What To Do When Your Child Knocks A Tooth

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What To Do When Your Child Knocks A Tooth


chipped-toothThere are some dental emergencies that are not considered life-threatening but that still may require immediate care such as:

  • If your child cannot function normally or displays some changeable moods such as lack of sleep, moodiness or listlessness
  • If injured tooth is obstructing the child’s bite
  • If the child complains of constant and/or severe pain or swelling
  • Pain from a decayed or abscessed tooth (not impacting breathing or swallowing)
  • If there is bleeding and does not stop after taking the appropriate measures to control it
  • If tooth is knocked out, broken or it cannot be accounted for
  • If a primary front tooth (baby’s tooth) comes out; stays out. Consider this one a basic rule
  • If an adult front tooth comes out; it should be put straight back in as soon as possible
  • If a baby tooth is knocked out, do not attempt to replace it. Re-implanting a knocked out baby tooth may cause damage to the developing adult tooth.
  • Seek prompt dental care so any trauma to the lips and gums and associated pain can be assessed.
  • If following an injury, a child cannot sleep normally nor eat and sleep to the normal pattern

Below is a summary of the kinds of things that we see when kids injure themselves. Often these injuries are sports related, bike wrecks, and the quite common bumping the head of another child. There are different type of accidents and each require different dental attention.

Tooth Knocked Loose:

Sometimes the gums bleed some, the tooth seems loose, but is in the same position as before. Very common. Usually needs no treatment whether it is a baby tooth or a permanent tooth. Sometimes, if it is quite loose, we might place a splint to hold it in place while it heals. This looks kind of like braces that are worn for a few weeks. The outcome is usually good. Sometimes a baby tooth will turn dark.

Tooth Knocked Out of Position:

This is more serious. Retrieve the tooth, hold it by the crown (the part that is usually exposed in the mouth), and rinse off the tooth root with water if it’s dirty. Do not scrub it or remove any attached tissue fragments. If possible, try to put the tooth back in place. Make sure it’s facing the right way.

Never force it into the socket. If it’s not possible to reinsert the tooth in the socket, put the tooth in a small container of milk (or cup of water that contains a pinch of table salt, if milk is not available) or a product containing cell growth medium. In all cases, see your dentist as quickly as possible. Knocked out teeth with the highest chances of being saved are those seen by the dentist and returned to their socket within 1 hour of being knocked out.  Usually, repositioning the tooth is desirable, preferably the day of the accident. Sometimes front baby teeth get knocked backwards so much they interfere with biting properly. Repositioning is important here and is usually done the same day with finger pressure. Sometimes, with a permanent tooth, you can’t easily reposition the tooth with finger pressure. Short term orthodontic repositioning is best for these cases. Sometimes a tooth (usually a baby tooth) is pushed up into the gum. This is called an intruded tooth. If the baby tooth is intruded less than 50% of the crown length (the part you normally can see), then it will very likely re-erupt back into position with no problem. This takes a few months. If it is pushed up where you can’t even see it, then it may or may not re-erupt and may need some additional treatment even if it does. If it does not come back down, it may need to be removed. Sometimes there is such damage that it is best to remove it and not wait for re-eruption if you think it may be harmful to the permanent tooth. The act of knocking the tooth up there may damage the developing permanent tooth bud. You never really know until the now tooth comes in what actually happened. Usually nothing happens, but the worst you may expect is some kind of blemish or spot (fixable) on the permanent tooth.

Knocked Out Tooth:

Well, if it is a baby tooth, just leave it out and place it under the child’s pillow for the tooth fairy. It is not worth the risk to the developing permanent tooth to replant it. Now, if it is a permanent tooth, you really need to follow these instructions carefully because you do want to save the tooth. First, find the tooth. Do not scrub it clean, just put it in a moist environment like milk. Call the dentist right away. He/she may direct you to rinse the tooth and put it back in right away. Most people don’t like the idea of doing that, so your dentist can replant the tooth. It’s fairly easy to do. The problem is that even though it is back in, you probably need a splint to keep the tooth in position while it heals. It is best to get the tooth back in as soon as possible. After several days the tooth will need a root canal to remove the now dead inside part of the tooth. There is one exception in that if the tooth is very new and has not developed a full root, it might heal on it’s own.

