Toothache: what to do straight away, when an abscess is dangerous and where to find help at night and at weekends

Toothache: what to do straight away, before you see a dentist?

Toothache can be eased with home measures, but none of them treats the cause, so their aim is to get you through to the appointment, not to replace it. The NHS, the UK’s public health service, recommends a few simple steps that need no prescription.

If you take regular medicines, are pregnant, or the pain affects a child, ask a pharmacist or doctor which painkiller to choose. Home measures make sense for a short time, not for weeks.

• Take an over-the-counter painkiller strictly as the leaflet or the pharmacist directs, and do not exceed the recommended dose.
• You can use a pain-relief gel intended for the mouth, or rinse your mouth with salt water.
• Eat soft food and chew on the other side, so as not to put load on the painful tooth.
• Brush your teeth with a soft toothbrush, including around the painful area.
• Avoid sweet, very hot and very cold food and drinks.
• Do not smoke, as it can make the symptoms worse.

When does toothache mean going to the SOR or calling 112?

You need to go to the hospital emergency department (SOR) or call 112, the emergency number, when swelling from a tooth makes breathing, speaking or swallowing difficult, because the infection may then threaten the airway. The American Dental Association (ADA) classes such swellings, together with bleeding that cannot be stopped, as potentially life-threatening conditions.

A fever and rapidly increasing facial swelling without difficulty breathing are a signal to get urgent dental help the same day, at a practice or an emergency dental service point. The list sets out the warning signs according to the NHS and the ADA.

• Difficulty breathing, speaking or swallowing.
• Swelling around the eye, eye pain or sudden problems with vision.
• Large swelling inside the mouth, or swelling that spreads down to the neck.
• Marked difficulty opening the mouth.
• Bleeding from the mouth that cannot be stopped with pressure.
• An injury to the facial bones after which breathing is difficult.

Is a tooth abscess dangerous, and how do you recognise one?

A tooth abscess becomes dangerous when the infection spreads beyond the tooth into the tissues of the face or neck, because it can then threaten breathing. The abscess itself is a collection of pus at the root of a tooth or in the gum, most often the result of untreated decay that has reached the pulp, or of gum disease.

The NHS lists the symptoms of an abscess as severe pain in the tooth or gum, redness in the mouth, sensitivity to hot and cold, a bad taste in the mouth, difficulty opening the mouth, swelling of the face or jaw, and a high temperature. The tooth may also hurt when you bite, and the gum over it may be tender.

An abscess does not heal by itself: even if it bursts and the pain eases, the source of infection in the tooth remains. Treatment consists of the dentist draining the pus, followed by root canal treatment or extraction of the tooth. An antibiotic does not replace this procedure, and whether one is needed is decided by the dentist after an examination.

What does each type of toothache mean, and how urgently should you see a dentist?

The character of the pain hints at the cause, but it does not replace an examination and an X-ray. The table is based on the ADA’s division into potentially life-threatening conditions and urgent conditions, which include, among others, severe pain from pulp inflammation, an abscess, dry socket, inflammation around an erupting wisdom tooth, a painful tooth fracture and a knocked-out tooth.

Pain that lasts more than 2 days, does not ease with painkillers, or comes with a fever, pain on biting, red gums or swelling is, according to the NHS, a reason to see a dentist. Spontaneous, throbbing pain that wakes you at night often means pulp inflammation needing root canal treatment, while brief sensitivity to cold that passes within a few seconds is usually not an emergency, although it also needs checking.

A tooth knocked out completely: what to do in the first minutes?

A knocked-out permanent tooth needs to go back into its socket as soon as possible, because after 30 minutes out of the mouth in dry conditions most of the cells of the ligament around the root die. The 2020 guidelines of the International Association of Dental Traumatology (IADT) describe what to do step by step.

The outlook depends on time: a tooth put back within about 15 minutes has the greatest chance of keeping living cells. Sixty minutes dry is the threshold after which the cells are usually dead, but even then putting the tooth back is usually recommended.

• Find the tooth and hold it by the crown, the white part, never by the root.
• If it is dirty, rinse it briefly in milk, saline or saliva.
• Put the tooth back into the socket straight away and bite on gauze or a tissue to hold it in place.
• If it cannot be put back, keep the tooth in milk, or without milk in saliva collected in a cup or in saline; water is a poorer choice, but better than keeping it dry.
• See a dentist immediately; the Polish IADT poster says no later than within two hours.
• Do not put a knocked-out milk tooth back in a child’s mouth; take the child to a dentist instead.

Does a dentist have to see you with toothache?

A practice that has an NFZ contract for dental treatment (NFZ is Poland’s National Health Fund) helps a patient who comes in with pain on the day they come in: this is set out in § 6 of the regulation on guaranteed dental services. No referral to a dentist is needed.

At night, at weekends and on public holidays there is the NFZ emergency dental service: on working days from 19:00 to 7:00 the next day, and round the clock at weekends and on non-working days. The nearest point, in Białystok too, is shown on the map at pacjent.gov.pl and by the free NFZ patient helpline (Telefoniczna Informacja Pacjenta) on 800 190 590.

Emergency care includes, among other things, anaesthesia, a dressing, an extraction and incision of an abscess with drainage, and for adults, root canal treatment on the NFZ covers only incisors and canines. Private practices set their own rules on seeing patients in pain, so it is worth phoning before you travel.

How it works at DentalBlue

At DentalBlue in Białystok, a visit in pain includes a panoramic X-ray in the clinic’s radiology unit, a consultation, an examination and pain relief. In the clinic’s price list, the item “Wizyta z bólem” (visit in pain) costs 340 zł and “Nacięcie i drenaż ropnia” (incision and drainage of an abscess) 200 zł; the final scope and cost are set by the dentist after the examination, and prices may change. When inflammation is too acute for local anaesthesia to work, treatment under general anaesthesia is decided at a joint dental and anaesthesiology consultation. The clinic is open Monday to Friday from 8:00 to 20:00 and on Saturdays from 8:00 to 16:00, and is closed on Sundays; reception: 85 748 00 50.