In the event you or a loved one knocks out a tooth because of some type of trauma, there are some things you should do right away. If the tooth has been avulsed completely and the root is not fractured, keep it moist. The cells on the root of the tooth should not be allowed to dry out or they will die. Dead cells on the surface of a tooth preclude it from being re-implanted into the socket.

It was once common to suggest placing the tooth in milk until a dentist could be consulted, and doing so is far preferable to allowing the tooth to dry out. However, milk is not readily available all the time and using such introduces foreign proteins, fats, milk sugars and the like onto the root surface. Commercially prepared kits to preserve knocked out teeth are available and any good sports medicine first aid kit should contain such. If, however, nothing is available, place the tooth into the cheek so saliva can continue to moisten and bathe the tooth. Better yet, if the root is not visibly dirty, try returning the tooth to the socket itself, that is if the socket is not distorted or crushed and it is not too painful.

You should contact your dentist for a tooth avulsion immediately so that the tooth may be returned to the socket and stabilized in some manner. Often, such teeth will reattached into the socket and continue to serve the patient. Avulsed teeth, however, have had their blood supply to the inner pulp broken, and as such, the inner soft pulp of the tooth will die. An avulsed tooth that is re-implanted into the jaw must have root canal therapy completed on it. Typically this will be done once the tooth is stabilized for a time and the attachment reforms. Some dentists will perform endodontic therapy on a tooth while outside of the mouth--keeping it moist all the while--and then return the tooth to the mouth.

It is important that when a tooth is re-implanted, that the tooth itself is stabilized in such a fashion that it has just a slight amount of movement to it or the tooth is more likely to ankylose--or become one with the bone. Often this means some wiring of the arch or even some orthodontic brackets.

Timely and proper treatment for a tooth avulsion is important to long-term success in retaining the tooth. While there is no guarantee than a tooth can be saved, once its knocked out, good success with re-implantation of teeth is common if the knocked out tooth is treated correctly and prompt re-implantation and stabilization is done.

Swelling of the soft tissues of the face is often associated with an infected tooth. Once decay has entered into the soft center of the tooth, known as the pulp, bacteria can make their way into the bone. This can be a painful experience as pressure within the bone exerts pressure on the nerves which surround the teeth. Left untreated, the infection can "eat" its way out of the bone and begin to swell soft tissues.

Dental infections come in two varieties, a localized abscess that forms a pus epulis or a cellulitis, which is a more diffuse type of swelling. Epulis formation often produces swelling that is soft, warm, red and localized to a smaller area. In such cases, the pus from the infection can be drained and the patient is placed on antibiotics until the offending tooth is either extracted or treated with root canal therapy. In cases of cellulitis, where the infection is much more firm, diffuse and no focal point for pus formation is noted, the swelling cannot be drained. This type of infection--typically more severe--must be treated aggressively with antibiotic and a rapid treatment of the infection source. Patient that do not begin to see noticable improvement in 2 to 3 days after being placed on antibiotics must let their dentist know their antibiotic is not working. Some bacteria associated with tooth infection do not respond to first-line antibiotics and stronger antibiotics may need to be considered.

Swelling in certain areas is more dangerous than others. Swelling in the area of the upper eye teeth--called a canine space infection--can travel up about the nose. Concerns about cranial, secondary infections are warranted with this location, and prompt care is even more of a concern. Swelling with infected wisdom teeth can sometimes cause impairment of the airway because of swelling of the tongue or pharynx. This type of swelling can be life threatening and must be treated aggressively and promptly as well.

When you are first seen by a dentist, they may or may not recommend that the infection be drained. Drainage can be accomplished by opening the tooth and allowing exudate to flow out the root canal, or it may be achieved by incision for the swollen tissue. The treatment choice of either extracting the tooth or attempting to save it with root canal therapy is often the deciding factor. If the tooth can be removed at that first visit, drainage may not be necessary in all cases.

Any patient presenting with a dental infection will be placed on antibiotics and often pain medication as well. It is imperative that the patient be compliant in taking all of the antibiotic and to take it as prescribed. Even if the tooth is extracted or a root canal is completed, the antibiotic prescription should be finished. In recent years, the advent of antibiotic resistant bacteria has made the importance of doing complete rounds of antibiotic therapy all the more important. If you stop your antibiotic after only a couple of days of therapy, the strong bacteria may still be alive and viable. Such bacteria can reproduce and cause another infection that is more resistant to antibiotic than the first one.

If you are on antibiotic therapy for several days and see the infection worsening, you must contact the doctor who prescribed your antibiotic. Some bacteria are resistant to certain types of antibiotics and not changing the antibiotic in a timely fashion can lead to significant problems. As a rule of thumb, if after 48 hours of dosing on a particular antibiotic, the swelling does not begin to get better, you need to seek further help. In addition, patients can develop drug allergies to certain types of antibiotics that they have had on multiple occasions before. If severe itching, sudden reddening of the skin--with or without hives development--, difficulty breathing because of chest constriction, or a flushed feeling occurs soon after taking a dose of antibiotics occurs, you could be suffering from a severe allergic reaction. Go immediately to the hospital emergecy room with the aid of a family member or call 911. Slight itching, stomach upset or mild hives can indicate an early allergic reaction and the antibiotic should not be continued. You should contact your dentist for further instructions and a different antibiotic.

While saving an infected tooth is usually the best course of action, heavily damaged teeth that are not restorable or financial constraints often dictate a tooth must be extracted. Should the tooth appear to be a surgical extraction, you will most likely be referred to an oral surgeon. Infected teeth can be difficult to anesthetize and significant bone removal can make the procedure difficult. An oral surgeon who can do general anesthesia, concious sedation and who has many specialized instruments can make a difficult extraction much more pleasant for the patient. Whatever course of action you chose--to either remove a tooth or to save it with root canal therapy, it is important that the treatment be done promptly. Leaving infected teeth in the mouth will result in subsequent infections which can grow more severe with each onset. Repeatedly "hitting" an infection with antibiotics is not a good practice and is the primary cause for drug resistance in bacteria. As such, our office will only provide two rounds of antibiotics for any given dental problem. It is imperative that the patient work quickly to have the treatment planned procedure completed.