threatening emergencies, such as maxillofacial trauma, uncontrolled bleeding from the mouth, or facial swelling that crosses the midline or impacts breathing or speaking, need to be treated as emergencies and require attention by oral and maxillofacial surgeons in a hospital setting.

What is urgent?

The following are examples of urgent dental conditions requiring prompt treatment, but usually not a trip to the ER: 

• Severe tooth pain (“toothache”) – This condition is typically due to inflammation of the tooth’s pulp (nerve inside the tooth) and is most commonly caused by decay, whether it be the first cavity in the tooth or under an existing filling or crown. 
• Abscess (infection) resulting in localized pain and swelling – Severe decay is again the likely cause, leading to death of the tooth’s pulp (nerve). Swelling may be limited to a “gum boil” on the gums, or in more severe cases, significant swelling of the face or jaw. 
• Fracture of tooth or restoration (filling, crown) resulting in pain and/or causing soft tissue trauma – When the biting surface and/or side of a tooth chips or breaks, the tooth may become sensitive and/or the sharp edge may cut into the gums, tongue or cheek. 
• Dental trauma resulting in avulsion (tooth knocked out) or luxation (tooth present but loose) – This is typically due to an accident, such as automobile collision, where part of the tooth is fractured, pushed in, knocked loose, or completely knocked out. Patients suffering these conditions often need to be seen immediately, especially in the case of an avulsed (knocked out) tooth. In some instances, the injury may extend beyond the teeth, to jaw or facial fractures. 
• Loss of temporary or permanent restoration (filling, crown, bridge) – Loss of the existing filling or crown can result in sensitivity, gum irritation, or (after a period of days/weeks) even shifting of other teeth. 
• Pericoronitis – A condition involving inflammation of the gums surrounding a tooth, typically a third molar (wisdom tooth). This condition most often occurs in partially erupted (not fully visible) molars that have a flap of gum tissue partially covering the tooth. 
• Postoperative osteitis (“dry socket”) following tooth extraction – Typically appearing three to four days following an extraction, dry sockets require frequent, if not daily, dressing changes. 
• Need for biopsy of abnormal tissue – Mouth sores or patches on the tongue, lips, cheeks, or gums that do not resolve on their own are examples of abnormal tissue that may require an oral biopsy, where a sample of the tissue is removed and analyzed by an oral pathology laboratory.

Other conditions that may require prompt dental care during this time include removing sutures (stitches); adjusting dentures that are irritating, broken, or malfunctioning, especially for cancer patients undergoing chemotherapy or radiation; and trimming broken or twisted orthodontic wires or appliances to avoid piercing or ulcerating the gums, lips, or tongue. 

Patients who have to go in for treatment should be prepared to answer screening questions and have their temperature checked. Friends or family members may be asked to wait outside. 

Making the call

Patients with non-urgent dental needs during the COVID-19 crisis are advised to wait until restrictions on dental care are lifted.

Patients with urgent dental needs should contact their dental professionals to see what can be done for interim relief until they can see their dentist. This might include avoiding certain types of foods, taking pain medications or antibiotics, or using an over-the-counter temporary filling or cement, available at drugstores.

Anyone who doesn’t have a dentist, or who has questions, are encouraged to call the dental information hotline, 713-486-4000. Staff will take calls between 8 a.m. and 5 p.m. Monday through Friday. Information is also posted on the school’s website.