Dental Emergencies: What to Do in the First Hour, and What to Avoid

A dental emergency is rarely life-threatening, but acting correctly in the first hour can determine whether a tooth is saved or lost. UK access to emergency dental care is uneven — NHS 111 is the appropriate first call, but waiting times vary. Here is a practical decision tree for the most common dental emergencies.

The five most common dental emergencies

1. Knocked-out adult tooth (avulsion)

This is the only true emergency where minutes count. The tooth has been knocked completely out — root and all — usually from sport or an accident.

What to do:

• Find the tooth. Hold it by the crown (white part), never the root.
• If dirty, rinse briefly under running water — do not scrub or sterilise.
• If possible, push the tooth back into the socket and bite gently on a clean cloth to hold it.
• If you cannot reimplant, store the tooth in milk, saline, or saliva (in your cheek or under your tongue if no other option). Never store in water.
• Get to a dentist or A&E within 30–60 minutes. The implant prognosis drops sharply after 60 minutes.

This protocol does not apply to baby teeth — knocked-out baby teeth are not reimplanted because of risk to the developing adult tooth underneath.

2. Severe toothache with swelling (likely abscess)

Throbbing pain, possibly with facial swelling, fever, and difficulty sleeping.

What to do:

• Paracetamol or ibuprofen at standard doses.
• Sleep with head elevated.
• Cold compress for swelling.
• Contact NHS 111 if you cannot get same-day private appointment.
• Go to A&E if facial swelling is increasing rapidly, you cannot swallow, you cannot breathe normally, or you have high fever and feel systemically unwell.

An abscess will not resolve on its own with painkillers. Definitive treatment requires drainage and addressing the source.

3. Cracked or broken tooth

A crack or fracture, sometimes with pain on biting, sometimes painless.

What to do:

• Save any broken pieces in milk if you have them.
• Avoid biting on the affected side.
• OTC analgesia for pain.
• Contact dentist within 24–48 hours for assessment.

If the crack reaches the pulp (severe pain, sensitivity to hot), faster review is needed. The cracked tooth syndrome guide covers the diagnostic workflow.

4. Lost crown or filling

A crown has come off, or a filling has fallen out.

What to do:

• Save the crown if you have it — it can usually be re-cemented.
• Avoid the area when chewing.
• Pharmacy temporary cement (e.g. Dentemp) can hold a crown in place for a few days.
• Routine appointment within 1–2 weeks; sooner if there is sensitivity.

5. Soft-tissue injury (bitten lip, cut tongue, gum laceration)

What to do:

• Direct pressure with clean gauze or a cloth for 10–15 minutes.
• Cold compress for swelling.
• If bleeding does not stop in 20 minutes, A&E.
• Most soft-tissue injuries heal without sutures in the mouth — the tissue heals fast.

Pain management without prescription

For dental pain awaiting professional care, the most evidence-based regimen is paracetamol and ibuprofen in rotation rather than either alone:

• Paracetamol 1 g every 6 hours (max 4 g/24 hours).
• Ibuprofen 400 mg every 6 hours (max 1.2 g/24 hours over the counter; up to 2.4 g with prescription).
• Take them at 3-hour staggered intervals so analgesia is continuous.
• Do not exceed maximums; check for contraindications (kidney disease, GI bleeding history, certain medication interactions).

Codeine-containing OTC analgesics provide marginal additional benefit for dental pain at the cost of side effects. Aspirin is no longer first-line for dental pain because of bleeding risk.

What to avoid

• Aspirin directly on the gum: a folk remedy that causes chemical burns. Take it orally if at all.
• Heat applied to a swollen face: increases swelling. Use cold.
• Self-prescribing antibiotics: ineffective without drainage; risks antibiotic resistance.
• Delaying treatment because the pain reduces: a periapical abscess that quietens has often found a way to drain through a sinus tract; the underlying infection is still there.
• “Pulling teeth at home”: mostly an internet phenomenon. Don’t.

Accessing UK emergency dental care

The NHS pathway:

• Day 1 priority: call your registered NHS dentist; most have emergency slots.
• If unregistered or unavailable: NHS 111 (or 111 online) — directs to nearest emergency dental service.
• Out of hours: 111 again, or A&E for genuine emergencies (severe facial swelling, breathing difficulty, uncontrollable bleeding).

Private emergency dental care is available in most UK cities with same-day appointments at premium cost. Travel insurance occasionally covers emergency dental abroad — check your policy if you are abroad.

Frequently asked questions

How fast do I need to see a dentist after a tooth is knocked out?

Within 30–60 minutes for the best chance of reimplantation. After 60 minutes the implant survival rate drops sharply; after a few hours, replantation is unlikely to succeed and an implant is the more realistic plan. If you cannot reach a dentist quickly, A&E can sometimes hold the situation while a dentist is contacted.

Can I take antibiotics for a toothache?

Antibiotics alone do not treat dental pain — they reduce bacterial load but the source (decay, fracture, infected pulp) needs definitive treatment. Self-prescribing antibiotics is not recommended; if a dentist judges them necessary, they will prescribe at the appropriate moment. Most dental pain is treatable without antibiotics if seen promptly.

What counts as a real dental emergency requiring A&E?

Severe facial swelling that is rapidly increasing, difficulty swallowing, difficulty breathing, uncontrollable bleeding from a tooth socket, severe trauma involving multiple teeth or jaw fracture, or a high fever with feeling systemically unwell. Most other dental issues — toothache, single broken tooth, lost filling — can wait for NHS 111 or next-day appointment.

Should I go to my dentist or A&E?

Dentist (or NHS 111) for almost all dental issues. A&E for the genuine emergencies listed above (airway, severe spreading infection, major trauma). A&E does not have dentists on duty in most UK hospitals — they will manage the immediate problem and refer for dental follow-up. Save A&E capacity for the situations where it is genuinely needed.