A bad toothache is worrying enough during the day, and it can be hard to know what to do next when it starts at night or your dentist is closed. Severe pain, significant swelling, uncontrolled bleeding and injuries involving a knocked-out or displaced adult tooth all need prompt attention, and if swelling is making it difficult to breathe, talk or swallow, there is heavy bleeding into the throat, or the injury is severe, call 000 or go to an emergency department. This guide draws on Healthdirect, the Australian Dental Association's public education site and other Australian health sources to explain which warning signs should not be ignored and where to seek help. It is general information only, not medical or dental advice, and cannot tell you what is causing the problem or which treatment you need. For health advice in Australia, call Healthdirect on 1800 022 222.
Is this a dental emergency?
Try to arrange urgent dental care today if you have severe or increasing tooth pain, swelling in the gum, cheek, jaw or face, signs of a dental abscess such as pain, swelling, fever or a bad taste, an adult tooth that has been knocked out or pushed out of position, a broken tooth causing pain or exposing the inside of the tooth, bleeding that does not settle with firm pressure, pain or swelling after a recent extraction that is getting worse, or damage to braces or another appliance that is injuring the mouth.
Call 000 or attend an emergency department if you are having trouble breathing, talking or swallowing, have very heavy bleeding, or have major facial or jaw trauma, since these problems may need medical care as well as dental treatment. Not every dental problem needs an after-hours appointment, but pain alone does not reveal how serious the cause is: a milder toothache that persists for more than two days, or does not improve with ordinary pain relief, should still be assessed.
A permanent tooth has been knocked out
The Australian Dental Association's dental trauma guidance says a knocked-out adult tooth should be handled by the white crown rather than the root. If it is dirty, the guidance recommends a gentle rinse in milk or saline without scrubbing, and the tooth can be transported in milk or the person's saliva while urgent dental care is arranged. A knocked-out baby tooth should not be placed back in the mouth.
Because it can be difficult to identify the tooth, its direction and any accompanying injuries, this guide does not reproduce the reinsertion procedure for an adult tooth. Contact a dentist immediately and follow the Australian Dental Association's guidance directly. If the injury involves loss of consciousness, heavy bleeding or other serious trauma, call 000.
A tooth is cracked or broken
The Australian Dental Association's dental trauma information recommends taking any piece of a broken tooth to the dentist, since it may sometimes be possible to reattach it. A crack can extend further than is visible, so the damage needs to be assessed rather than judged from appearance alone.
There is severe swelling or a possible abscess
Healthdirect explains that a dental abscess does not get better on its own and needs assessment by a dentist or doctor. Treatment depends on the cause and may involve draining the infection, treating the tooth or removing it. Antibiotics may be used in some circumstances, but they do not replace treatment of the source.
If swelling affects breathing, talking or swallowing, Healthdirect advises calling 000 or attending an emergency department.
Bleeding will not stop
Healthdirect's dental bleeding guidance recommends applying pressure with dampened gauze or a clean cloth and leaving it in place rather than repeatedly removing it. Heavy bleeding, blood going down the throat, or bleeding associated with a serious injury needs urgent medical assessment.
A veneer, crown, filling or appliance has come loose
A veneer can detach, a crown or filling can come out, and a brace wire or bracket can break. These problems may not require a hospital emergency department, but the tooth or soft tissue may still need timely dental attention.
The Australian Dental Association's teledentistry guidance says loose crowns and bridges should be kept safely until they can be assessed and should not be recemented at home because of the risk of swallowing or inhaling them. A detached veneer should also be kept safe and discussed with a dentist rather than attached with household glue. The same guidance recommends contacting the treating orthodontist when a wire or bracket comes loose, and explaining if an appliance is cutting the mouth or appears embedded in tissue when arranging care.
A few things the published guidance warns against
The information below summarises published Australian guidance and is not a substitute for instructions from a dentist, doctor or emergency service. For questions about pain medicines, speak with a pharmacist, dentist or doctor who can take account of other medicines and health conditions.
Worth doing
Practical steps that are safe to take before you're seen
- Handle a knocked-out adult tooth by the crown and keep it in milk or saliva
- Apply firm pressure with damp gauze to bleeding and leave it in place
- Keep a loose crown, bridge or veneer safe and contact the practice promptly
Easy to get wrong
What the published guidance says not to do
- Scrubbing the root of a knocked-out adult tooth or storing it in water
- Reinserting a knocked-out baby tooth
- Recementing a loose crown or bridge at home
- Assuming a dental abscess has resolved because the pain has eased
What happens at an emergency dental appointment?
The first aim is to identify the source of the problem and deal with immediate pain, infection, bleeding or damage. The appointment may include a history, examination and dental X-ray, and treatment depends on the finding.
A dentist might place a temporary filling, drain an abscess, begin root canal treatment, repair or protect a tooth, replant or stabilise an injured tooth, adjust an appliance, or remove a tooth that cannot be restored. Sometimes the safest immediate step is temporary treatment followed by a longer appointment later. Ask what has been done, what symptoms would need further urgent care, and what the expected next step will cost, since an emergency visit fee may not include all follow-up treatment.
Finding after-hours dental care in Australia
Start with your usual dental practice, even when it is closed. Its recorded message or website may explain its after-hours arrangements. If that does not help, search for an emergency dentist using your suburb or postcode and confirm by phone that the practice is open and can assess the problem.
Public dental services differ between states and usually have eligibility rules. Hospital emergency departments do not provide routine dental treatment, but they are the right place for breathing or swallowing difficulty, major facial trauma and uncontrolled bleeding. For health advice when you are unsure where to go, call Healthdirect on 1800 022 222. In an emergency, call 000.
Frequently asked
Severe, increasing or persistent toothache needs prompt dental assessment, particularly when it comes with swelling, fever, pain on biting or a bad taste. Contact a dentist today. If swelling affects breathing, talking or swallowing, call 000 or attend an emergency department.
A suspected abscess needs prompt care because the infection will not resolve on its own. Pain, swelling, fever or a bad taste can occur. Seek urgent dental or medical assessment. Call 000 if swelling is affecting the airway or swallowing, or if the person is seriously unwell.
An emergency department is appropriate for airway problems, uncontrolled bleeding, severe facial trauma or serious illness. Hospitals generally do not provide routine dental repairs. For tooth pain, broken teeth and most localised dental infections, an emergency dentist is usually the appropriate first service.
The Australian Dental Association advises handling an adult tooth by the crown rather than the root and keeping it in milk or the person's saliva while urgent dental care is arranged. Do not reinsert a baby tooth. Read the Australian Dental Association's dental trauma instructions directly rather than relying on a short summary.
The total depends on the examination, X-rays and treatment required. Ask whether the quoted emergency fee covers assessment only or includes treatment. If further work will be needed, request a written estimate once the immediate problem has been assessed.
