Erev Yom Kippur, Two O'Clock, and a Tooth That Could Not Wait

Quick answer: A tooth that has been building for a week will not politely wait through a twenty-five-hour fast. If something has been niggling in the days before Yom Kippur, deal with it beforehand — and if you are caught out on the afternoon itself, phone rather than assuming nothing can be done.

The call

Two o'clock on erev Yom Kippur. Kol Nidrei in under four hours. Aharon, 49, from Beit Shemesh, phoned to ask whether there was any point coming in.

He had had a dull ache in an upper molar since the previous Shabbat. It had been manageable. That morning it had become a throb, and he had done the arithmetic: no food, no drink, no tablets, from before sunset until the following night.

What we found

We saw him at 2:30. Upper left second molar, deep decay under an old filling, cold pain lasting well over a minute, early tenderness to tapping. Irreversible pulpitis, on the point of becoming an acute periapical problem.

No swelling, no fever, no trismus — a straightforward, treatable emergency, if there was time.

There was. An emergency pulpectomy takes about an hour.

What we did

Local anaesthetic, rubber dam, access, and complete removal of the inflamed pulp from all four canals. Cleaned, shaped, dressed with calcium hydroxide, and sealed with a solid temporary that would hold for weeks.

The fast-day considerations, since they come up every year: local anaesthetic is injected, not swallowed; the water spray was suctioned continuously and he was positioned so nothing pooled at the back of his throat; and he was told to spit rather than swallow. Anything requiring a halachic judgement is a question for a rav — but the treatment itself removes the need for oral painkillers, which is precisely the point.

He was out by 3:45, comfortable, and davened Kol Nidrei without a tooth on his mind.

We completed the root canal ten days later and crowned it six weeks after that.

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The last word: what actually counts as a dental emergency

This is the hundredth of these stories, and across all of them the same distinctions keep recurring. They are worth setting out in one place.

Go to a hospital emergency department now: - Facial swelling reaching the eye, or spreading under the jaw or into the neck - Difficulty swallowing or breathing, drooling, or a changed voice - Fever with facial swelling - Inability to open the mouth more than about two fingers - Bleeding you cannot stop with twenty minutes of firm pressure - A suspected broken jaw — the key sign is a bite that has changed - Head injury, vomiting or drowsiness after a fall

Phone a dentist immediately, same day: - A knocked-out permanent tooth — put it back in the socket or in milk first - A tooth pushed out of position or loose after an injury - A broken tooth with a red or bleeding spot in the middle - Severe toothache that painkillers no longer control - Facial or gum swelling without the red flags above - A jaw locked open

Within a day or two: - A crown, bridge, veneer or temporary that has come off - A broken tooth or lost filling with a sharp edge - Pain on biting, or a persistent bad taste - A denture that has broken

Within a week or two: - Sensitivity that lingers, but does not wake you - A lost filling with no pain - Recurrent bleeding gums - A loose partial denture

And regardless of anything else on this list: any ulcer, lump, or red or white patch in the mouth that lasts more than three weeks needs examining. Always.

What to do if this happens to you

1. Deal with a niggling tooth in the week before a fast, not the afternoon of it.
2. Phone even when you think it is too late. An hour is often enough.
3. Ask your rav about the halachic aspects, and your dentist about the clinical ones.
4. Break the fast without hesitation for spreading swelling, fever or difficulty swallowing.
5. Take painkillers before the fast begins if you cannot be treated in time.
6. Book the follow-up before you leave. Emergency treatment stops the pain; it does not finish the job.

In pain before a chag or a fast? Call Ramat Beit Shemesh Urgent Dental Care on 055-985-8845 or message https://wa.me/972559858845. We keep emergency slots every day. Harav Kook 28/1, Beit Shemesh.

Based on real cases treated at the clinic. Names have been changed.