A dental emergency is one of the few medical situations where what you do in the first 30 minutes can change the outcome. A knocked-out tooth has the best shot at being saved if it’s back in the socket within an hour. An abscess that’s caught early is a simple appointment. The same abscess at 48 hours is an ER visit.
This guide covers the most common emergencies we see at Nations Dental Studio, what to do before you reach a dentist, and how to tell the difference between “wait for morning” and “go to the ER right now.” Dr. Diana D’Aoust wrote it based on what she sees in our practice.
If you’re in pain right now, call us at (615) 933-5800 or book an emergency appointment. The rest of this page is reference for whatever you’re dealing with.
Is This Actually an Emergency?
Not every dental problem needs same-day care. Use this list to decide.
Same-day care:
- A tooth knocked out completely
- Severe pain that won’t quit
- Facial swelling around the jaw, eye, or neck
- A cracked or broken tooth with sharp edges or visible nerve
- Bleeding that won’t stop after 15-20 minutes of pressure
- Signs of infection: fever, swelling, pus, foul taste
- Trauma to your jaw or face
Can wait a few days:
- Mild tooth sensitivity
- A small chip with no pain
- A rough filling
- Mild gum irritation
- A lost filling or crown with no exposed nerve
When in doubt, call. We’d rather hear from you and tell you it’s fine than have you sit on something serious.
Knocked-Out Tooth
The most time-sensitive emergency in dentistry. Adult teeth can often be saved if they’re reimplanted within the first hour.
What to do, in order
- Find the tooth. Pick it up by the white part (the crown). Never touch the root.
- If it’s dirty, rinse it gently. Use water or milk for a few seconds. No scrubbing. No soap. No tissue.
- Try to put it back in the socket. Push it in gently and bite down on a clean cloth to hold it there. The socket is the best place for it.
- If you can’t reinsert it, keep it moist. Drop it in a small container of cold milk. Milk preserves the root cells better than anything else you have on hand. Saliva works if there’s no milk (hold it between your cheek and gum). Saline solution is also fine. Never use tap water. It kills the root cells in minutes.
- Call a dentist immediately. Within 30 to 60 minutes is the window. After two hours, replantation rarely succeeds.
What not to do
- Don’t handle the root or scrub anything off it.
- Don’t let the tooth dry out.
- Don’t store it in water.
- Don’t wrap it in paper towels.
- Don’t wait for office hours if it’s after hours. Knocked-out teeth are why most dentists keep an emergency line.
A note from Dr. D’Aoust: we’ve successfully replanted teeth that were out for 45 minutes. We’ve also seen perfectly viable teeth fail because no one realized the clock was running. The window is short. Call as soon as the tooth is in milk and you’re on your way.
Cracked or Broken Tooth
Severity depends on how deep the crack runs. A surface chip is cosmetic. A crack into the nerve is urgent.
What to do
- Rinse your mouth with warm water.
- Hold a cold compress against your cheek (15 minutes on, 15 off) to cut swelling and dull pain.
- Save any tooth fragments. Rinse them and bring them.
- Cover sharp edges with sugarless gum or dental wax if they’re cutting your tongue or cheek.
- Take ibuprofen if you can. It handles dental pain better than acetaminophen because it reduces inflammation too.
- Call a dentist.
Signs the crack is serious
- Sharp pain when biting
- Pain that comes and goes with hot or cold
- Sensitivity that lingers after you take the trigger away
- A visible vertical crack line
Cracks don’t heal. Untreated, they grow and eventually kill the tooth. The fix is usually a crown or root canal, and the cost goes up sharply if the crack reaches the nerve. Catching it early is the difference between an $800 crown and a $2,500 root canal plus crown.
Severe Toothache
Pain that wakes you up, ruins meals, or throbs constantly almost always means something is wrong inside the tooth: decay reaching the nerve, an infection, or a crack. None of those self-resolve.
What to do for relief while you wait for an appointment
- Salt water rinse. Half a teaspoon of salt in 8 ounces of warm water. Swish gently. Reduces bacteria, eases inflammation.
- Floss. Trapped food causes a surprising number of severe toothaches. Floss carefully around the painful tooth. Sometimes the pain stops within minutes.
- Ibuprofen (Advil, Motrin). Follow the label. Don’t exceed the dose. Alternating with acetaminophen every 3 hours gets more relief than either alone.
- Cold compress on the cheek if there’s swelling.
- Avoid triggers. Skip very hot, cold, or sweet food until you’re seen.
Don’t do these things
- Don’t put aspirin on your tooth or gums. It’s an old home remedy and it burns the tissue.
- Don’t pack the cavity with clove oil. A drop on a cotton swab is fine for short-term relief. Soaking the tissue in it causes its own problems.
- Don’t ignore the pain hoping it’ll pass. The cause has to be treated.
If salt water and ibuprofen aren’t touching the pain, that’s your signal it’s deeper than a food trap. Call.
Lost Filling or Crown
Usually not painful, but the exposed tooth is more fragile than it feels.
What to do
- Keep the crown if you have it. Rinse it gently. Most crowns can be recemented if they’re intact.
- Protect the tooth temporarily. Pharmacy dental cement or denture adhesive works for a few days. Never use superglue.
- Chew on the other side until you’re seen.
- A drop of clove oil on a cotton swab handles sensitivity for short stretches.
