Emergency Care

If you experience a dental emergency, be sure to call our practice as soon as possible. After hours if you are a current patient and have an urgent dental emergency call Dr. Billings at her home. In an extreme emergency involving swelling, bleeding and pain you should go to a hospital emergency room.

We are here to help you. When your dental health is at risk, we’ll do everything we can to make sure you’re treated as soon as possible. While dental emergencies are rare, they can happen, and it’s important to know how to take care of your teeth no matter what.

Common dental emergencies include:

Broken or cracked teeth

emergency-dental-careA minor chip, especially on the edges of front teeth, can be repaired with a simple white filling, or sometimes the chip can be smoothed to remove rough edges. A fractured front tooth can involve a simple filling, a crown, or if broken into the nerve, a root canal and crown. If the tooth cannot be saved implants and crowns provide “lifelike” replacements.A fractured or cracked back tooth can cause sensitivity to cold and chewing. Usually, this is not an urgent emergency. Depending on the type of fracture you may need a crown. You will probably be more comfortable by taking ibuprofen or acetaminophen.Rarely, if the fracture extends into the root, you may need an extraction. If there is pain or swelling, rinse your mouth with warm water to clean the area. Use cold compresses on the area to reduce swelling. If there is swelling, and your body temperature is higher than usual, call our office immediately, or go to your nearest emergency room clinic. Our local oral surgeons are Dr. Edwards (253) 838-2123, Dr. Molan (253) 333-9750, and Dr. Guo (253) 838-3223.


You wake up in the night with a toothache, or maybe you’ve been suffering for days. What should you do?Occasionally, discomfort can be caused by food getting stuck between your teeth. First, rinse your mouth with warm water to make sure it is clean. Use floss in an up-and-down motion, or use a device to clean between the teeth, gently rubbing the sides of the tooth to remove any food that might be caught.

Never put aspirin or any other painkiller against the gums near the aching tooth because it may burn the gum tissue. If the pain persists make an appointment for an examination of the area.

The most common cause of an aching tooth is a premature, heavy bite on the tooth. At night we all clench and grind our teeth, and the tooth that hits first can become quite irritated. You can try an over the counter Biteguard. Make an appointment for an examination of the area.

Occasionally the pain can be due to an infection of the tooth nerve or the bone around the tooth. If your pain is accompanied by swelling you should be seen by a dentist or emergency medical clinic as soon as possible. If the tooth can be saved, you may need a root canal or emergency periodontal care. We refer root canal emergencies to Dr. Nguyen at (253) 952-3636. Periodontal emergencies are referred to Dr. Kang at (206) 400-0800, and or Dr. Mark Sebastian at (253) 941-6242 in Federal Way.

Jaw Pain (TMD)

Jaw pain can be caused by occlusal disharmonies (often the bite needs to be checked after dental work), oral habits such as grinding and clenching, opening your mouth for extended times, trauma or injury to the jaw, and stress at home or at work. You may have a dull ache around the ear and the pain often radiates into the face. You may have tenderness of the muscles or teeth. Your mouth opening may be limited and you may have headaches

What to do for Jaw Pain:

  • Do not open too wide, and avoid clenching.
  • Remember “lips together, teeth apart”.
  • Soft chew diet
  • Apply warm moist heat. Apply hot towels or a water bottle in intervals of ½ hour on with ½ hour of rest.
  • Limit intake of sugar and caffeine
  • Avoid sleeping on your jaw. Try a cervical pillow or roll up a towel to place under your neck.
  • Wear your Biteguard at night. (Do not wear biteguard 24 hrs a day.) Over the counter biteguards are available at most pharmacies for around $25.
  • The adult medication of choice is over the counter ibuprofen, 200mg. Take 1 to 4 tablets with meals three times a day for five days. If necessary for pain you can take 1 to 4 tablets with meals twice a day for an additional 15 days. At this point you should cease taking ibuprofen. (Do not take ibuprofen if your physician has instructed you not to, if it interferes with any of your medications, or if it irritates your stomach.) Acetaminophen can be substituted for ibuprofen when necessary.
  • Finally, be good to yourself. Do something enjoyable. If your pain becomes severe or unmanageable, and you have been examined to rule out tooth problems, you will need to see a specialist in Oral Medicine or your physician. We will refer you to South Sound Oral Medicine at 253-874-2583.

Loose temporary or permanent crown

If your temporary crown is loose or missing, it is seldom an urgent emergency. If possible, call our office so we can re-cement or remake the temporary crown. If you cannot get in right away try to chew on the other side so as not to damage the prepared tooth.

