Swelling in the mouth or having a tooth knocked out of the socket are two serious dental emergencies that require prompt dental attention.
Oral swelling is almost always caused by an infection of a tooth or the gums. Swelling that is caused by a tooth is the result of a deep cavity or trauma that causes bacteria to infect the tiny nerves and blood vessels within the tooth. Untreated, the infection spreads, killing the tissues within the tooth and forming pus, the product of a tooth abscess. The abscess looks for a way to spread, but because the tooth is hard and confining, it moves into the surrounding jawbone, and then to the cheek and near the gums. Untreated, the swelling can spread to the throat and become fatal if it prevents our ability to breathe.
Swelling caused by an infected tooth will be treated with either root canal therapy, where the infected nerves and blood supply are removed from the tooth, or by a tooth extraction. In most cases, it is preferable to save the tooth with root canal therapy. If the swelling is hard, the dentist may make a small incision to drain the infection. Antibiotics may be prescribed as an adjunct to the dental treatments.
A gum infection can cause swelling when plaque, a bacterial film that forms continuously around the teeth, and debris, get trapped under the gum line. This almost always occurs in people with pre-existing gum disease, where the plaque and debris cannot be cleaned out.
The dentist can clean under the gum line to treat swelling caused by a gum infection. If the tooth or teeth are loose in the area of the swelling, they may require extraction. In some cases, antibiotics may also be prescribed.
Swelling can be very dangerous, and requires immediate attention. While you are waiting to visit the dentist, as well as after treatment, you can rinse with warm salt water (8 oz. of water with 1 tsp. of salt) every two hours to help bring the swelling down. You can take over-the-counter pain relievers such as ibuprofen (Advil®) or naproxen (Aleve®). Some topical ointments, such as Orajel® or others containing 10-20 percent benzocaine, can be helpful if rubbed over the swelling. If your dentist cannot see you within 24 hours, find a dentist who will, or go to a hospital emergency room.
Having a tooth knocked out requires immediate action. First, find the tooth, hold it by the crown, and rinse it off with plain water, but do not scrub the root. Place the tooth carefully back into the tooth socket, if possible. Otherwise, place it in a cup of milk or inside your cheek like a lozenge. You must get to the dentist within half an hour to have a good chance of saving the tooth.
The dentist will examine the site of injury and clean the tooth socket. The tooth will be replanted and joined to the surrounding teeth for 7-10 days for stability. If the tooth re-attaches to the jawbone, it will then require root canal therapy.
Always remember that the use of a custom athletic mouth guard can greatly reduce the risk of having a tooth knocked out during sports participation.
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