- Get in within a few days. Not an immediate emergency unless the nerve is exposed and painful, but the longer the tooth is uncovered, the more likely it is to decay or fracture.
If a filling fell out, gently clean the cavity and cover it with sugar-free gum or dental wax until your appointment.
Dental Abscess
This is the one we worry about most. An abscess is a pocket of pus from a bacterial infection inside the tooth or gum. It will not resolve on its own, and the infection can spread to surrounding bone, the bloodstream, or the airway. People die from untreated dental abscesses every year. It’s rare, but it’s preventable, which is why we’re going to be direct about it: do not wait this one out.
Warning signs
- Severe throbbing pain that radiates to the jaw, ear, or neck
- Pain with chewing or pressure
- Persistent bad taste in the mouth, or a sudden rush of foul-tasting fluid (the abscess ruptured)
- Facial swelling, especially around the cheek or under the jaw
- Fever
- Tender, swollen lymph nodes under the jaw or in the neck
- Difficulty breathing or swallowing (call 911 or go to an ER immediately)
What to do
- Call a dentist right away. Abscesses need professional treatment: drainage, antibiotics, and either a root canal or extraction. There’s no version of this you treat at home.
- Salt water rinse for some relief.
- Ibuprofen and acetaminophen, alternating, until you’re seen.
- Do not apply heat to the swelling. Heat helps the infection spread. Ice only.
- ER if any of these: difficulty breathing or swallowing, swelling reaching the eye or neck, fever over 101°F, or you feel systemically unwell (chills, racing heart, confusion).
Dr. D’Aoust: “When patients ask me what one thing I wish people knew, it’s that a dental abscess is a medical emergency, not just a dental problem. The infection can reach your bloodstream or your airway. If you’re seeing facial swelling and you can’t get a dentist on the phone, go to an ER. They can start IV antibiotics while you find a dentist.”
Soft Tissue Injuries
Cuts to the lips, tongue, cheeks, or gums bleed dramatically. Usually they look worse than they are.
What to do
- Rinse with salt water to clean the wound.
- Apply firm pressure with gauze or clean cloth. Hold for 15-20 minutes without peeking. Steady pressure stops most mouth bleeding.
- Cold compress outside the cheek for swelling.
- Don’t pull out anything embedded. Leave it and go to urgent care or a dentist.
Go in if:
- Bleeding doesn’t stop after 20 minutes of pressure
- The cut is deep, gaping, or won’t close
- A foreign object is stuck in the wound
- The injury came from something dirty or rusty (tetanus risk)
- You see signs of infection a day or two later: spreading redness, pus, fever
ER or Dentist? Where to Go in Nashville
Most dental emergencies need a dentist, not an ER. ERs can manage pain, prescribe antibiotics, and stabilize you, but they don’t fix teeth. You’ll usually leave the ER and end up at a dentist anyway.
Go to the ER if:
- You can’t breathe or swallow
- Facial swelling is reaching your eye, neck, or throat
- Bleeding won’t stop
- You had significant facial trauma (car accident, fall, assault)
- You have a high fever with facial swelling
- You’re showing signs of sepsis: confusion, racing heart, severe illness
In Nashville, Vanderbilt University Medical Center and TriStar Centennial Medical Center both have 24/7 ERs that handle dental trauma and infections. Call ahead if you can.
Go to a dentist if:
- A tooth is knocked out
- A tooth is broken or cracked
- Severe tooth pain
- Lost filling or crown
- An abscess without the severe symptoms above
- Soft tissue injuries that have stopped bleeding
Nations Dental Studio is in The Nations, off Charlotte Pike. We keep emergency slots open and aim for same-day appointments when patients call before noon.
What Happens at an Emergency Visit
Knowing the sequence cuts anxiety.
Quick triage. Pain level, what happened, how long ago. This determines what we do first.
Pain relief before anything else. Local anesthetic to numb the area. Nitrous oxide is available if you’re anxious.
X-ray. We look for what’s not visible: hidden fracture lines, abscesses at the root tip, decay under existing fillings.
Treatment. Depending on the emergency: reimplanting the tooth, bonding a chip, root canal therapy, extraction, draining an abscess, or a temporary restoration to stabilize you until a follow-up.
Home instructions. Specific to what we did, with a phone number to call if anything changes.
Most emergency visits take 30 to 60 minutes. Complex cases (multiple teeth, sedation, surgical extractions) take longer.
Prevention
You can’t stop every emergency, but most of the ones we see are preventable.
- Wear a mouthguard for contact sports and any activity where you might take an impact. We make custom sports mouth guards that fit better than the boil-and-bite versions.
- Avoid chewing ice, popcorn kernels, and hard candy. We see more cracked teeth from popcorn than anything else.
- Don’t use your teeth to open packages or bottles. The cracks we repair from this are usually preventable.
- Keep up with regular cleanings and exams. Most abscesses start as small problems we’d have caught months earlier.
- Address small issues before they grow. A small cavity is a 30-minute filling. The same tooth in a year is a root canal and crown.
If You’re in The Nations
For Nashville-area patients, call us if you have a dental emergency during business hours. We prioritize emergency calls and will tell you honestly whether you need to come in now, later today, or whether the ER is the right call. The phone is staffed by people who can triage, not a recorded menu.
If it’s after hours and you can’t reach us, use the criteria above to decide between waiting for morning, going to urgent care, or going to the ER. If a tooth is knocked out, keep it in milk and get to whoever can see you soonest.