The OPTISMILE Podcast 18 – Dental Emergencies: Expert Tips for Urgent Care

Welcome and Introduction

0:03 – 0:45

Eon Engelbrecht introduces the podcast “Save Your Money, Save Your Teeth,” which aims to provide practical dental care advice from Dr. Clifford Yudelman. For more information on dental emergencies, visit OptiSmile’s Guide to Common Dental Emergencies in Cape Town.

Introduction and Topic Overview

0:45 – 1:39

Dr. Clifford Yudelman joins the discussion, expressing his enjoyment in doing these podcasts and emphasising the importance of providing accurate dental information.

Defining a Dental Emergency

1:40 – 2:56

Dr Yudelman defines a dental emergency as severe pain, swelling, a knocked-out tooth, and uncontrolled bleeding and emphasizes the importance of prompt attention.

Handling a Knocked-Out Tooth

2:57 – 6:39

Dr. Yudelman details steps to take if a tooth is knocked out during sports, including keeping it moist, handling it correctly, and seeking immediate dental attention to reinsert it.

Pain and Shock Management

6:39 – 8:02

Discussion on the pain associated with losing a tooth and the importance of staying calm to manage the situation effectively.

Dealing with Lost Crowns or Fillings

8:31 – 10:17

Advice on managing a loose crown or filling, including storing it safely and seeking prompt dental re-cementing to avoid further complications.

Managing a Cracked or Chipped Tooth

10:34 – 12:19

This section provides guidance on what to do if you crack or chip a tooth, including seeing a dentist promptly and managing immediate discomfort.

Toothaches and Dental Emergencies

12:35 – 13:47

Understanding when a toothache is a dental emergency, particularly when it involves severe pain, persistent discomfort, or signs of infection.

Handling Severe Tooth Abscesses

14:05 – 16:34

Steps to manage a severe tooth abscess include using warm salt water rinses, cold compresses, and appropriate pain relievers until professional help is available. Listen to our podcast “Toothache Troubles: Managing Dental Pain And Costs.”

Managing Bleeding Gums and Swollen Jaw

16:35 – 17:54

Advice on dealing with bleeding gums and a swollen jaw, emphasising the use of salt water rinses and cold compresses, and understanding when to seek emergency care.

Common Mistakes and Myths in Dental Emergencies

18:07 – 20:35

Dr. Yudelman discusses common mistakes people make during dental emergencies, such as relying on home remedies or delaying professional treatment, and debunking myths that can worsen the situation.

Conclusion and Takeaway

20:35 – 21:27

Eon Engelbrecht summarises the key points discussed, thanking Dr Yudelman for his insights and encouraging listeners to consult with dental professionals for tailored advice.

Outro and Promotion

21:45 – 22:30

Promotional segment highlighting OptiSmile’s expertise and encouraging listeners to visit their website for more information and to book appointments.

 

Transcript

[Eon Engelbrecht E-Radio-SA] (0:03 – 0:45)

Welcome again to “Save Your Money, Save Your Teeth”, the go-to podcast where curiosity meets dentistry straight from the experts. I’m Eon, and every week, I’m chatting with Dr. Clifford Yudelman. We take a deep dive into the world of dental care from a consumer’s perspective.

So whether you are looking to brighten that smile or protect your wallet, we have got you covered with practical advice and the latest insights. So stick around as we uncover the secrets to maintaining both your dental health and also your finances. Today, a very interesting topic is “handling dental emergencies”.

Dr. Yudelman, welcome back once again.

[Dr Clifford Yudelman OptiSmile] (0:45 – 0:57)

Hi Eon, thanks for having me back again. I’m really enjoying doing these podcasts, and I hope people listening today have heard some of our previous ones and will stay tuned for more helpful information.

[Eon Engelbrecht E-Radio-SA] (0:58 – 1:13)

I’m so pleased I’ve got the opportunity. Thank you. No, thank you so much to you for joining us and sharing your expertise.

It’s so interesting and insightful. Every single week, I’m learning something. It feels like I could qualify as a dentist, you know, eventually.

[Dr Clifford Yudelman OptiSmile] (1:17 – 1:39)

Thank you. That’s my goal, you know. People need to be their own doctors and dentists.

These days, there’s a lot of information on the internet, but it might not always be the best information, and I’m trying to balance it and give people, you know, consumer power to know my own opinion. Thank you very much.

