Mouth and Dental Emergencies Practice Questions

30 multiple-choice questions on Mouth and dental emergencies for paramedic and EMT students, from Chapter 20 (Diseases of the Eyes, Ears, Nose, and Throat). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

30 practice questions

1. A 30-year-old has a front tooth knocked out in a fight 10 minutes ago. What is the best way to transport the tooth?

   1. A. In tap water for hours
   2. B. In milk or a balanced salt solution
   3. C. Wrapped in dry gauze
   4. D. Scrubbed clean, then wrapped in a towel
   Show answer

   Answer: B. In milk or a balanced salt solution

   Store an avulsed tooth in a balanced salt solution (such as a tooth preservation kit), cold milk, or saline. Avoid drying, scrubbing, or prolonged water storage, which damage the root cells.

2. When handling an avulsed permanent tooth, you should hold it by the:

   1. A. Socket end
   2. B. Crown
   3. C. Root
   4. D. Nerve
   Show answer

   Answer: B. Crown

   Hold the tooth by the crown (the chewing surface) to avoid damaging the periodontal ligament cells on the root that are needed for reimplantation.

3. Reimplantation of an avulsed permanent tooth has the best chance of success when done within about:

   1. A. 1 hour
   2. B. 12 hours
   3. C. 6 hours
   4. D. 24 hours
   Show answer

   Answer: A. 1 hour

   Success falls steeply with time outside the socket; reimplantation within about an hour, ideally much sooner, gives the best results.

4. Which avulsed tooth should NOT be reimplanted?

   1. A. A primary tooth
   2. B. A permanent incisor
   3. C. A permanent canine
   4. D. A permanent molar
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   Answer: A. A primary tooth

   Primary teeth are not reimplanted because doing so can damage the developing permanent tooth bud beneath.

5. A patient has severe throbbing tooth pain, swelling of the cheek, and fever. What is the most likely cause?

   1. A. TMJ dislocation
   2. B. Maxillary sinusitis
   3. C. Dental abscess
   4. D. Parotid gland infection
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   Answer: C. Dental abscess

   A dental abscess is a localized collection of pus from a tooth infection. It can spread into deeper neck spaces if untreated. Maxillary sinusitis causes pressure under the eye with nasal discharge rather than throbbing pain in one tooth, a parotid infection swells the area in front of the ear, and a TMJ dislocation locks the jaw without fever.

6. A 70-year-old who receives IV zoledronic acid for bone metastases had a tooth pulled 2 months ago. The socket never healed, and you can see yellow-white bone in her gum. What is the most likely cause?

   1. A. A dry socket after the extraction
   2. B. A retained piece of tooth root
   3. C. Oral thrush from her cancer treatment
   4. D. Jaw bone damage from her bone drug
   Show answer

   Answer: D. Jaw bone damage from her bone drug

   Bisphosphonates such as zoledronic acid and denosumab, especially at cancer doses, can cause medication-related osteonecrosis of the jaw, in which bone is exposed and fails to heal after a dental extraction. She needs referral to her oncology and oral surgery teams. A dry socket after the extraction is painful but resolves within about 1 to 2 weeks, a retained piece of tooth root does not look like exposed bone, and oral thrush forms white patches that wipe off.

7. A healthy 35-year-old has a severe toothache with no swelling, fever or trouble swallowing. Medical control asks your view on the best first pain treatment. Which choice fits current dental guidance?

   1. A. Ibuprofen with acetaminophen
   2. B. An oral opioid as the first choice
   3. C. Antibiotics to stop the pain
   4. D. Topical benzocaine as the main treatment
   Show answer

   Answer: A. Ibuprofen with acetaminophen

   For acute dental pain in adults without contraindications, the ADA guideline favors an NSAID such as ibuprofen, alone or combined with acetaminophen, which relieves pain as well as or better than opioids with fewer harms. An oral opioid is not the first choice, antibiotics do not relieve pain from the tooth when there is no spreading infection, and topical benzocaine gives brief relief and carries a methemoglobinemia risk.

