The short answer
Go to the emergency room or call 911 for facial swelling with fever, any trouble breathing or swallowing, bleeding that will not stop with steady pressure, a jaw you cannot close, or a head injury. For a toothache, a knocked-out or broken tooth, a lost crown or an abscess without those signs, call a dentist first: a hospital can ease pain but usually cannot treat the tooth.
General information, not a diagnosis. Your dentist will examine your mouth before recommending treatment.
Start with the red flags
It is late, something hurts or is bleeding, and you are deciding between the hospital and waiting for a dentist. Check this list first. If any of these is true, the answer is the emergency room or 911, and the tooth comes later.
- Trouble breathing or swallowing, or swelling that is spreading toward the eye or down the neck.
- Swelling of the face or jaw together with a fever. A swollen area of the upper or lower jaw is a very serious symptom of a tooth abscess.
- Bleeding that does not slow after firm, steady pressure with gauze.
- You cannot close your upper and lower teeth together, which can mean a broken jaw.
- A blow to the head with passing out, confusion or vomiting, or a deep cut to the face, lip or tongue.
If it is only the tooth, call a dentist first
A severe toothache, a chipped or cracked tooth, a lost filling or crown, a loose tooth, or a pimple-like bump on the gum without fever or spreading swelling is a dental problem. Hospitals are staffed by physicians and nurses rather than dentists, so an emergency department visit for a toothache typically ends with pain medicine, sometimes antibiotics, and a referral to a dentist. The tooth itself is still untreated.
Our office at 3600 N Verdugo Rd #201 in Glendale is open Monday and Wednesday 11 AM to 7 PM, Thursday 10 AM to 4 PM, and Friday 10 AM to 6 PM, and is closed Tuesday, Saturday and Sunday. During those hours, call (818) 541-1110; we offer same-day appointments when possible for patients in pain. The emergency dentist page lists what we treat.
Outside those hours, use the first steps below, watch for the red flags above, and call when we open. If a red flag appears at any point, stop waiting and go to the ER. The site's longer page on emergency dentist vs. emergency room explains the reasoning in more depth; this guide is the short version for tonight.
| What is happening | Go to | First step | Why |
|---|---|---|---|
| Face or jaw swelling with fever, or trouble breathing or swallowing | ER or 911 now | Do not wait for office hours | A swollen jaw is a very serious sign; infection can spread |
| Bleeding that will not stop with steady pressure | ER | Keep firm pressure with gauze on the way | Hospitals control bleeding and stitch deep cuts |
| Cannot close your teeth together, or a head injury with fainting or confusion | ER | Support the jaw; do not test it | Possible fracture or concussion needs medical care first |
| Knocked-out adult tooth, no other injury | Dentist, ideally within 30 minutes | Hold by the crown; reinsert or keep in milk | The chance of saving it falls as the root dries |
| Severe toothache or gum bump, no fever or spreading swelling | Dentist, same day when possible | Warm rinse, floss, pain reliever as directed | A hospital eases pain but does not treat the cause |
| Chipped or cracked tooth, lost filling or crown | Dentist | Save the pieces, cold compress, chew on the other side | An exposed inner tooth can become infected |
The first steps for each problem
These are the first-aid steps the ADA, the AAE and MedlinePlus give for the most common situations. They buy time; they do not replace the visit. The post what to do in a dental emergency has more detail on each.
- Knocked-out adult tooth: pick it up by the crown, not the root. Rinse gently with water only, no scrubbing. Try to put it back in the socket and hold it there by biting gently on gauze. If you cannot, keep it in milk or inside your cheek, not tap water, and get to a dentist, ideally within 30 minutes. A tooth can sometimes be saved after an hour or more, so do not give up.
- Knocked-out baby tooth: do not try to put it back. Call so the area can be checked.
- Cracked or broken tooth: rinse with warm water, save any pieces, and hold a cold compress on the cheek for swelling. Avoid chewing on that side.
- Toothache: rinse with warm water and gently floss to remove trapped food. Take an over-the-counter pain reliever as directed. Do not put aspirin on the tooth or gum.
- Lost filling or crown: keep the crown clean and bring it. Avoid chewing on that side. See lost filling or crown: what to do.
- Bitten lip or tongue: clean gently with water and apply a cold compress. Bleeding that will not stop with pressure is an ER matter.
- Something stuck between teeth: try floss. Do not use anything sharp or pointed.
How to describe it on the phone
Whoever answers, at the office or at the hospital, will decide how urgently to see you based on what you say. Have these points ready before you dial, and say the alarming ones first.
- Which tooth or which side, and whether it is an adult tooth or a child's baby tooth.
- When it started and what happened: a fall, a hit, biting something hard, or nothing you can point to.
- Any swelling and where it is, and whether you have a fever or feel unwell.
- Whether you can open and close your mouth and swallow normally.
- Whether there is bleeding and how long it has been going.
- What you have taken for the pain and when, and any medicines you take every day, especially blood thinners.
- Allergies, pregnancy, diabetes, or heart conditions that affect how you can be treated.
- For a knocked-out tooth: how long it has been out and how it is being stored.
What to bring
Bring the tooth or the crown if you have it, stored as described above. Bring a photo ID and your dental insurance card. We accept all PPO dental plans and do not accept Medi-Cal or Denti-Cal; the insurance and payment page explains the options if you are not insured.
Bring a list of your medications and allergies, or the bottles themselves. If you are coming from the ER, bring the discharge paperwork and any prescriptions, because the dentist needs to know what was given and what the hospital found. If a child is the patient, a parent or legal guardian needs to come along.
What the ER can and cannot do, and what comes after
An emergency department can control bleeding, stitch deep cuts, check for a broken jaw or a head injury, and manage pain and infection with medicine. Those are medical jobs and the ER does them well. What it generally cannot do is repair, replace or save a tooth, because that takes a dentist with dental equipment.
So an ER visit for a dental problem is a first step, not the whole treatment. A tooth abscess still needs a root canal, an extraction or drainage to clear the source of the infection, and antibiotics alone do not fix it. Once the hospital has stabilized you, call a dentist as soon as you are able; the longer a damaged tooth waits, the lower the chance it can be repaired.
If what you have is gum or facial swelling, the post why severe gum swelling is a dental emergency explains what it can mean, and abscessed tooth warning signs covers the signs that should move you faster.
If you have not been to our office before, what to expect at your first visit covers the forms and the exam. And if the problem turns out to be a tooth that zings rather than throbs, why are my teeth sensitive explains the usual causes, none of which are emergencies.