[Eon Engelbrecht E-Radio-SA] (1:40 – 1:58)

And you’re doing very well. Thank you so much, doctor. So today, now we will definitely know at the end of this episode what we need to do in a dental emergency and what you do in a dental emergency.

But let’s quickly start off with the question, what actually qualifies as a dental emergency doctor?

[Dr Clifford Yudelman OptiSmile] (1:59 – 2:56)

So today, we’re talking about dental emergencies, truly things that are unexpected. We’ve spoken before about sensitivity and toothaches and bleeding gums, and these types of things generally creep up on you and then by a Friday afternoon, especially before a public holiday on the Monday when it’s a long weekend, somebody can now have what they think is a dental emergency when the tooth has actually been getting progressively sensitive all week. The type of emergency we’re talking about today is something unexpected.

So, things like severe pain or swelling. So, if you’ve got pain or swelling, it indicates an infection or a significant injury, and that needs prompt attention. For a knocked-out or detached tooth, immediate treatment can save the tooth.

Uncontrolled bleeding requires urgent care to prevent further complications. So those are the types of emergencies we’re going to talk about today.

[Eon Engelbrecht E-Radio-SA] (2:57 – 3:08)

Okay, and let’s say I’m playing sports outside, and bam, there goes a tooth, you know, thanks to a ball hitting me in the mouth. What on earth would I do now?

[Dr Clifford Yudelman OptiSmile] (3:08 – 6:39)

Okay, so that’s a good one to start with. So if it’s yourself or a kid playing sport, first of all, any kind of contact sport like rugby or even basketball, things like that, where people get hit with elbows, one should always get or make sure you’re wearing a properly fitted mouth guard or gum guard. The ones that you get in the shops are pretty good these days, but one made by your dentist would really work better.

So if you look at someone and there’s a lot of bleeding in the lips, or the lips are cut, you can generally expect that the tooth will still be in place. But if somebody’s got their mouth open and they happen to be smiling or laughing and then something hits them straight in the tooth, and it’s not cushioned by a lip, it can knock the tooth clean out, and I think that’s what you’re talking about here. So it’s very important to keep the tooth.

You want to keep it moist in some milk or saliva. You don’t want to touch the root of the tooth. So when a tooth gets knocked out, there are little fibres.

Imagine you pull a carrot out from the ground and look at those little strings hanging off the end of the carrot; there are fine little hairs, and it’s the same with the tooth. So you want to only handle it by the crown of the tooth, not by the root. If it’s dirty, you can rinse it gently underwater, but don’t scrub it or use soap.

If you’re in the middle of a rugby field and there’s nothing, there’s no tap or anything, the patient or the person who loses the tooth, there’d be a lot of blood, they can literally spit on it or suck on it gently and the sooner you get the tooth back in place within seconds or minutes, every minute counts. So basically, you just want to try to gently reinsert the tooth into the socket and hold it in place by biting down on a clean cloth or a piece of gauze. You want to keep the area clean and avoid eating or drinking anything other than water to reduce the risk of infection.

Use over-the-counter pain relievers to manage pain until you can see a dentist. Obviously, staying calm is important so you can think clearly and act quickly, and this increases the chance of saving the tooth. And then you really want to see a dentist as soon as possible.

So I would go, if you’ve got your own dentist, like at OptiSmile, all of our phone numbers and individual dentist numbers are on the machine for patients of record. You’d find it hard to get a regular dentist to come out and see you immediately, so the best thing is to go to the nearest emergency room. Most hospital emergency rooms have an oral surgeon on duty who the ER person will call.

You really want to get a dentist to look at that. Once the tooth is held back in place, it starts reattaching immediately and needs to be pushed all the way back into the socket. If there’s no bone or anything broken, which is often the case, the tooth is just literally knocked out. It should fit back in really well.

Then, a dentist would splint it. They would put a little wire or piece of composite, and they don’t want to splint it for too long, just for a short period of time until it reattaches. It doesn’t always need a root canal. The tooth can actually stay vital. But yeah, you don’t want to wait two or three days.

You really want to try to see a dentist immediately.

[Eon Engelbrecht E-Radio-SA] (6:39 – 7:05)

Doctor, that sounds unbelievably painful. Is it actually painful when you lose a tooth? I remember as kids, my brother was, I think he was on a scooter or he was skateboarding and he fell on the tar road and he actually lost his one tooth.

