Dental emergencies in Vietnam: toothache, a broken tooth, and why facial swelling is urgent

Teeth have a talent for failing at the worst moment. The pain tends to arrive at two in the morning, on a Sunday, on an island, or the day before a flight. And because dental problems feel like an inconvenience rather than an illness, people sit on them. That is fine for a chipped edge. It is genuinely dangerous for an infection that has started to spread into the face.

This page is about sorting one from the other. What can wait until a dental surgery opens, what needs seeing the same day, and the small number of presentations that are hospital work. It is not a diagnosis of the tooth that is hurting. Nothing here substitutes for an examination and an X-ray.

Facial swelling is the emergency

A dental infection that has escaped the tooth travels along tissue planes in the face and neck. The structures it reaches are the airway and the eye. This is the one dental scenario that goes to a hospital emergency department rather than a dental chair. Ring 115 or go straight to hospital if you see:

• Swelling that is closing an eye, or spreading down into the neck
• Difficulty swallowing, drooling, or a voice that has changed
• Any difficulty breathing, or a feeling of tightness in the throat
• A mouth that will not open more than a finger or two wide
• Fever with shaking chills alongside the swelling
• A hard, tense swelling under the jaw or the tongue, with the tongue pushed up
• Confusion or drowsiness in someone with a dental infection
• Any facial swelling in a child, or in someone with diabetes or a suppressed immune system

The reason for that list is anatomy rather than caution. Infection under the tongue and in the floor of the mouth can obstruct an airway over hours. Infection tracking towards the eye socket and the veins behind it is the other serious route. Both are managed with drainage, intravenous antibiotics and monitoring. Neither is improved by waiting to see how it looks in the morning.

What is usually causing sudden toothache

Most severe dental pain comes from one of three places. The pattern of the pain says a good deal about which.

Pulpitis — an inflamed nerve inside the tooth — is the one that wakes people. It throbs, it lingers after something cold or sweet, it is often hard to localise to one tooth, and it is worse lying flat. A periapical abscess, where infection has reached the tip of the root, is more localised. The tooth feels raised. Biting on it is unbearable, and tapping it reproduces the pain exactly. Then there is pericoronitis. The inflamed gum flap over a partly erupted wisdom tooth gives pain at the back of the jaw, a bad taste, and a jaw that does not want to open.

A cracked tooth behaves differently again. A sharp jab on biting and releasing, with nothing much the rest of the time. And pain in the upper back teeth during a cold or after a flight is quite often the sinus above them rather than the teeth at all. Worth knowing before anyone drills anything.

A tooth broken, loosened or knocked out

Motorbike accidents, a low doorway, a wave, a hard coconut shell. The urgency depends entirely on what came out.

A chipped enamel edge with no pain can wait for a proper appointment. A fracture deep enough to show a pink or bleeding spot in the middle has exposed the pulp. That one needs seeing the same day. The nerve is open to the mouth.

A tooth knocked completely out of an adult jaw is the time-critical one. Handle it by the crown, never by the root. Rinse it in milk or saline if it is dirty, and put it back into the socket the right way round if that is at all possible, biting gently on a cloth to hold it. If it cannot go back, it travels in milk or saline, or in the patient's own saliva inside a sealed bag — never in water and never dry. The chance of a replanted tooth surviving falls with every hour outside the socket, so this is a same-hour errand.

A baby tooth is the exception. It is not put back. Replanting it can damage the adult tooth developing above. Get the child seen, but do not force the tooth in.

Getting through the night

None of the following treats the cause. All of it makes the wait more bearable, and none of it makes the dentist's job harder — which is more than can be said for some of the folk remedies in circulation.

• Take whatever simple painkiller you normally use, at the dose printed on the packet, and take it before the pain peaks rather than after
• Sleep propped up. Lying flat raises the pressure inside an inflamed tooth and is why the pain is worst at night
• Rinse with warm salty water several times a day, especially with pericoronitis or a gum infection
• Hold a cold pack against the outside of the cheek, wrapped in a cloth, in short spells
• Avoid very hot, very cold and very sweet food on that side, and chew on the other side
• A temporary dental filling material from a pharmacy will cover an exposed cavity or a lost filling for a few days and is worth having in a long-stay kit
• Do not put aspirin or crushed tablets onto the gum. It burns the tissue and leaves a chemical ulcer on top of the original problem
• Clove oil on a cotton pledget touched to the cavity is traditional and mildly numbing. Pouring it around the mouth irritates everything it touches

Why antibiotics are a bridge and not the treatment

Pharmacies across Vietnam will sell antibiotics for a toothache without a prescription. Plenty of travellers take a course, feel better, and fly home. The infection usually comes back. The source is still inside the tooth.

A dental abscess is a collection of pus in a space with no drainage. Antibiotics can reduce the surrounding cellulitis and buy time, which is sometimes exactly what is needed in the hours before treatment. What resolves it is opening the tooth, draining the pus, and then either root canal treatment or extraction. Taking repeated courses instead of having the tooth dealt with produces a partially treated infection that recurs. It also contributes to the resistance problem the region already has.

The sensible version is antibiotics when a clinician judges the infection is spreading, alongside an appointment to deal with the cause — not instead of one.

Flights, dives and pressure

Air trapped under a filling, in a cracked tooth, or in an inflamed tooth socket behaves like air in any other sealed space. It expands as the cabin climbs or as a diver ascends. And it hurts. Barodontalgia is uncommon but it is real. It has a habit of finding teeth with recent work or untreated decay.

Practically: a tooth that has been grumbling is worth sorting before a long-haul flight or a dive trip rather than after. And pain in the upper teeth that appears on descent, in both sides at once, is more likely the sinuses than a dental problem.

Where dental care actually is

Vietnam has a large private dental sector. The standard in the cities is generally good. A fair number of people come here for treatment deliberately. Da Nang, Ho Chi Minh City, Hanoi, Hue and Nha Trang all have surgeries used to foreign patients, and many run weekend hours.

The gaps are predictable. The islands and the smaller highland towns, Sunday evenings everywhere, and public holidays when very little is open. If you are heading somewhere remote with a known dental problem, having it looked at before you go is worth more than any kit you can pack.

What a home visit adds, and where it stops

We are not a dental surgery and we will say so on the phone. Nobody is going to drain an abscess or replant a tooth at your accommodation. A visit that implied otherwise would be selling you something.

What a clinician coming to you does cover is the medical half of a dental problem, which is often the half that is making the night unbearable.

• An assessment of whether this is a dental appointment tomorrow or an emergency department now, which is the question most people actually have
• Pain control that works well enough to sleep, and a plan for the hours in between
• A judgement on whether the infection has spread beyond the tooth, and treatment started if it has
• Help finding a dental surgery that opens next, and a handover of what has already been given
• Checking the rest of the picture after an accident, since a tooth broken on a motorbike usually arrives with grazes and a head that needs asking about
• An itemised invoice and a written report, which dental claims on travel policies tend to ask for in more detail than medical ones

The part to remember

Pain in one tooth is an appointment. Swelling in the face is a hospital, tonight. An adult tooth knocked out goes back in the socket or into milk within the hour. Antibiotics from a pharmacy counter postpone a dental problem rather than resolving it. The tooth will be waiting when the course runs out.