What to do in the first ten minutes.

1. 1Pick the tooth up by the crown, the part you normally see. Do not touch or scrub the root surface.
2. 2If it is dirty, rinse it for a few seconds in cold milk or saline, never under a running tap.
3. 3Put it straight back in the socket the right way round and bite gently on a clean cloth to hold it.
4. 4If it will not go back, store it in cold milk or in the mouth against the cheek, and call us immediately.

Avoid. Do not store the tooth in tap water, do not let it dry out, and do not scrub the root. The periodontal ligament cells on the root are what allow it to reattach, and they die quickly.

A knocked-out baby tooth is different: do not try to put it back, because it can damage the permanent tooth forming above it. Call us the same day.

1. 1Rinse with warm salt water and keep any pieces of the tooth in milk.
2. 2Stop chewing on that side entirely, including soft food.
3. 3Hold a cold compress against the outside of the cheek for ten minutes at a time.
4. 4Call us and describe whether the break is sharp, painful to bite on, or bleeding from the middle of the tooth.

Avoid. Do not file a sharp edge down yourself and do not seal the tooth with household glue. If the pink pulp is visible in the middle of the fracture, that is a same-day appointment, not a next-week one.

A cusp that breaks off a back tooth often signals an older crack running under a large filling, which is why we image and test the tooth rather than simply rebuilding the missing corner.

1. 1Note what provokes it: cold, heat, biting, or nothing at all.
2. 2Take your usual over-the-counter painkiller at the dose on the packet, if it is safe for you.
3. 3Sleep with your head propped higher, which reduces the pressure that makes pulpitis worse at night.
4. 4Call the same-day line and tell us whether the pain lingers after the trigger is removed.

Avoid. Do not hold aspirin against the gum, which burns the tissue, and do not rely on antibiotics from a previous course. Pain that lingers for minutes after cold usually means the pulp is irreversibly inflamed, and that needs treatment rather than tablets.

Go to an emergency room, not a dental studio, if there is swelling spreading towards the eye or under the jaw, a fever, or any difficulty breathing or swallowing.

1. 1Keep the crown or veneer, rinse it and bring it with you. It can often be recemented.
2. 2Keep the exposed tooth clean and avoid very hot, cold or sweet things on that side.
3. 3Temporary dental cement from a pharmacy can hold a crown for a day or two if the fit is obvious.
4. 4Book within a few days, because an unprotected prepared tooth shifts and the crown stops fitting.

Avoid. Never use superglue or household adhesive. It contaminates the fitting surface, is toxic to the pulp and usually means a crown that could have been recemented has to be remade.

If a crown came off with the post or a piece of tooth inside it, say so when you call. That changes what the appointment needs to be.

1. 1Press firmly on the area with clean gauze or a cloth for a full ten to fifteen minutes without peeking.
2. 2Use a cold compress on the outside to slow the bleeding and limit swelling.
3. 3Rinse gently with salt water once the bleeding has stopped.
4. 4Call us if bleeding continues past fifteen minutes of steady pressure, or if the cut gapes open.

Avoid. Do not keep lifting the gauze to check, which restarts the clot each time. A wound through the lip border, or one with gravel or debris in it, is a medical rather than a dental appointment.

Gums that bleed every time you brush are not an emergency but are not normal either. That is gingival inflammation and it is reversible.

1. 1For a sharp wire or attachment, cover it with orthodontic wax or a small piece of sugar-free gum.
2. 2For a lost aligner, go back to the previous set rather than skipping ahead, and tell us.
3. 3For a cracked retainer, keep wearing it if it is still comfortable and bring it in.
4. 4Call so we can decide whether you need an appointment or just a replacement tray.

Avoid. Do not cut a wire yourself and do not skip forward to the next aligner to catch up. Teeth move back faster than they move forward, and a week without a retainer can undo months.

Retainers are for life, not for the first year. Most relapse we see began with a retainer that broke and never got replaced.