8. A patient bit through his tongue during a seizure and is bleeding heavily. What is the first priority?

   1. A. Pack the mouth tightly
   2. B. Insert a bite block
   3. C. Clear the airway
   4. D. Assess for a head injury
   Show answer

   Answer: C. Clear the airway

   Oral bleeding threatens the airway. Position to allow drainage, suction as needed, and control bleeding with direct pressure if safe. Packing the mouth tightly can block the airway, a bite block does not protect against aspirated blood and can injure the mouth, and a head injury assessment matters but comes after the airway is cleared.

9. A patient has bleeding from a tooth socket after a dental extraction earlier in the day. What is usually effective?

   1. A. Suck through a straw
   2. B. Rinse vigorously with water
   3. C. Have him bite firmly on gauze
   4. D. Apply heat to the cheek
   Show answer

   Answer: C. Have him bite firmly on gauze

   Direct pressure from biting on folded gauze for 15 to 20 minutes usually controls socket bleeding. Rinsing and sucking can dislodge the clot.

10. Several days after a tooth extraction, a patient has severe pain radiating to the ear and a foul taste, with no fever. What is the likely cause?

    1. A. Dry socket
    2. B. Mastoiditis
    3. C. Septal hematoma
    4. D. Ludwig's angina
    Show answer

    Answer: A. Dry socket

    Alveolar osteitis (dry socket) occurs when the clot is lost from the socket, exposing bone. It causes severe pain 2 to 4 days after extraction and is not usually an emergency.

11. A patient cannot close his mouth after a wide yawn, and the jaw is locked open with pain in front of the ears. What is most likely?

    1. A. Mandible fracture
    2. B. Ludwig's angina
    3. C. TMJ dislocation
    4. D. Dental abscess
    Show answer

    Answer: C. TMJ dislocation

    Anterior dislocation of the temporomandibular joint locks the mouth open. Reduction is generally performed in the ED; support the jaw and transport.

12. After a punch to the jaw, a patient says his teeth no longer fit together correctly. What injury is most likely?

    1. A. Nasal fracture
    2. B. Zygoma contusion
    3. C. Mandible fracture
    4. D. Orbital fracture
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    Answer: C. Mandible fracture

    Malocclusion, pain, swelling, and numbness of the lower lip suggest a mandible fracture. Watch the airway, especially with bilateral fractures.

13. A 25-year-old had jaw surgery 3 days ago, and his upper and lower teeth are wired together. He is now nauseated and starting to vomit. What is the most important action?

    1. A. Have him swallow the vomit
    2. B. Lay him flat on his back
    3. C. Cut the wires or elastic bands
    4. D. Insert an oral airway between the teeth
    Show answer

    Answer: C. Cut the wires or elastic bands

    A patient whose jaws are wired or banded shut cannot clear vomit and is at high risk of aspiration. These patients are given cutters, so cut the wires or elastic bands as instructed, turn him to the side, suction and give an antiemetic per protocol. Having him swallow the vomit or laying him flat increases aspiration, and an oral airway cannot pass between wired teeth.

14. A child has white patches in the mouth that can be wiped off, leaving red areas. What is the likely cause?

    1. A. Diphtheria
    2. B. Herpes zoster
    3. C. Leukoplakia
    4. D. Oral thrush
    Show answer

    Answer: D. Oral thrush

    Thrush is a fungal infection common in infants, people on antibiotics or inhaled steroids, and immunocompromised patients.

15. A 10-month-old is drooling and chewing on toys. He has a temperature of 39.6 °C (103.3 °F) and is less active than usual. His parent says he is just teething. How should you view the fever?

    1. A. It is expected with a new tooth
    2. B. It confirms an ear infection
    3. C. It is too high to blame on teething
    4. D. It needs no care while he is drooling
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    Answer: C. It is too high to blame on teething

    Teething can cause drooling, fussiness and at most a slight rise in temperature, but it does not cause a high fever or lethargy. A temperature of 39.6 °C in a less active infant needs evaluation for infection. It is not expected with a new tooth, the fever alone does not confirm an ear infection, and drooling does not make the fever harmless.

