Quick answer: The ER can stabilize emergencies—rule out dangerous infections, control intense pain (sometimes with a dental nerve block), drain certain abscesses, start antibiotics when indicated, repair cuts, and order medical imaging. Most ERs cannot do fillings, crowns, or root canals. If you don’t have red-flag symptoms (see below), you’ll usually get faster, definitive treatment with an emergency dentist.
When Is Tooth Pain an Emergency?
Go to the ER immediately if you have any of the following:
- Trouble breathing or swallowing, or uncontrolled drooling
- Rapidly spreading facial swelling, especially near the eye or neck
- Uncontrolled bleeding after 10–15 minutes of firm pressure
- Major trauma to face/jaw, suspected fracture, or you can’t open/close your mouth
- High fever or you feel systemically ill (chills, confusion)
- You’re immunocompromised (e.g., chemotherapy, transplant) and have signs of infection
If none of the above is present, call a dentist for same-day/next-day care.
ER vs. Emergency Dentist vs. Urgent Care (How to Choose)
Choose the ER if you have airway/breathing problems, rapidly spreading swelling, high fever, severe trauma, or bleeding that won’t stop.
Choose an emergency dentist for: severe toothache, broken/chipped tooth, lost filling/crown, localized swelling without fever, or a knocked-out tooth you can get treated within an hour.
Urgent care can help with short-term pain relief and prescriptions when a dentist is closed—but you’ll still need a dentist for the fix.
What the ER Can Do for Severe Tooth Pain
- Triage & stabilize: rule out airway compromise and deep or spreading infection
- Pain control: stronger analgesics and, when available, dental nerve blocks
- Incision & drainage: open and drain some facial/dental abscesses when appropriate
- Antibiotics (when indicated): for bacterial infections with systemic signs
- Imaging & trauma care: medical X-rays/CT for fractures or deep infections; repair oral lacerations
- Referrals: direct you to urgent dental care or oral surgery for definitive treatment
What the ER Cannot Do (Most Hospitals)
- Fillings, root canals, permanent crowns, routine dental X-rays
- Recement most crowns/bridges or repair orthodontic appliances
- Provide a long-term solution for pain from decay or an inflamed tooth nerve (pulpitis)
Bottom line: ER = medical stabilization; Dentist = definitive dental fix.
Common Dental Emergencies & First Steps
Severe toothache (pulpitis or cracked tooth): quick relief & what’s next
Right now
- Rinse with warm saltwater and gently floss to clear trapped food
- Cold compress to cheek 10–15 min on/off; avoid heat
- OTC pain relievers as labeled (acetaminophen or ibuprofen/naproxen if safe); do not place aspirin on gums
- Soft foods; avoid chewing on the painful side
At the dentist
- Same-day exam and X-ray; nerve block if needed
- Definitive fix: filling/bonding (minor decay/crack), crown (structural support), or root canal (inflamed/infected nerve)
- If full treatment must wait, a medicated temporary may calm the tooth
Go to the ER now if pain is accompanied by breathing/swallowing trouble, high fever with spreading swelling, or uncontrolled bleeding.
Knocked-out permanent tooth (avulsion): do this now
- Handle by the crown (top), not the root
- If dirty, quickly rinse with saline/water—no scrubbing; keep tissue attached
- Replant immediately (correct orientation), apply gentle pressure, bite on gauze
- If you can’t replant, keep moist in milk, saline, or Save-a-Tooth® (avoid tap water)
- See a dentist at once—the first 60 minutes offers the best chance to save it
- Do not replant a baby tooth.
Chipped or broken tooth
- Save fragments (in milk or saline if possible)
- Rinse mouth; if bleeding, firm gauze pressure for 10–15 minutes
- Cold compress to reduce swelling; avoid biting on the tooth
- Dentist can smooth sharp edges, place temporary bonding/cover, then plan bonding, onlay/crown, or root canal if the nerve is involved
Lost filling or crown
- Temporary seal with sugarless gum or OTC dental cement
- Do not use super glue
- Schedule a prompt dental visit for definitive repair
Dental abscess (localized swelling/pain)
- Warm saltwater rinses
- Dentist visit ASAP; ER if fever, rapidly spreading swelling, jaw tightness (trismus), or airway symptoms
- Antibiotics help only when there’s bacterial infection—definitive dental treatment is still required
At-Home Relief Until You’re Seen
- Rinse: warm saltwater (½ tsp salt in 8 oz water), several times daily
- Clean: gentle flossing to remove trapped food
- Reduce swelling: cold compress up to 15 minutes at a time
- Pain relief: labeled OTC meds (acetaminophen/ibuprofen/naproxen) if safe for you
- Rest: sleep with your head elevated
- Avoid: chewing on the sore side; very hot/cold foods/drinks
- Do NOT: place aspirin on gums; apply direct heat to the face
Costs & Insurance: ER vs. Dentist
- ER: higher copays/facility fees; you’ll often still need a dentist afterward
- Dentist: typically lower total cost because you receive definitive treatment (e.g., root canal, extraction, repair)
- Ask about clear estimates, insurance benefits, and financing for larger cases
Pediatric Considerations (short version)
- ER now for breathing/swallowing trouble, rapidly spreading swelling, uncontrolled bleeding, head/neck trauma, or a knocked-out permanent tooth you can’t replant
- Same-day dentist for severe pain without red flags, chipped/cracked/loose teeth, lost filling/crown with sharp edges
- Baby teeth: do not replant; book a dental check—sharp edges can be smoothed. A local Pediatrics team can help remedy the pain but it is better to see a trained practitioner for dental work.
- Pain & swelling: cold compress; weight-based acetaminophen/ibuprofen; no aspirin in children
Prevention & Follow-Up
- 6-month checkups/cleanings catch cracks, decay, and gum issues early
- Treat lingering sensitivity before it becomes a night-time toothache
- Wear a mouthguard for contact sports and if you grind at night
- After any ER/urgent visit, book a definitive dental appointment to fix the cause
Get the Right Care in Washington, DC
For urgent dental pain without red flags, contact us for same-day/next-day care and a definitive fix:
- General Dentistry in Washington, DC — exams, cleanings, fillings, emergency visits.
If a tooth can’t be saved or you’re planning a replacement:
- Dental Implants in Washington, DC — single tooth, multiple teeth, or full-arch solutions.
If you’re experiencing trouble breathing or swallowing, rapidly worsening swelling, or uncontrolled bleeding, call 911 or go to the nearest ER.
FAQs
What can the ER do for severe tooth pain right now?
Assess for red flags, control pain (sometimes with a nerve block), drain certain abscesses, start antibiotics when indicated, repair cuts, and order imaging. Most ERs cannot perform fillings, crowns, or root canals.
When should I go to the ER immediately?
Breathing/swallowing trouble, rapidly spreading swelling (eye/neck), uncontrolled bleeding, major trauma/suspected fracture, facial weakness/numbness, or high fever with worsening swelling.
When is a dentist the better choice?
Severe pain without red flags, chipped/cracked tooth, lost filling/crown, localized abscess without airway risk, or a knocked-out tooth you can get treated within an hour.
Will antibiotics cure an inflamed tooth nerve or crack?
No. Antibiotics don’t fix pulpitis or structural problems; you need a root canal, restoration, or extraction.
Knocked-out tooth—what’s the first step?
Handle by the crown, replant immediately if you can; otherwise store in milk/saline and see a dentist ASAP (best within 60 minutes). Do not replant baby teeth.
Ready to be out of pain? Call DC Implant & Cosmetic Dentistry for same-day relief and a clear plan to protect your smile going forward.