You can place the temporary crown back onto the tooth by putting a dab of vaseline or denture adhesive inside the crown and placing it back on the tooth. (The cheek side of the temporary crown is usually longer than the tongue side).

If a permanent crown has become dislodged, make an appointment for the crown to be re-cemented. Save the crown and bring it to the office for evaluation and re-cementation.

A blow to the head, jaw or lips

Go to your hospital emergency room immediately. They can evaluate your condition and refer you to an oral surgeon if necessary. If a tooth has been knocked out, hold the tooth by the crown and if it is dirty rinse the tooth in water. Do not scrub it or remove any attached tissue fragments. If possible, gently insert and hold the tooth in its socket. If that isn’t possible, put the tooth in a cup of milk and get to the dentist (Preferably an Endodontist – Dr Nguyen at 253-952-3636) as quickly as possible. Remember to take the tooth with you!

Mouth sores, wisdom tooth discomfort

If you have pain and swelling from inflammation, and there is no infection try warm salt water rinses (1 tsp salt in an 8 oz glass of warm water). If you are having pain with eating try Miracle Mouth Rinse. Mix equal parts by volume of over the counter liquid Benadryl and Kaopectate (You may substitute Maalox.). Rinse with one teaspoon every two hours and spit out. This is not recommended for small children incapable of spitting out the rinse. If you have wisdom teeth you will most likely be referred to an oral surgeon. Mouth sores should heal in about a week. You may feel more comfortable taking ibuprofen (if tolerated) or acetaminophen. If not, make an appointment to have the areas of discomfort examined.

If wisdom teeth are present you will most likely be referred to an oral surgeon.

What to expect after dental procedures

It is normal to experience some hot, cold and pressure sensitivity, and tenderness after your appointment. Injection sites and gums may also be sore. For a few days you may want to take ibuprofen or acetaminophen with meals. Rinse with warm salt water (1 tsp of salt in an 8 oz glass of water). Follow recommended oral hygiene instructions. Try to avoid eating hard and sticky foods, and if possible chew on the opposite side of your mouth.

Very deep cavities may involve the nerve of the tooth. If you have severe pain that is not relieved by following the above instructions, you may need root canal treatment. We refer to Dr. Nguyen at 253-952-3636.

Discomfort after dental procedures

Some sensitivity is normal after any tooth has been worked on, especially if there has been tooth decay. The degree of discomfort varies from person to person. Removing decay can irritate the nerves and result in a painful sensitivity. If this is the only cause, expect the tooth to be getting gradually better,usually within a couple of days.

If the sensitivity is intense, or lingers on for a few days or weeks, it is important for you to return to our office for a check. Most lingering pain or difficulty with chewing is due to the “bite” being a little off. If some teeth meet before all others, those teeth receive all the pressure that the rest of the teeth should share. Not only will it cause the teeth to be uncomfortable, but it can lead to TMJ (temporomandibular joint) pain. When patients are numb it is difficult to bite down just right, but coming back to the office without anesthetic allows us to do a painless bite adjustment of the fillings or crowns. This will usually solve the problem. There could be other causes for your problems, but this is the most common and easiest to fix, so we would start here. With some patients more than one adjustment appointment may be necessary.

Though they are very tough and stone-like on the outside, teeth are living tissues. There are many nerves (pulp) in your teeth. When there is deep decay or fractures in a tooth, and treatment is close to the pulp, the tissue can become inflamed. The result can be a “bad” toothache. An endodontist (specialist) should be consulted to determine if a root canal needs to be done. A crown may be necessary to bind together fractured parts of the tooth. Teeth with deep decay or traumatic injury may feel fine before treatment and become painful later. When the pulp dies from trauma or infection, the only treatment is extraction or root canal treatment. It is impossible to repair a tooth with a “split root”, but most other root and related pain is correctable with treatment.

Sensitivity from Bleaching

It is normal for patients to experience some mild sensitivity, especially if your teeth are normally sensitive. This discomfort usually disappears once you’ve completed the bleaching process. If your gums are irritated reduce the amount of whitening gel that you put in the trays, and wipe off the excess from the gum line with a toothbrush, tissue or finger. It may be necessary to wear the bleach trays every other day, to give your teeth a break. This does not affect the results of the bleaching; it just makes the process take longer. Use toothpaste for sensitive teeth, like Sensodyne. If you plan to do touch-up bleaching in the future, you may be able to prevent cold discomfort by brushing with a product like Sensodyne two weeks prior to bleaching.