I remember it was hanging by a thread. That thread you just mentioned now and the carrot analogy that’s brilliant. That’s what I saw.

There was a lot of blood. That’s also what I remember.

[Dr Clifford Yudelman OptiSmile] (7:06 – 8:02)

Yes, so literally, I’m sorry to hear that your brother lost his tooth, but if somebody was calm and just calmed him down, and in that case, where the tooth is still hanging, you can actually just push it straight back in. Just stay calm, and you just push it straight back in and then have him bite on some gauze. There shouldn’t be much pain at all, to be honest, because you go into a bit of a state of shock, and you get endorphins.

The nerve in the tooth tends to be different from the kind of pain that you would get if a tooth was broken and the nerve was sticking out of the tooth. A tooth that’s been dislodged or avulsed, especially if it’s only partially, the sooner you get it back into place and hold it in position, the less pain and swelling and infection and any kind of complications there are. That’s why I’m pleased we started with this first point; that’s very important.

[Eon Engelbrecht E-Radio-SA] (8:03 – 8:24)

It’s so good that you mentioned this now, and the good news is that we actually managed to save his tooth. I think my aunt pushed it back in, and then we actually went to the dentist, but he still got it today, and it’s fine. Brilliant.

So we managed to save it, but at that stage, with a dangling out of his mouth almost, it looked like it was a goner.

[Dr Clifford Yudelman OptiSmile] (8:25 – 8:30)

It was quite scary to see that, to be honest.

[Eon Engelbrecht E-Radio-SA] (8:31 – 8:40)

So doctor, what do we do when, okay, this is probably less serious, where a crown is lost, or maybe a filling is lost? What should we do?

[Dr Clifford Yudelman OptiSmile] (8:41 – 10:17)

Okay, so if a crown feels loose, you want to try and get it out of your mouth because you don’t want to have it come loose, and then you choke on it, or you inhale it at night. Initially, don’t try to stick it back yourself. Just put it in an envelope or a big ziplock bag.

If you put it in a tissue, you’ll definitely throw it away. 90% of the time, if a crown comes loose because you’re chewing a toffee, the dentist can just clean it up and re-cement it if you go back in within a day or two. You don’t want to leave a crown out for a week because the teeth start shifting, and then you’re going to have to get impressions or a scan done to get a new crown.

So, ideally, you want to get your crown re-cemented immediately or within a day or two. You can get temporary dental cement from some chemists. I don’t know how available those are in South Africa.

If it’s not sensitive or it’s not in the front, the best is for a dentist to re-cement it. We are always available for patients of record, and during the week, Monday to Friday, when we open, if somebody calls and we can fit them in and help them out, we do. If a crown has come out more than once, then it’s time to get a new crown because it means that something’s not fitting correctly.

If a filling feels loose when you’re flossing, it’s best to see a dentist as soon as possible because if a filling is rattling around and it hasn’t actually come out, that’s when you can get quite a lot of decay under a filling that’s come loose but it’s still intact.

[Eon Engelbrecht E-Radio-SA] (10:18 – 10:33)

Okay, and now let’s say you bite on something hard. You’re going out for the evening, and you bite on something hard in the restaurant, and you hear a crunch, and now you see, oh no, I’ve got a chipped tooth, or my tooth is now cracked. What are the immediate actions that one can take?

[Dr Clifford Yudelman OptiSmile] (10:34 – 12:19)

So that’s a great question because I think in a future podcast, we must definitely speak about something called cracked tooth syndrome. When you bite hard on something, if you’re eating something soft like a hamburger and there’s a little piece of bone in there or you’re eating a salad and you hit maybe a walnut shell or you’re eating some olives and you don’t know that there’s a pip inside and you bite down on something that you think is soft and something’s hard inside, you can actually get a partial crack in your tooth and when a dentist looks in your mouth they may not see anything but the tooth can subsequently be painful to biting.

You definitely want to get something like that sorted out before the tooth splits because then you can lose the tooth, or a large piece can break off. We’ll go into that in a lot of detail in another podcast, but if it’s a front tooth that’s got a large filling and you’ve broken a corner off, you want to obviously get in and see the dentist as soon as possible, but it’s not urgent other than a cosmetic emergency. If your tooth is actually split and it’s loose, and the two sides of the tooth are in your mouth, you want to try to see the dentist the same day or the next day because you can get quite a severe infection in a place like that and just stick to soft foods until you can see the dentist.

