I'm a Harvard-trained dental specialist, an orthodontist. There are many types of dental emergencies, each of which has steps that are very different. While orthodontists typically delegate standard toothaches to general dentists, most people are not aware that orthodontists deal with the most pressing emergency in dentistry—acute traumatic injury. In other words, orthodontists not only see patients with broken brackets, pokey wires, and the like, but they are essential members of the dental trauma team.
Traumatic dental injuries need to be treated more rapidly than a cavity or even a root canal. When a tooth is knocked out of the mouth or pushed out of position, there is a short timeline for re-implantation or repositioning of about an hour. A dentist needs to be contacted immediately. In the meantime, the tooth, if it has been knocked out of the mouth, needs to be preserved in a very specific way.
First, the tooth should be very gently cleaned of any debris. Aggressive cleaning will ruin the healing process since the cells attached to the tooth's surface must remain in place and alive for the tooth to be re-implanted successfully. Next, the tooth should be preserved in Hank's balanced salt solution when possible. For the common person without access to this solution, cold skim milk is the best easily available alternative. Then, before re-implantation, it is important to know if other facial trauma or bone breakage has occurred. The tooth socket should be checked by the dentist and, whenever possible, an attempt should be made to reposition the tooth to its correct place. If the tooth can be repositioned successfully, the next step is to stabilize the tooth in place while allowing enough flexibility of movement for the tooth to move physiologically in its socket. This is best done by an orthodontist. Brackets are placed on the re-implanted tooth and nearby teeth and a light, flexible wire is placed. The bracing of the re-implanted tooth with the wire to the other teeth will help the tooth heal in position, while a flexible wire will allow the tooth to still move within its physiological range to reduce the risk that the tooth fuses to the bone around it—the main long-term risk of re-implantation. The younger the patient, the better the chance the re-implanted tooth will survive. In many cases, the tooth will need root canal therapy as well.