Emergency room, or dentist? Here is how to tell.

One rule, before anything else

Somebody is bleeding, somebody is crying, and you are in the kitchen deciding where to point the car. Here is the rule everything below is built on.

A hospital is for the child. A dentist is for the teeth. If the injury involves breathing, the head, the jaw, or blood you cannot slow, that is a whole-child problem: emergency room. If the damage is to a tooth, a gum, or a lip that has settled, it is a tooth problem: us.

Not sure which you are looking at? Call (239) 482-2722. One number reaches both offices, Monday to Friday, 8 to 5, and a real human answers.

And if the answer is obviously 911, stop reading and dial. You can call us from the hospital parking lot.

Go to the emergency room, or call 911

These signs are about more than teeth. If any one is true, the hospital comes first, even when a tooth is clearly damaged too.

• Trouble breathing or swallowing. Any struggle for air, any coughing that will not settle, any trouble getting a swallow down. Call 911 for this one.
• Bleeding that will not slow. Hold clean gauze on the spot with steady, gentle pressure and resist lifting it to check. Mouths bleed dramatically and most of it stops. Blood that keeps soaking through does not wait.
• Any sign the head took the hit too. Drowsiness, confusion, vomiting, a headache that keeps building, or losing consciousness at all, even for a second.
• A jaw that is not working right. It will not open or close the usual way, it sits crooked, or the bite suddenly feels wrong. That can mean a broken jaw, which is hospital territory.
• A deep cut on the face. Especially one that gapes open, crosses the border of the lip, or came from a car accident or a serious fall.
• Facial swelling with a fever. A swollen cheek, jaw or eyelid plus a fever is the one dental-sounding thing nobody should sit on overnight. In office hours call us immediately. Outside them, go to the emergency room.

None of those are maybes. Being checked and sent home is a good outcome.

Call us first

These are teeth, and teeth are ours. An emergency room can look at them and will usually tell you to see a dentist anyway.

• A tooth knocked out or knocked loose. A permanent tooth out of the socket is the one injury where minutes count: hold it by the crown, never the root, keep it in cold milk, come in now. If we are closed, call (239) 482-2722, and if you cannot reach dental care at that hour, take your child and the tooth, still in its milk, to an emergency room. Full steps sit with our other emergency guides. A baby tooth is never pushed back in.
• A toothache. Including one that wakes a child at night, and one that has already faded, because whatever caused it has not.
• A chipped, cracked or broken tooth. Bring any pieces you find, in milk if there is a carton handy.
• A bump or a pimple on the gum, with no facial swelling and no fever. It often does not hurt, which is exactly why it gets ignored. Call us this week.
• Something wedged between two teeth. Try gentle floss once. If it will not come free, leave it and call rather than going after it with anything sharp.
• A bitten lip, tongue or cheek that has stopped bleeding. Cold compress on the outside of the cheek, then a call, because the fall that split a lip often loosened a tooth nobody has checked.

One warning for either list: never rest an aspirin against a sore tooth or on the gum. It can burn the tissue.

When the answer is both, in that order

Plenty of real accidents land on both lists. A bike goes down hard, and now there is a gap where a front tooth was and a child who seems foggy.

The order never changes. The hospital clears your child. Then we take care of the teeth. Airway, head, jaw and bleeding get ruled out by people equipped for it. A tooth waits a few hours without complaint. A brain injury does not.

Here is the part nobody explains in the waiting room. An emergency room is built to stabilize a child and generally does not do dental repair. They control bleeding, check for a head injury or a broken jaw, close a cut on the face. Putting a tooth back in its socket or rebuilding a broken front tooth is usually not what a hospital does. So we are the second call either way, and the sooner it comes after they discharge you, the better.

Take the tooth with you: a knocked-out permanent tooth rides to the hospital in a cup of cold milk.

What to tell whoever you call

Whoever answers, ours or the hospital's, can only decide from what you tell them. Get this much out in one breath:

• What happened, and what time. The clock matters for a tooth that is out.
• Your child's age, and whether the tooth is a baby tooth or a permanent one. If you cannot tell, say so.
• What you can see right now: bleeding, swelling, a loose tooth, a gap, a chip, a cut.
• Whether your child hit their head, blacked out briefly, or has thrown up.
• Whether there is a fever.
• Any health conditions or allergies, and anything your child takes regularly.
• Whether the tooth or the broken pieces are with you, and what they are sitting in.

What the urgent visit looks like

Because you called ahead, the front desk knows who is walking in. We look at the tooth, the socket and the neighbors beside it, take a digital X-ray only if one is needed, and tell you what we found before anything is decided. Comfort options are discussed with your pediatric dentist first, and you can stay beside your child. Sedation and comfort covers the options, and what to expect covers an ordinary visit.

The rule, one more time

Hospitals are for the child. Dentists are for the teeth. Breathing, head, jaw, bleeding you cannot slow, or swelling with a fever: emergency room. Knocked out, loose, chipped, aching, bitten or stuck: us. Both at once means hospital first and us right after.

When the lists do not settle it, the phone will. Call (239) 482-2722 and let somebody else carry the decision for a minute. Once things are calm, you can book the follow up the same way.