Management of Acute Dental Problems

Brief description of condition

Lost, chipped, fractured or loose filling; cracked, chipped, fractured or split tooth or part of tooth; loose or displaced crowns, bridges or veneers.

Key signs and symptoms

Typically may include:

• Pain (general and localized; tenderness to bite)
• Sensitivity to hot, cold and sweet and chewing of food
• Open cavity
• Section of tooth or filling missing
• Sharp edge on tooth
• Mobile section of tooth or teeth
• Mobility or loss of restoration
• Trauma to the soft tissues of the tongue, lips or cheek from sharp edges of the fracture site
• Gingival inflammation
• Recurrent caries

Initial management

If it is known or suspected that the patient has inhaled a piece of tooth, filling or restoration, send the patient immediately to emergency medical care via NHS 24.

If the patient has an open cavity or fractured tooth, either provide a temporary dressing or advise the patient to use an emergency temporary repair kit which can be purchased at a pharmacy.

Recommend optimal analgesia.

If the painful symptoms are not relieved with optimal analgesia, advise the patient to seek urgent dental care.

If pain is relieved or is not a significant component, advise the patient to seek non-urgent dental care.

Subsequent Care

If tooth fragments or fillings, consider:

• Smoothing any rough edge, removing any loose or displaced tooth fragments or defective fillings.
• Providing a temporary palliative dressing or permanent filling.
• Pulp therapy (direct pulp cap, pulpotomy or root canal treatment) if fracture involves the pulp.
• Extracting if the tooth is not restorable.

If crowns, bridges and veneers, consider:

• Recementing the restoration with a temporary or permanent cement, depending on the integrity of the tooth beneath and whether a new restoration is needed.
• Providing temporary coverage.
• Making permanent replacements.
• Providing a new crown for a primary tooth.