What are the signs of a dental emergency?

Signs of a Dental Emergency

Dental emergencies requiring immediate attention include avulsion of a permanent tooth, crown fracture with exposed pulp, extensive gingival or facial swelling, tooth displacement interfering with bite/occlusion, and inability to close the jaw properly. 1, 2

Critical Signs Requiring Same-Day/Immediate Dental Referral

Trauma-Related Emergencies

• Avulsion of a permanent tooth is the most serious dental injury and requires immediate replantation within minutes to hours for optimal prognosis 1
• Crown fracture with visible pulp exposure (complicated fracture) requires immediate pulp therapy to preserve tooth vitality, particularly in immature permanent teeth 1
• Multiple teeth moving together as a segment indicates alveolar bone fracture requiring immediate repositioning and splinting 1, 2
• Tooth displacement interfering with occlusion (ability to bite teeth together properly) necessitates urgent repositioning to prevent permanent malocclusion 1, 2
• Severe extrusive luxation (>3mm) or severe intrusive luxation where the tooth is not visible clinically requires immediate dental intervention 1

Infection-Related Emergencies

• Extensive gingival or facial swelling developing after dental trauma or in association with a tooth indicates potential abscess formation requiring immediate referral 1, 2
• Parulis (gingival abscess or "gum boil") appearing on the gingiva adjacent to a previously injured tooth signals pulpal necrosis requiring extraction evaluation 1
• Gingival swelling with increased tooth mobility suggests pulpal necrosis and potential periapical abscess 1, 2

Airway and Functional Emergencies

• Abnormal jaw movement with inability to close the jaw may indicate mandibular dislocation requiring immediate repositioning 3, 2
• Excessive tooth mobility with concern for aspiration of the crown portion, particularly with suspected root fracture, requires immediate evaluation 1

Signs Requiring Dental Referral Within Days (Not Immediate)

Post-Trauma Complications

• Gray tooth discoloration developing after trauma indicates pulpal hemorrhage and potential necrosis, requiring referral within a few days 1, 2
• Tooth sensitivity with exposed dentin from enamel-dentin fractures (uncomplicated) should be seen within a few days to cover exposed dentin and reduce bacterial contamination risk 1
• Subluxation with tooth mobility but no displacement requires monitoring and referral within days if discoloration or parulis develops 1

Common Pitfalls and Clinical Pearls

Primary vs. Permanent Teeth

• Never replant an avulsed primary tooth as this risks damage to the underlying permanent tooth germ, whereas permanent tooth avulsion requires immediate replantation 1
• Primary tooth intrusion typically re-erupts spontaneously and requires observation rather than immediate intervention, unlike permanent tooth intrusion which may need orthodontic repositioning 1

Pain as an Unreliable Indicator

• Children may not report pain from a necrotic tooth, so caregivers must watch for visual signs including discoloration, swelling, and parulis rather than relying on pain complaints 1
• Approximately 96.7% of pediatric dental emergencies involve pain, but 16.3% do not require immediate attention, emphasizing the need to assess specific injury patterns rather than pain alone 4

Red Flags for Child Abuse

• Trauma affecting the oral cavity in children younger than 5 years should raise suspicion for non-accidental injury, particularly with severe tooth injury or inconsistent mechanism 3, 2

Clinical Context

The most common pediatric dental emergencies are pain due to caries and its consequences (50.2% of cases) and dental trauma (26.7% of cases), with dental trauma being the predominant reason for emergency visits in university hospital settings 4, 5. Emergency visits peak on Sundays, between 9 PM and midnight, and in spring months, with males affected nearly twice as often as females 5.