It is late, the tooth is thumping in time with your heartbeat, and your phone has just told you that every practice near you closed hours ago. The next few hours are far more manageable than twenty minutes of searching has made them look, so let us go through them in the order that actually helps.
What can you actually do in the next few hours?
Let us start with the part that never makes the top of a search result, because it is free and it is dull: for ordinary toothache, the most useful thing available tonight is already in a kitchen cupboard.
Ibuprofen and paracetamol can be taken together by most adults who are able to take both, at the doses printed on the packets, and the pair does a good deal more than either one alone. They work by completely different routes: paracetamol changes how the brain registers the pain, while ibuprofen goes after the swelling causing it. And swelling is the whole story with a tooth. Picture a blister trapped under a fingernail. It is ordinary swelling happening inside a hard box with no give in it at all, so the pressure has nowhere to go except onto the nerve. Bring the swelling down and the throb goes quiet, which is why an anti-inflammatory so often does the heavy lifting at one in the morning.
Then the thing to please not do, and the most persistent piece of folklore in all of dentistry: an aspirin held against the gum. Aspirin only works once it is in your bloodstream, and pressed neat against soft tissue it is simply an acid, so you are left with a white chemical burn on the gum and the toothache you started with.
How you lie down matters more than you would ever guess. Flat on your back, more blood arrives at your head, the pressure inside that sealed box rises with it, and the throb gets louder just as the house goes quiet. Prop yourself up on an extra pillow or two, and for a lot of people that is the difference between a night’s sleep and none.
A cold pack on the outside of the cheek is worth having, and heat is worth avoiding, since warmth brings more blood to the area and more blood is the last thing you want. Warm salty water is kind to a gum that has gone sore around a tooth. Chew on the other side, and keep drinks near room temperature if the tooth has turned sensitive. Clove oil, if there is any in the cupboard, numbs the surface and changes nothing underneath. If the ache began in the days after a filling rather than out of nowhere, that one has its own explanation, and it is a gentler one than tonight feels.
If what has happened is that a filling has dropped out or a crown has come off, a tube of temporary filling material from any pharmacy will cover the hole and keep the air and the cold off it until morning. Put the crown somewhere safe in a pot, and whatever tonight suggests to you, keep the superglue in the drawer: glue sets in a layer that then has to be drilled off, and it can ruin a crown that would otherwise have gone straight back on.
What if a tooth has been knocked out?
Everything above buys you time. This is the one thing that has none.
A knocked-out adult tooth is a real race against the clock, because the living fibres that hold it in its socket begin to die as soon as it is out and drying. Pick it up by the crown, the chewing end, never by the root. If it is dirty, rinse it briefly in milk, or water if there is no milk in the house. Then either put it straight back into its socket and bite gently on a clean folded cloth to hold it there, or drop it into a cup of milk. Then go to whoever can see you soonest, because the sooner it is back the better its chances. A child’s baby tooth is the exception: that one is not put back, so keep it and bring them in.
When should you ring 111?
NHS 111 is the door for urgent NHS dental care in the evening and at the weekend, and it is worth knowing what is on the other side of it before you dial. You are assessed over the phone, and where an urgent NHS dental slot exists, they find you one. It costs the NHS urgent charge, £27.90, unless you are exempt.
The words doing the quiet work in that sentence are “where one exists”. Those slots are limited, which is an argument for ringing at nine in the evening rather than at midnight. The slot itself is there to get you out of pain and make the tooth safe; the repair that follows happens back at your own dentist. If your difficulty is that there is no dentist of your own to go back to, that is a problem a great many people round here are having, and it is worth untangling on a calmer day than this one.
When is it A&E, and when is it 999?
This is a short list, and almost nobody reading a page like this at nine in the evening is on it, which is the first useful thing to know.
