Dental Emergency After Hours: Should You Go to the ER or Wait for a Dentist?

It is late, the pain is bad, and the practice is closed. The question is simple and the answer is not obvious: is this an emergency room problem, or does it wait until morning?

Getting this right matters more than people expect. An emergency department is the right place for some dental situations and the wrong place for most, and the difference shows up in both your recovery and your bill.

Go to the emergency room, or call 911, for these

These are medical emergencies that happen to involve the mouth. Do not wait for a dental appointment:

• Difficulty breathing or swallowing, or any sensation of the throat closing.
• Facial swelling that is spreading, particularly towards the eye or down into the neck.
• Swelling with fever, chills, or feeling generally very unwell, which can indicate a spreading infection.
• Bleeding that will not stop with firm pressure after about twenty minutes.
• A serious facial injury, or any suspicion the jaw is broken.
• Trauma involving loss of consciousness, confusion, or vomiting after a blow to the head.

The common thread is that these threaten the airway, involve uncontrolled bleeding, or indicate infection spreading beyond the tooth. A dental infection that reaches the tissues of the neck is a genuine emergency, which is why swelling that is moving rather than static is the single most important thing to act on.

What an emergency department can and cannot do

This is the part most people do not know until they are sitting there. Emergency departments are generally not staffed or equipped to provide definitive dental treatment. They are very good at managing infection that has become dangerous, controlling bleeding, treating facial trauma and providing pain relief.

What they usually cannot do is treat the cause: they will not perform a root canal, place a filling, or remove the tooth that is causing the problem. For a straightforward toothache, that means antibiotics and painkillers, then a referral back to a dentist for the actual treatment.

The scale of this is well documented. The American Dental Association estimates around two million emergency department visits each year in the United States for dental pain, and reports that an ED visit for dental care costs roughly three times a visit to the dentist, averaging in the region of $749 when the patient is not admitted. Analysis of hospital data has found that abscesses and tooth decay, both largely preventable, accounted for the large majority of dental-related emergency visits.

So for most toothaches, the emergency room is an expensive route to a prescription and a referral.

Situations for a dentist, urgently but not the ER

• A knocked-out permanent tooth. This one is genuinely time-critical, so call an emergency dental line immediately, and handle the tooth by the crown, not the root.
• Severe toothache without facial swelling.
• A broken or badly cracked tooth.
• A lost crown or filling, especially if the tooth is sharp or sensitive.
• A dental abscess or gum boil where the swelling is localised and not spreading.
• Bleeding after an extraction that slows with pressure.
• An orthodontic wire causing injury.

Most of these are uncomfortable rather than dangerous, and are far better dealt with by someone who can treat the cause.

Getting through the night

If you have decided it can wait until morning, the aim is to stay comfortable without making things worse:

• Take over-the-counter pain relief as directed on the packet, and follow the label and any advice from your pharmacist or doctor about what is suitable for you.
• Use a cold compress against the outside of the cheek, twenty minutes on and twenty off.
• Sleep with your head propped up. Lying flat increases pressure and pain.
• Rinse gently with warm salt water.
• Avoid very hot, very cold, hard or sugary food.
• Do not place aspirin directly against the gum. It burns the tissue and does not help the tooth.
• Do not apply heat to a swollen face, which can encourage infection to spread.

If the swelling grows, you develop a fever, or swallowing becomes difficult while you are waiting, that changes the answer. Go to the emergency room.

Before you need it: three things worth doing

• Save your dental practice's number in your phone, and check what its out-of-hours arrangements are.
• Know who to call for your children, and keep the same details for them.
• Do not ignore a tooth that has been grumbling for weeks. Almost every 2am emergency was a manageable problem a month earlier.

In North Orange County

For patients in Fullerton and nearby communities such as Brea, Placentia, La Habra and Buena Park, the practical route for most dental emergencies is to call a dental practice first thing rather than sitting in an emergency department overnight. Practices that keep time free for urgent cases can usually see you the same day, and can treat the cause rather than only the symptom.

The exception remains the list at the top of this article. If breathing, swallowing, spreading swelling or uncontrolled bleeding is involved, the emergency room is the right choice and the cost is not the consideration.