If you have a toothache you cannot ignore and no insurance, the first step is to work out how serious it is. Some problems call for the emergency room right away. Others can be handled by a dentist or a low-cost clinic within a day or two, often for much less money. This guide helps you sort out which is which and what to do next.
When to go to the ER
Go to the nearest emergency room, or call 911, if you have any of these:
- Swelling in your face, jaw or neck, especially if it is spreading
- Fever along with tooth or gum pain
- Trouble breathing or trouble swallowing
- Bleeding that will not stop with steady pressure
- A serious injury to the face or jaw, or a jaw you think may be broken
A tooth infection can sometimes spread beyond the mouth, and that can become dangerous. Do not wait to see whether swelling goes down on its own. If you are not sure whether your symptoms are serious, it is safer to get checked than to wait.
Emergency, urgent, or can it wait?
Not every dental problem needs the ER. As a general guide:
- Needs care today: severe pain that will not let up, a knocked-out adult tooth, a painful bump on the gum that may be an abscess, a broken tooth with pain, or bleeding after a tooth was pulled.
- Call a dentist within a day or two: a lost filling or crown, a chipped tooth without pain, or mild sensitivity to hot and cold.
If you are unsure, call a dental office and describe your symptoms. Many offices give emergency instructions on their voicemail message, and staff can often tell you how quickly you need to be seen.
What the ER can and cannot do
Hospital emergency rooms can treat pain and infection in the short term. You may get antibiotics or pain medicine, and in serious cases the hospital may admit you or call in a specialist. But most ERs do not have a dentist who can fix the tooth itself, so you will often leave with a prescription and a referral.
ER visits can also cost far more than a dental office visit, and costs vary widely. If you do go, ask about financial assistance. Nonprofit hospitals are generally required to have a financial assistance policy, and many other hospitals offer discounts too. You can also ask for an itemized bill and a payment plan.
When you check in, say clearly that the problem is dental and bring a list of your medicines, so the staff can treat you safely and point you to the right follow-up.
Try a dentist first when it is safe to wait
For severe pain without the warning signs above, calling dental offices is usually faster and cheaper than the ER. Many offices hold time for emergencies. Tell them you do not have insurance and ask:
- What is the cash price for an emergency exam and X-ray?
- Can you treat only the urgent problem today and plan the rest for later?
- Do you offer a payment plan, an in-house membership or a discount for patients without insurance?
- What are my options for this tooth, and what does each one cost?
Sometimes the choice is between saving a tooth, which may involve a root canal and a crown, and having it pulled. Pulling a tooth usually costs less up front, but a missing tooth can cause other problems and expenses later. Talk through the tradeoffs with the dentist, and ask for the prices in writing before you agree to treatment.
Where to find low-cost emergency dental care
- Community health centers. Many offer dental care on a sliding fee scale and may keep same-day or urgent slots. Call and say you have a dental emergency.
- Dental schools. Some have urgent-care clinics where students treat patients under supervision, often at lower fees. Expect a longer visit.
- Free and charitable clinics. Some set aside hours for urgent problems, though many have waiting lists.
- Medicaid. If you qualify, it may cover emergency dental care. Adult dental benefits vary widely by state, and children are covered more broadly.
- 211. This free helpline can point you to local programs and assistance in much of the country.
Ease the pain while you wait
These steps can help you stay comfortable until you are seen. They do not treat an infection, so they are not a substitute for care.
- Rinse gently with warm salt water.
- Hold a cold compress against the outside of your cheek for short periods.
- Keep your head raised when you rest.
- Take over-the-counter pain relievers exactly as the label says. Ask a pharmacist first if you take other medicines, are pregnant or have other health conditions.
- Do not put aspirin or other pills directly on the gum. It can burn the tissue.
- If an adult tooth is knocked out, hold it by the crown (the white part), not the root. Rinse it gently if it is dirty, and try to place it back in the socket. If you cannot, keep it moist in milk and get to a dentist right away, ideally within an hour. Do not try to put a baby tooth back.
Pain that suddenly stops can sometimes mean the nerve has died, not that the problem is gone, and an infection may still be there. Get it checked.
Find affordable care near you
Having a plan before an emergency happens makes it easier to act quickly. You can find local dentists by state and browse free and sliding-scale dental clinics so you know who to call. Once the crisis passes, a regular checkup at a sliding-scale clinic can catch small problems before they turn into emergencies.
This article is general information, not medical advice. If you think you have a serious infection or any trouble with your airway, go to the ER, and confirm fees and hours directly with any clinic you call.