Hospital is the right door for a facial swelling that is closing an eye or making it hard to breathe or swallow, for bleeding that will not stop after twenty minutes of firm pressure on a clean folded cloth, and for a blow to the face where the jaw may be broken or where you were knocked out. Those go to A&E, and to 999 if breathing or swallowing is affected. Everything else that hurts in your mouth is a job for a dentist, and the hospital will tell you so kindly, because A&E does not treat toothache.
Can it wait until the morning?
For most of what sends people searching at this hour, yes. A tooth that has been building up to tonight for a fortnight is not transformed by being seen at eleven in the evening instead of nine in the morning, because what changes things is the treatment, and that is the same treatment either way.
So the plan for most people is the unglamorous one. Get through tonight with the cupboard and the extra pillow, and ring a practice as early as you can in the morning. Early genuinely matters, because same-day emergency slots are given out as the day fills, so the caller who rings first thing gets a choice and the one who rings after lunch gets whatever is left.
An emergency appointment at The Dental Barn in practice hours is £27.90, the same figure as the NHS urgent charge, and you do not have to be a patient of ours or registered anywhere to have one. It covers the examination and getting you out of pain: the tooth numbed, an abscess drained, the nerve dressed, the filling or the crown made safe. What the tooth needs after that is priced from the fee guide and written down for you to decide on once the pain has gone. What we can do the same day is set out tooth by tooth.
What does an out of hours dentist cost, and what does it buy?
Sometimes waiting for morning is not an acceptable answer, and at two o’clock that is a perfectly reasonable position to hold.
An out-of-hours emergency consultation at The Dental Barn is £150, against £27.90 for the same appointment in practice hours. Anywhere you ring, an out-of-hours fee sits above the daytime one, because a surgery has to be opened, lit and staffed with a dentist and a nurse for one person’s tooth. Members of our plans have that out-of-hours consultation included; the plans start at £10.62 a month and cover the year’s examinations and hygiene visits, with ten per cent off treatment (the plan page lists what the discount does not cover).
| The door | What it is for | What it costs |
|---|---|---|
| Out of hours at The Dental Barn | Out of pain tonight, the tooth made safe, the repair planned | £150 |
| The same appointment in practice hours | The same visit, tomorrow, at the NHS urgent figure | £27.90 |
| NHS urgent care through 111 | An urgent NHS slot where one exists, then back to your own dentist | £27.90 |
What an out-of-hours visit buys is relief and safety tonight, and it is worth being plain that this is different from a finished repair at midnight. The nerve is dressed or taken out, which is the first stage of a root canal, £76.60. An abscess is drained. A tooth that cannot be saved comes out, from £76.60. Then the real repair, the root canal or the filling or the crown, is planned, priced and booked for a day when you have slept. Nobody makes a good decision about a crown while their jaw is throbbing.
And then the question everybody asks on the phone. Can you just give me antibiotics? Less often than people expect, and for a good reason. A tooth infection sits inside the tooth, down a canal where the blood supply has already died, and tablets travel in blood, so they struggle to reach where the trouble is coming from. Where an infection is spreading into the tissues around the tooth, antibiotics are the right treatment and are prescribed on the day, £30. The tooth itself still has to be dealt with at the tooth.
Where we are, and who you would see
The Barn is at 4 Fernhill Court, Balsall Street East, Balsall Common, CV7 7FR, which sits between the village and Berkswell, a few minutes from Knowle, Kenilworth and Meriden. The number is 01676 611000.
Emergencies go to whichever of the four dentists can see you soonest, and two of them have done a great deal of this kind of work. Dr William Tarn-Chapman began in a busy NHS practice in central Birmingham where emergency care was the daily job, and Dr Amelia Reed spent twelve years in oral surgery and sedation alongside the maxillofacial teams at the Queen Elizabeth and Solihull hospitals, so a difficult extraction and a frightened patient are both familiar ground. All four are on the General Dental Council register, and the practice is run by the team behind Designer Smiles in Solihull, a practice rated 4.9 from 132 Google reviews.
For tonight, though, it really is the cupboard and the extra pillow, and then the phone in the morning. Sleep propped up. It helps more than it sounds like it will.
