How to handle your child's dental emergency

What to do when your child's tooth gets knocked out:
Having a tooth knocked out is a traumatic experience for both parents and children, especially a front tooth, as those are most commonly lost due to trauma. Upset parents and children often focus on the lost tooth at first glance, but -that may not be the most threatening injury!

The most important first step in any dental trauma situation is to assure that your child hasn't had a serious head injury that could be life-threatening. Common signs of head injury include loss of consciousness, nausea, unsteady gate, disturbed vision, and confusion. Any of these symptoms can signal a true emergency, and your child should be taken to an Emergency Room immediately for a complete evaluation; the dental injury is a far lower priority. Remember that these danger signs can develop over time after an injury, so even if not present immediately your child should be monitored carefully for 12-24 hours following a traumatic injury.

Once you are comfortable that your child does not have a head injury, it is time to look at the mouth. Quickly cleaning the face and gently wiping out the mouth will make your child feel better and allow you to see the injury more clearly. Call your dentist right away and tell them what happened and what you are able to see; your dentist can offer you the best advice.

How to stop the bleeding:
Most bleeding associated with the loss of a tooth can be controlled with some direct pressure. First, clean the face and mouth as much as possible to be certain that the bleeding is only coming from the tooth socket and not another injury elsewhere in or around the mouth. Once you identify the tooth socket as the source of the bleeding, applying some direct pressure with a clean, moist washcloth for a few minutes will stop most of the bleeding. Often simply having your child bite on and hold the moist washcloth firmly over the socket can be effective. If you're not where a washcloth is handy, any clean, moist cloth or sturdy paper towel or napkin will work in the same way, though cloth is definitely better than paper for this purpose.

Wiping the mouth out is a better initial strategy than rinsing until you identify the specific problem. Especially for young or crying children, attempted rinsing can result in a swallowed tooth or tooth fragment. Once any bleeding is controlled, gentle rinsing can be effective, though forceful spitting should be avoided.

How to save the tooth:
Your dentist can tell you what can be done with it, if anything, but seeing the tooth and evaluating its condition can be important. In some cases teeth can be replanted (replaced in the socket) and in other cases fragments can be re-bonded for an immediate esthetic restoration.

Baby teeth that are knocked out should not be replanted; there is a risk that the underlying permanent tooth could be damaged during the replantation process.

Permanent teeth, if intact, can be replanted and potentially remain functional for many years. The sooner the dentist sees your child and the better the condition of the tooth, the higher the chances of a successful replantation are. Ideally the tooth should be transported to the dentist in a suitable liquid, such as milk, and replanted in less than an hour after it was knocked out - in this case, minutes literally count! It is important that you do not touch the root of the tooth any more than necessary, and you should never attempt to "clean" the tooth by wiping or scraping the root. Your dentist will clean and prepare the tooth for replantation.

If you are not sure whether your child has knocked out a baby or a permanent tooth, err on the side of caution and get that tooth into milk and to your dentist right away!

When to see a dentist or an oral surgeon:
He or she (and the tooth!) should be taken to the dentist immediately. The sooner your child receives care, the better the outcome will be.

A general dentist, a pediatric dentist or an oral surgeon should be able to manage your child's injury. The dentist with whom you and your child already have a relationship should be your first call. As a matter of fact, this is one of the reasons why having a "dental home" (a dental practice where your child receives care on a regular basis) is so important, even for children who do not have much tooth decay. I often ask parents if the time of a trauma like this is when they want to be scouring the internet or yellow pages looking for a dentist!

When it "breaks" and isn't all the way out:
Often parents think that their child's tooth has been knocked out, only to find that the tooth has broken, and only the crown of the tooth is missing. Depending on where and how the tooth has broken, your dentist can advise you on the treatment options after examining your child. Be sure to take the fragment with you to the dentist; in some cases the fragment can be bonded to the remaining part of the tooth for an immediate esthetic restoration. Even if the fragment cannot be attached via bonding, seeing it will give your dentist important information about how and where the tooth was broken.

Use an "emergency kit" to carry the tooth:
Keeping a knocked out tooth in an appropriate liquid on the way to the dentist is important. Milk is probably the best commonly-available liquid for this purpose.

There are solutions for tooth transport that are even better than milk. These solutions were actually developed as media for transportation of organs to be transplanted. Many drugstores carry consumer friendly versions of these solutions including a small plastic container with a basket to hold the tooth in the solution during transport. These tooth transport kits are commonly found in the section of the store dedicated to sports injuries, but may also be found in the tooth care aisle in some stores. Many sports first aid boxes will also include these kits, so if your child is playing an organized sport, be sure that one is available and that it is not out-of-date.

Use Mouth Guards:
Children playing contact sports should always have a properly fitting mouth guard and should wear it routinely. When it comes to mouth guards there are several kinds to be aware of. Obviously the best is the type made by your dentist, custom fitted to your child's mouth; these tend to be the most comfortable, stay in place best, and to be the most effective. They can even be fabricated with your child's favorite team colors or logo!

Commercially produced mouth guards are also available from the drugstore and those which are heated and fitted to your child's mouth at home are the most effective. They tend to be bulkier and less comfortable than custom made versions. The least effective type are the mouth guards which are "one size fits all," and are not fitted to your child's mouth at all.

Regardless of the type of mouth guard being used, remember that your child's mouth is constantly growing and changing. For this reason, all mouth guards should be replaced with each new sports season. If the mouth guard no longer fits, it will not be comfortable, your child will not wear it, and it will not protect your child's teeth.

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About Dr. Jeffrey Wood:
Dr. Wood is a distinguished educator in the field of pediatric dentistry and has been honored with several awards, including the Golden Apple Award from the American Dental Association for outstanding mentoring of predoctoral dental students interested in academic careers. Significantly involved in organized pediatric dentistry, Wood chairs the Council on Pre-doctoral Education for the American Academy of Pediatric Dentistry, where he also serves as media spokesperson. He is currently treasurer and a member of the board of directors for the California Society of Pediatric Dentistry and is also vice president for the Western Society of Pediatric Dentistry. Wood is a fellow of the International College of Dentists and the American College of Dentists and participates in the American Academy of Pediatric Dentistry's Leadership Institute at the Kellogg School of Management at Northwestern University.

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