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Tooth Injury

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Definition

  • Injury to a tooth

First Aid Advice For Knocked-Out Permanent Tooth 

  • To save the tooth, it must be reimplanted as soon as possible (2 hours is the outer limit for survival). Right away is best. If more than 30 minutes away from dental or medical care, replace the tooth in the socket before coming in. Use the following technique:
  • Rinse off the tooth with saliva or water (do not scrub it).
  • Replace it in the socket facing the correct way.
  • Press down on the tooth with your thumb until the crown is level with the adjacent tooth.
  • Have your child bite down on a wad of cloth to stabilize the tooth until you can reach your dentist.
  • Note: Baby teeth can't be re-implanted.

Types of Tooth Injuries 

  • Loosened tooth - may bleed a little from the gums. Usually tightens up on its own.
  • Displaced tooth (usually pushed inward)
  • Chipped or fractured tooth
  • Avulsed (knocked out) tooth - a dental emergency for permanent teeth

Transporting a Knocked-Out Permanent Tooth 

  • If unable to put the tooth back in its socket, follow these instructions:
  • It is very important to keep the tooth moist. Do not let it dry out.
  • Transport the tooth in milk or saliva (Milk is best per ADA 2003)
  • MILK TRANSPORT OPTION 1 (best): Place tooth in a small plastic bag with some milk. Put the plastic bag in a cup of ice.
  • MILK TRANSPORT OPTION 2: Place tooth in a cup of cold milk.
  • SALIVA TRANSPORT OPTION 1: Put the tooth inside the child's mouth. (Be careful not to swallow it) (EXCEPTION: Age less than 12 years old)
  • SALIVA TRANSPORT OPTION 2: Put the tooth in a cup and keep tooth moist with child's saliva (spit).

When to Call Your Doctor for Tooth Injury

Call Your Dentist or Doctor Now (night or day) If

  • You think your child has a serious injury
  • Permanent tooth knocked out (Reason: needs reimplantation ASAP; 2 hours is the deadline for tooth survival)
  • Permanent tooth is almost falling out
  • Baby tooth is almost falling out
  • Bleeding won't stop after 10 minutes of direct pressure
  • Tooth is greatly pushed out of its normal position
  • Tooth that's pushed out of its normal position interferes with normal bite
  • Severe pain
  • Age under 1 year old

Call Your Dentist Within 24 Hours (between 9 am and 4 pm) If

  • You think your child needs to be seen
  • Baby tooth knocked out by injury (Reason: can't be reimplanted but dentist will check for damage to permanent tooth)
  • Tooth is slightly pushed out of its normal position
  • Can see a chip or fracture line (crack) in the tooth
  • Tooth feels very loose when you try to move it

Call Your Dentist During Weekday Office Hours If

  • Tooth sensitive to cold fluids
  • Tooth becomes a darker color
  • You have other questions or concerns

Parent Care at Home If

  • Minor tooth injury and you don't think your child needs to be seen

Home Care Advice for Minor Dental Injuries

  1. Local Cold: For pain, apply a piece of ice or a popsicle to the injured gum area for 20 minutes.
  2. Pain Medicine: If it still hurts, give acetaminophen (e.g., Tylenol) or ibuprofen.
  3. Soft Diet: For any loose teeth, offer a soft diet for 3 days. By then, it should be tightened up.
  4. Call Your Dentist If:
    • Pain becomes severe
    • Tooth becomes sensitive to hot or cold fluids
    • Tooth becomes a darker color
    • Your child becomes worse

And remember, contact your doctor if your child develops any of the "When to Call Your Doctor" symptoms.

References

  1. Creighton PR. Common pediatric dental problems. Pediatr Clin North Am. 1998; 45:1579-1600.
  2. Flores MT. Traumatic injuries in the primary dentition. Dental Traumatology. 2002;18:287-298.
  3. Fried I and Erickson P. Anterior tooth trauma in the primary dentition: Incidence, classification, treatment methods, and sequelae: A review of the literature. ASDC J Dent Child. 1995;62:256-261.
  4. Layug ML. Interim storage of avulsed permanent teeth. J Can Dent Assoc. 1998;64(5):357-63, 365-369.
  5. McTigue DJ. Diagnosis and management of dental injuries in children. Pediatr Clin North Am. 2000;47:1067-1084.
  6. Nowak AJ, Slayton RL. Trauma to primary teeth: Setting a steady management course for the office. Contemp Pediatr. 2002;19(11):99-118.
  7. Shusterman S. Pediatric dental update. Pediatr Rev. 1994;15:311-318.

Disclaimer

This information is not intended to be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Author and Senior Reviewer: Barton D. Schmitt, M.D.

Last Reviewed: 9/1/2010

Last Revised: 9/23/2010 1:57:54 PM

Copyright 1994-2011 Barton D. Schmitt, M.D.

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