If you start getting swelling, swelling could take a good few days after anything like this. You won’t get immediate swelling, but you can use a cold compress if you’ve got swelling and rinse with warm water to keep an area clean, like a little chip or a crack or a piece that’s fallen off a tooth is generally not as serious as one would think.

[Eon Engelbrecht E-Radio-SA] (12:19 – 12:35)

So, something a little more common would be a toothache. A lot of people get toothaches, and sometimes they pop a panado or a gen pain, and then they’re fine again until it happens again. But when is a toothache actually considered a dental emergency doctor?

[Dr Clifford Yudelman OptiSmile] (12:35 – 13:47)

Okay, that’s great because we’ve spoken about toothaches before, but for people who haven’t heard that, the podcast on toothaches, as I mentioned earlier, if you’re getting a toothache, it starts off just a bit niggly or just with hot or with cold, and it’s not yet an emergency. If you leave it, then you start getting into the situation we’re talking about now. So severe pain, that’s pain that’s intense or persistent, or if you drink something warm and it’s like a deep throbbing, that’s a sign of infection or an abscess, and you don’t want to wait to the next stage, which is swelling or fever.

You can start getting an even more serious infection where your cheek and your eye swell up or down near the corner of your jaw, and it can even cause your throat and everything to swell and then pain on biting may indicate a cracked tooth or a severe cavity that needs immediate attention. So, this is a little bit different to when you are drinking or eating something cold, and then the tooth hurts for a minute or so. We’re talking now about persistent pain.

I would definitely consider that a dental emergency.

[Eon Engelbrecht E-Radio-SA] (13:48 – 14:05)

And then something else that sounds quite serious is a severe tooth abscess, and I think that it can have some serious effects on your health if left untreated. Let’s say you’ve got a severe tooth abscess now, but you can’t get to the dentist immediately. What do you do?

[Dr Clifford Yudelman OptiSmile] (14:05 – 16:34)

So the common things are to rinse with warm salt water to help reduce pain and draw out any infection. If there’s swelling on the outside, you don’t want to put heat on it, but you want to put a cold and ice pack for a few minutes on and a few minutes off. Don’t put ice directly on your face.

Wrap the ice in a wet, moist dishcloth. Over-the-counter pain relievers like ibuprofen. I usually recommend 400 milligrams of Ibuprofen, which is two Nurofen with food four times a day, and then two Panados, a thousand milligrams of panado in between the Nurofen.

That works for a lot of toothaches and dentists listening to this, and even doctors might not like what I’m about to say, but if there’s absolutely no way you can get in to see a dentist and your face is starting to swell and your neighbour or your husband or wife has some leftover penicillin or amoxicillin and you’re not allergic to it, I would recommend going on to just plain penicillin or amoxicillin right away. Some chemists in South Africa are quite friendly that way, especially if you know your chemist and they know that you’re not allergic. They may give you or sell you a few penicillins over-the-counter until you can get in to see the doctor or save you a trip to the emergency room. I don’t really recommend that route, but since this is about saving your money and saving your teeth, that’s my opinion.

If you’re on antibiotics like amoxicillin or Augmentin, which is a type of amoxicillin for 24 to 48 hours, and the swelling is increasing, that’s very serious. It means that you’ve got a bacteria that’s resistant to amoxicillin, and you need a second antibiotic. You also, once you start on the antibiotics, say somebody gives you five or six leftover ones, and then you take it according to the directions, you don’t want to just do that, and then after two days, the swelling is going down, and then you stop because then you’ll be in for big problems.

A course of antibiotics should last anywhere from five to seven days in most cases. I know that can be a bit controversial, but that’s what we do on this podcast. We just try to give everyday types of information.

That’s my own opinion.

[Eon Engelbrecht E-Radio-SA] (16:35 – 16:45)

So, in the case of bleeding gums or maybe a swollen jaw for whatever reason, how can this be managed before we go to a dentist?

[Dr Clifford Yudelman OptiSmile] (16:46 – 17:54)

I think it’s pretty similar: the warm salt water and the cold compresses. If it’s bleeding gums, generally, it’s not an emergency. If your gums are bleeding, this means you’ve got to brush and floss better.