16. A patient has a painful, swollen area below the jaw that worsens when eating. What is the likely cause?

    1. A. Salivary gland stone
    2. B. A dental abscess
    3. C. An enlarged lymph node
    4. D. Peritonsillar abscess
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    Answer: A. Salivary gland stone

    A salivary stone (sialolithiasis) blocks the duct, so the gland swells and hurts when saliva flow increases during meals. A dental abscess causes constant pain at a tooth, an enlarged lymph node does not change with eating, and a peritonsillar abscess causes one-sided throat pain with trismus.

17. A child fell while carrying a pencil in her mouth and has a puncture to the soft palate. What is a key concern?

    1. A. Carotid artery injury
    2. B. Facial nerve injury
    3. C. Jaw joint dislocation
    4. D. A chipped front tooth
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    Answer: A. Carotid artery injury

    Penetrating injuries to the soft palate or lateral pharynx can injure the carotid artery or deep neck structures, which can bleed or lead to a delayed stroke. These patients need evaluation even if they look well. The facial nerve runs through the cheek and parotid area rather than behind the soft palate, a fall onto a pencil does not usually dislocate the jaw, and a chipped tooth is a minor concern next to a vascular injury.

18. A patient has an object impaled through the cheek that is bleeding into the mouth and interfering with the airway. What is appropriate per many protocols?

    1. A. Push it farther through
    2. B. Cut it flush with the skin
    3. C. Remove it and pack both sides
    4. D. Leave it and lay supine
    Show answer

    Answer: C. Remove it and pack both sides

    The cheek is an exception: if an impaled object compromises the airway or cannot be stabilized, it may be removed per protocol, with dressing on the outside and gauze packing inside, leaving some outside to prevent aspiration.

19. Which dental injury involves a tooth being pushed into the socket?

    1. A. Fracture
    2. B. Avulsion
    3. C. Extrusion
    4. D. Intrusion
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    Answer: D. Intrusion

    Intrusion drives the tooth into the alveolar bone. Avulsion is complete removal; extrusion is partial displacement out of the socket.

20. A fractured tooth shows a pink or red spot in the center. What does this indicate?

    1. A. Exposed dentin
    2. B. Gum infection
    3. C. A root fracture
    4. D. Exposed pulp
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    Answer: D. Exposed pulp

    A pink dot indicates pulp exposure, which is painful and needs prompt dental care to reduce infection risk. Exposed dentin looks yellowish rather than pink, a root fracture lies below the gum line and is not seen on the broken surface, and gum infection causes swollen, red gums rather than a spot in the tooth.

21. A patient on chemotherapy has painful ulcers throughout the mouth and cannot eat. What is the likely cause?

    1. A. Mucositis
    2. B. Ludwig's angina
    3. C. TMJ dislocation
    4. D. Sialolithiasis
    Show answer

    Answer: A. Mucositis

    Chemotherapy and radiation can damage rapidly dividing mucosal cells, causing painful ulcers. These patients are at risk for dehydration and infection.

22. A dental infection can spread to which area and cause life-threatening complications?

    1. A. The middle ear
    2. B. The parotid gland
    3. C. Deep neck spaces
    4. D. The thyroid gland
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    Answer: C. Deep neck spaces

    Infection can track into submandibular, parapharyngeal, and retropharyngeal spaces and the mediastinum, causing airway obstruction and sepsis. Dental infections do not usually spread to the middle ear, the parotid gland or the thyroid gland; ear pain from a bad tooth is referred pain.

23. A patient with jaw pain while exercising and diaphoresis has no dental findings. What should you consider?

    1. A. Temporomandibular arthritis
    2. B. Acute coronary syndrome
    3. C. Dental caries
    4. D. Alveolar osteitis
    Show answer

    Answer: B. Acute coronary syndrome

    Ischemic cardiac pain can radiate to the jaw. Exertional jaw pain with diaphoresis warrants a 12-lead ECG and ACS evaluation.