Broken or Chipped Tooth:

Quite common, especially in older kids. Save any pieces. Rinse the mouth using warm water; rinse any broken pieces. If there’s bleeding, apply a piece of gauze to the area for about 10 minutes or until the bleeding stops. Apply a cold compress to the outside of the mouth, cheek, or lip near the broken/chipped tooth to keep any swelling down and relieve pain.  The little chips in baby teeth are usually not much to worry about and can be smoothed out or left alone. Larger fractures might need a white filling to restore the lost tooth structure. It is quite distressing if a permanent tooth is fractured. Most of the time we can place a filling and the tooth looks good. Even if it is a large fracture, a filling can be placed first. It may need a crown later as the child gets older, but the fillings usually do quite well and look good. Just remember that if there is a filling there, it might get knocked off with a smaller blow than before. If the fracture is into the pulp (nerve) you will need to have it checked out sooner. There is a greater chance that the tooth may need a root canal the larger the pulp exposure and the longer it is exposed. The younger the tooth, the more likely you may see a good recovery.

Root fractures, and Various Other Bumps and Traumas:

Root fractures might just need a splint or just observation. They can, however, be serious enough that you may need a root canal or even loose the tooth.

Lips, Gums, and Tongues:

The mouth has a really good blood supply and therefore bleeds a lot when it sustains a trauma. The good news is that good blood supply usually means rapid healing. Sometimes stitches are needed and most of the time not. It depends on the severity and location. A “Busted Lip” will swell quite a bit, but will usually heal on it’s own.

If a young child has hit his/her mouth, there is lots of blood especially on the upper teeth lip area, look and see if it might just be a torn maxillary frenum. That’s the little piece of tissue that connects the upper lip to the gum between the two front teeth. If it was tight and gets hit and stretched too much it will tear. It bleeds a lot at first, but will likely be fine after 20 minutes or so. Usually no stitches are necessary. In fact there may be no treatment needed at all. This is a very common injury in preschoolers.

Abscessed Tooth:

An abscessed tooth is a painful infection at the root of a tooth or between the gum and a tooth. Some causes of tooth abscess are trauma to the tooth, such as when it is broken or chipped, gingivitis or gum disease. Though, it’s most commonly caused by severe tooth decay. These problems can cause openings in the tooth enamel, which allows bacteria to infect the center of the tooth (called the pulp). The infection may also spread from the root of the tooth to the bones supporting the tooth.  If the pulp in the root of the tooth dies as a result of infection, the toothache may stop. However, this doesn’t mean the infection has healed; the infection remains active and continues to spread and destroy tissue. Therefore, if you experience any of the above listed symptoms, it is important to see a dentist even if the pain subsides.

If the tooth is abscessed, the usual treatment at that point is often removal of the tooth allowing drainage through the socket. Also, there won’t be any further damage to the permanent tooth. In rare cases where there is a lot of root structure left, you can do a baby tooth root canal to remove the dead stuff and fill up the nerve chamber. Unlike a permanent tooth root canal, the material used has to be resorbable (that which can be broken down and assimilated back into the body) so it won’t interfere with eruption of the permanent tooth. Baby tooth root canals can be effective at reducing the chance of abscess or treating an already abscessed tooth. Plus you can lighten it back with a crown or filling. However, unlike permanent root canals, they are only effective around half of the time. In addition, if the child is very young, sedative medications may be necessary to help the child cooperate for treatment. So it can get complicated.

What Are the Symptoms of an Abscessed Tooth?
A toothache that is severe and continuous and results in gnawing or throbbing pain or sharp or shooting pain are common symptoms of an abscessed tooth. Other symptoms may include:

  • Fever
  • Pain when chewing
  • Sensitivity of the teeth to hot or cold
  • Bitter taste in the mouth
  • Foul smell to the breath
  • Swollen neck glands
  • General discomfort, uneasiness, or ill feeling
  • Redness and swelling of the gums
  • Swollen area of the upper or lower jaw