If you got bleeding because you had an extraction and now the clot has come loose, you want to go to the emergency room. Well, you can actually. There are ways to stop bleeding if it’s a recent extraction, but if it’s bleeding a lot, you want to contact the dentist or the oral surgeon who did the extraction. If perhaps you had an extraction and you didn’t tell a dentist that you were on blood thinners or aspirin, that can be very serious.

You definitely want to go to the emergency room. But bleeding gums is not an emergency. You can get over-the-counter mouthwashes with chlorhexidine.

 

Don’t want to use them too long. Corsodyl is one, and then there are other ones that don’t stain your teeth. We do have podcasts about bleeding gums.

I think, you know, listen to the previous podcasts.

[Eon Engelbrecht E-Radio-SA] (17:55 – 18:06)

So our final question for today, doctor, what are some common mistakes people make or maybe myths about what they do during a dental emergency that can actually worsen the situation?

[Dr Clifford Yudelman OptiSmile] (18:07 – 20:35)

So, the one thing is believing the pain will go away on its own. Assuming dental pain that will resolve without any treatment can definitely lead to serious complications. So don’t believe it’s just going to go away.

Using clove oil excessively. So clove oil, we all know what oil of clove smells like. It’s that old smell when you used to go to the dentist, there was a smell of clove oil.

While clove oil can provide temporary relief if you put it straight onto a cavity, it’s not something I believe in. An overuse can definitely irritate the gums or maybe lull you into a false sense of security, and then you end up with an infection. Same thing with hydrogen peroxide.

Some people put hydrogen peroxide directly on a dental wound or on an abscess. Not recommended. Rinsing your mouth out with alcohol like whisky, vodka, or brandy while maybe swallowing it will make you feel better, but don’t rinse with alcohol and don’t drink too much alcohol if you’re going to be heading off to the emergency room.

Chewing on aspirin or putting aspirin directly on the tooth or on the gums. This leads to something called an aspirin burn. It’s not recommended.

Something that sometimes people use is they put baking soda. I don’t recommend it. Don’t rinse with vinegar.

Vinegar can erode your enamel and make your teeth very sensitive. Something else to avoid and don’t ignore professional advice. If a dentist has told you to come back and get a root canal before this tooth gets worse, listen to what the dentist is telling you or go get a second opinion, but don’t just leave it.

Some people think that if you use a cold sore remedy, it’ll also work for some kind of dental injury, and that’s a lot of nonsense. Just go and see the dentist. Don’t put cold sore ointment on an infected gum.

It’s not going to work. The bottom line is to go to see the dentist every six months, brush and floss, listen to our podcasts, and one shouldn’t have to ever endure any of the stuff that we’ve spoken about except, of course, getting a tooth knocked out on the sports field if you’re not wearing a mouth guard, which is now, as you know, also preventable. So I hope people listening to this podcast don’t end up with any of these problems, but if they do, now they know what to do.

[Eon Engelbrecht E-Radio-SA] (20:35 – 21:27)

Exactly. Thank you so much, doctor. This was very, very interesting today, and now we know what to do in a medical or dental emergency. Thanks to you, Dr. Yudelman. Once again, thank you for sharing your expertise with us, doctor. Thank you very much, and see you next week. Absolutely, and that’s it for another edition of “Save Your Money, Save Your Teeth.”

Remember, while we strive to provide valuable insights, always consult with your own dental professional for tailored advice to your personal health and don’t forget to subscribe for more enlightening discussions and join us again next week as we continue to explore the fascinating intersection of dental health and financial savvy. Until then, keep smiling and taking great care of your teeth.

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Disclaimer: The content provided in this podcast, “Save Your Money Save Your Teeth” on Medical Mondays, is for informational and educational purposes only. It is not intended to serve as dental or medical advice. The insights and opinions expressed by Dr. Clifford Yudelman and any guests are designed to foster a better understanding of dental health, preventive measures, and general well-being, but should not be interpreted as professional dental or medical recommendations. Dr. Clifford Yudelman does not diagnose, treat, or offer prevention strategies for any health conditions directly through this podcast. This platform is not a substitute for the personalized care and advice provided by a licensed dental or healthcare professional. We strongly encourage our listeners to consult with their own dental care providers to address individual dental health needs and concerns. The information shared here aims to empower listeners with knowledge about dental health but must not be used as a basis for making health-related decisions without professional guidance. Your dental care provider is the best source of advice about your dental and overall health. Please always seek the advice of your dentist or other qualified health professionals regarding any questions or concerns about your dental health.

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