BACKGROUND Emergency physicians should be cognizant of complications following common procedures (including dental) and be able to readily care for patients with acute dental pain. METHODS A 22-year-old female presented with dental pain and difficulty swallowing that developed 48 hours after she underwent a dental extraction. The physical exam showed an uncomfortable, afebrile female with dysphonia, inability to tolerate secretions, and crepitus over the neck and anterior chest wall. CONCLUSIONS The use of a high-speed dental drill may have caused air to dissect through fascial planes leading to subcutaneous emphysema, or even through deeper planes resulting in pneumomediastinum. It should be noted that subcutaneous emphysema and pneumomediastinum are rare complications of dental procedures. CONCLUSIONS This case highlights an uncommon but potentially life-threatening complication following a routine dental procedure, which emergency clinicians should be attentive to and able to identify and thereby manage.