Dr. Jordan Lentfer routinely treats children with dental emergencies at Oregon Kids Pediatric Dentistry in Eugene.

“One of the most urgent concerns is when a permanent tooth gets knocked out,” she says. “It often happens when children are playing sports or if a child takes a spill or a fall.”

Saving a knocked-out tooth
Losing a permanent tooth can be scary for kids and parents. If your child experiences any kind of dental emergency, remain as calm as possible to lessen his or her anxiety. If you’re able to locate the tooth:

  • Handle it by the crown and avoid touching the root.
  • Rinse off dirt and debris with water without scrubbing or scraping the tooth.
  • If your child is older, position the tooth back into the socket and instruct them to gently bite down on a piece of gauze to hold the tooth in place. Do not attempt to reinsert the tooth into the mouth of a younger child because they may swallow it.

For younger children, or any child who can’t handle having the tooth reinserted back into their mouth, Dr. Lentfer says the most important thing is to keep the tooth moist.

“Have your child spit into a cup and keep the tooth in the spit. Spit is the best option. Another alternative is to put the tooth in milk, but never put it in water.”

The next step is to get your child to the dentist immediately, so their tooth can be stabilized with a splint. “Basically, we create instant braces by putting some type of a stabilizing wire around the tooth and then we bond it with a composite material, like a filling material,” she says.

The chances that a knocked-out tooth can successfully regrow the ligament that reconnects it to the bone depends on how soon the tooth gets back into the mouth.

“If you get the tooth back in within 60 minutes, if not immediately after it gets knocked out, it has a high success rate of reattaching,” says Dr. Lentfer. “If it’s out of the mouth for more than an hour, the success rate drops significantly.”

If a baby tooth gets knocked out, Dr. Lentfer says do not attempt to put it back into your child’s mouth; doing so will most likely lead to infection and cause damage to developing permanent teeth. However, if your child knocks out a baby tooth and you can’t find it, you should contact your dentist to evaluate if a chest X-ray is necessary to ensure that your child didn’t breathe it into their lungs.

Handling other types of dental emergencies
It’s estimated that more than one third of children will experience some type of dental trauma. Two common risk periods for dental emergencies are:

  • Toddlerhood (18-40 months), when children begin to explore their surroundings
  • Preadolescence & adolescence, when sports injuries become more common

A “bumped” or loose tooth
If your child sustains and injury that results in a loose permanent tooth, it’s also worth a call to your pediatric dentist.

Dr. Lentfer says, “If the tooth is just a little bit wiggly, put your kiddo on a soft diet for 7-10 days, keep the tooth clean and usually it resolves and hardens up again. But we still want to see that child just to rule out that there’s no root fracture.”

A cracked tooth
A cracked tooth is not as serious as a knocked-out tooth, but it still requires a visit to your dentist. There are several different types of tooth fractures, ranging from a crack in the enamel to pulp exposure, which requires immediate attention.

“If you look at the crack and it’s still yellow or white, normal tooth structure, it’s not urgent,” says Dr. Lentfer. “What’s really urgent is if you crack a tooth, especially a permanent tooth, and you look at the bottom of it and there’s red or pink, that means the nerve was likely exposed. The sooner that we cover up that nerve, the better the chance of long-term success and less chance of having to have multiple root canal therapy treatments.”

If your child cracks a baby tooth and the nerve is exposed, more often than not that tooth will have to be extracted. Your pediatric dentist can assess the severity of a fracture using dental X-rays and offer the appropriate treatment.

Cut or bitten cheek, lip or tongue
If your child accidentally cuts or bites their cheek, lip or tongue and is bleeding, apply firm, direct pressure to the area with gauze or a clean cloth. If the bleeding becomes uncontrollable, call your pediatrician immediately.

Dr. Lenter says most cuts and bites will heal on their own. She suggests having your child rinse their mouth with warm saltwater and administer pain reliever if needed.

“We do not recommend using over the counter numbing agents, like Orajel. It can cause unintentional overdose, especially in young children and it can irritate the injured tissue in the mouth.”

Toothaches can be caused by several things. If your child is in pain, rinse their mouth thoroughly to clean it out, then look for food or other particles that may be lodged in between the teeth or in the gums. Use dental floss to gently dislodge any that you find.

“If it’s a toothache that has your child up all night and in a lot of pain, that could be something more serious, like a developing infection. Call your dentist if their pain isn’t going away with ibuprofen or acetaminophen,” she says.

Call your dentist when an emergency occurs
While dental emergencies can be scary, acting quickly can potentially save a tooth, prevent infection and reduce the need for extensive dental treatment down the road. For the majority of dental emergencies, families are encouraged to contact their pediatric dentist before going to the emergency room.

“Emergency docs are great, but they don’t have the tools and instruments that we have in our office. So, contact your dentist first if you have a knocked-out tooth, a chipped tooth, a cracked tooth or an abscess. We want to help you with that.”

The American Academy of Pediatric Dentistry offers this brief guide to help parents and caregivers be prepared for the most common types of childhood tooth injuries. Print it and keep it on the fridge or near the phone so family members and babysitters know what to do in the event of an emergency.

When to go to the emergency room
Go to the emergency room if you suspect your child has a fractured or broken jaw or skull. Even if your child is conscious, it is important for pediatric doctors to rule out delayed concussion and internal bleeding.