24. A 60-year-old who smokes and drinks heavily has a painless sore on the side of his tongue that has not healed in 6 weeks. What is the most appropriate advice?

    1. A. Prompt checkup for oral cancer
    2. B. Rinse with salt water for a month
    3. C. It is a normal canker sore
    4. D. Stop brushing that side of the mouth
    Show answer

    Answer: A. Prompt checkup for oral cancer

    A mouth sore that has not healed after about 2 to 3 weeks, especially in a person who smokes and drinks, needs prompt evaluation for oral cancer. Rinsing with salt water for another month delays diagnosis, a canker sore is painful and heals within about 2 weeks, and avoiding brushing does nothing for the lesion.

25. A patient's tooth was knocked out, and you do not have milk or a preservation kit. Per many protocols, what alternative is acceptable?

    1. A. A cup of sports drink
    2. B. A dry sealed plastic bag
    3. C. Saline-moistened gauze
    4. D. An alcohol-soaked pad
    Show answer

    Answer: C. Saline-moistened gauze

    When milk or a balanced salt solution is unavailable, keeping the tooth moist with saline is acceptable. Some guidance allows the patient's own saliva if they can safely hold it.

26. A patient with poor dental hygiene has a toothache and swelling in the lower jaw. Which finding would change this from routine to urgent?

    1. A. Trouble swallowing
    2. B. Persistent bad breath
    3. C. Redness of the gums
    4. D. Mild sensitivity to cold
    Show answer

    Answer: A. Trouble swallowing

    Dysphagia, drooling, stridor, trismus, or swelling under the tongue suggests spread toward the deep spaces and a potential airway emergency.

27. A 12-year-old's permanent front tooth was knocked out, and his coach rinsed it and pushed it back into the socket before you arrived. What should you do?

    1. A. Pull it out and store it in milk
    2. B. Pull it out and rinse it again
    3. C. Leave it and have him bite gauze
    4. D. Wrap the tooth in dry gauze
    Show answer

    Answer: C. Leave it and have him bite gauze

    Replanting a permanent tooth quickly gives the best chance of saving it. If it is already back in the socket, leave it there, have the patient bite gently on gauze or cloth to hold it, and arrange prompt dental care. Pulling it out to store it in milk or rinse it again damages the root cells and wastes the early replant, and dry gauze would dry out the root.

28. A 79-year-old woke up unable to find her partial denture, which has metal clasps. She is drooling, cannot swallow her saliva and has pain in her lower neck and chest. She is breathing normally. What should you suspect?

    1. A. A heart attack with atypical pain
    2. B. A stroke affecting swallowing
    3. C. A denture stuck in her esophagus
    4. D. Oral thrush blocking her throat
    Show answer

    Answer: C. A denture stuck in her esophagus

    Swallowed dentures, especially those with metal clasps, can lodge in the esophagus, causing drooling, inability to swallow saliva and neck or chest pain, and the sharp clasps can perforate the wall. Keep her upright and transport for urgent removal. A heart attack does not stop her from swallowing saliva, a stroke would cause other deficits, and thrush does not block swallowing suddenly.

29. A 9-year-old fell on his face and has a chipped permanent incisor with no bleeding. What is the appropriate management?

    1. A. Ignore it if there is no bleeding
    2. B. Pull the remaining tooth out
    3. C. File the edge smooth on scene
    4. D. Save fragment, refer to dentist
    Show answer

    Answer: D. Save fragment, refer to dentist

    Save any fragments, which a dentist may bond back, and arrange dental evaluation. Also assess for other facial and head injuries.

30. Bleeding from the lips and tongue is usually well controlled by:

    1. A. Direct pressure
    2. B. Frequent rinsing with water
    3. C. Tilting the head back
    4. D. Packing gauze deep in the mouth
    Show answer

    Answer: A. Direct pressure

    The face and mouth are highly vascular, but direct pressure with gauze usually controls bleeding. Avoid positions that send blood toward the airway. Frequent rinsing washes away the forming clot, gauze packed deep in the mouth can be aspirated or block the airway, and tilting the head back sends blood toward the throat.