Broken or Knocked-Out Tooth in a Child

Adult tooth knocked out: act now

This is the one true dental emergency and the clock matters. A permanent tooth reimplanted within thirty minutes has a good chance of surviving. After an hour the odds fall sharply.

Find the tooth. Pick it up by the crown, never the root. The root surface carries the living cells that allow it to reattach, and wiping or scrubbing them off is what usually kills the tooth.

If it is dirty, rinse it briefly in milk or saline. A few seconds only. Do not scrub, do not use soap, do not use tap water for longer than a moment.

Put it back in the socket if you can. The right way round, gently, until it is level with the neighbouring teeth. Have your child bite gently on a clean cloth to hold it. This is by far the best thing you can do.

If you cannot, keep it wet. In milk, ideally. Saliva works: in a clean container with some of the child's own spit, or held inside their cheek if they are old enough not to swallow it. Never in water, and never wrapped in tissue.

Then get to a dentist immediately. Call ahead so we are ready.

Baby tooth knocked out: do not put it back

The opposite advice, and it matters. A reimplanted baby tooth can damage the permanent tooth developing directly above it. Leave it out.

Control the bleeding with gentle pressure on a clean cloth, and bring the child in the same day so we can check the socket, look for fragments, and take a radiograph if the impact was significant. Bring the tooth so we can confirm it came out whole.

If you are not certain whether it was a baby tooth or an adult one, keep it in milk and let us decide.

Chipped or broken tooth

Find the fragment if you can and keep it in milk. Broken pieces can sometimes be bonded straight back on, and the result is better than a rebuild.

Rinse the mouth with warm water. Cold compress on the outside of the lip or cheek for swelling. Paracetamol for pain, at the dose for their weight.

How urgent it is depends on how deep the break goes. A small chip of enamel can wait a day or two. A break showing yellow dentine underneath should be seen within twenty-four hours. Any pink or red spot in the middle of the break means the nerve is exposed, and that is same-day, because it is both painful and a route for infection.

Tooth pushed out of position or loose

A tooth driven sideways, upwards into the gum, or left wobbling needs to be seen the same day even though nothing is missing. The blood supply may be compromised and the tooth may need repositioning and splinting.

Do not try to push it back yourself. Soft food, avoid using that side, come in.

When it is not just the tooth

Go to a hospital emergency department rather than a dental clinic if there was loss of consciousness, vomiting, confusion or persistent drowsiness after the impact, bleeding that will not stop after ten minutes of firm pressure, a suspected broken jaw, or the child cannot close their teeth together normally.

Head injury comes before dental injury, always.

What makes it worse

Handling the root, or scrubbing it clean. Storing a tooth dry, in tissue, or in water. Waiting to see whether it settles down. Putting a baby tooth back. Giving aspirin. Assuming a tooth that stopped hurting is fine, because a tooth that goes numb after an injury is often a tooth whose nerve has died.

Weeks and months afterwards

An injured tooth can look completely normal for months and then darken, which usually means the nerve did not survive. This is common and treatable, but it needs to be caught.

Any child who has had a significant dental injury should be reviewed periodically for a year or two, including radiographs, whether or not anything appeared to be wrong at the time. This applies particularly to baby teeth, because the damage that matters may be to the permanent tooth forming above.

Worth doing before it happens

A mouthguard for any contact sport, and for scootering and skateboarding. A fitted one from a dentist is considerably more protective than a boil-and-bite from a shop, and children will actually wear it because it fits.

Save a dental number in your phone now rather than searching for one with a bleeding child in front of you.