Dental emergency conditions in Sheffield: what is behind the pain

The pulp is the soft tissue in the middle of the tooth: nerve, blood vessels and a little connective tissue, in a chamber the width of a hair with hard walls all round. When decay, a crack or a deep filling irritates it, it swells, and because the walls do not give, the swelling squeezes its own blood supply. That is pulpitis.

Reversible pulpitis hurts sharply with cold and stops within seconds. Remove the cause, place a filling, and the nerve recovers. Irreversible pulpitis lingers for more than 10 to 30 seconds after hot or cold, aches on its own and wakes you at night. The nerve will not recover; it dies, and usually turns into an abscess a few weeks later. The choices are a pulpectomy today followed by root canal treatment, or an extraction. What it feels like is described in severe toothache.

A lower wisdom tooth that is only half through leaves a flap of gum over the back of it. Food and bacteria collect under the flap, the upper wisdom tooth bites down on it, and the flap becomes inflamed and infected. That is pericoronitis: pain at the back of the jaw, a bad taste, difficulty opening wide, sometimes a tender gland under the jaw. It is common in the late teens and twenties and tends to flare when you are run down.

First-line treatment is irrigation under the flap, warm salt water and chlorhexidine at home, and sometimes smoothing or removing the upper tooth that is biting on it. Antibiotics are added only when the infection is spreading. Repeated episodes usually mean the wisdom tooth should come out; see the pericoronitis guide and our wisdom teeth page.

A blow to the mouth can chip a tooth, loosen it in its socket, push it in, out or sideways, or knock it out altogether, and it can fracture the root or the surrounding bone at the same time. Each is managed differently and the first few hours matter. A tooth pushed out of position is repositioned and splinted. A knocked-out adult tooth is replanted, ideally within an hour, having been kept in milk. Baby teeth are never replanted.

Every injured tooth is X-rayed for a root fracture, tested for a living nerve, and reviewed over the following months, because the nerve can die quietly weeks later and the tooth darkens. The tooth trauma guide covers what to do at the scene and what follow-up to expect. Symptoms are described in knocked-out tooth and loose adult tooth.