child covering her mouth: what to do if your child breaks damages or knocks out a tooth

Around 50% of children experience some kind of dental trauma during their childhood – some severe, and others mild. Dental trauma is not life-threatening and a child rarely develops serious complications but injuries to primary (milk/baby) teeth may result in trauma to the permanent tooth bud, which is developing close to the roots of the milk teeth. This might have long-lasting effects on the health of the permanent tooth or on the appearance and self-confidence of the child. So what should you do when your child chips, damages, breaks or knocks out a tooth?

What to do in a dental emergency

If the child is knocked unconscious or has bleeding from the ear or nose, the child needs to be taken to the hospital straight away. If any of the following happens, you need to take the child to the dentist:

  • If there is pain, tenderness or sensitivity in the tooth.
  • If a tooth is broken, loose or missing after trauma.
  • If there is bleeding and it wouldn’t stop after applying pressure for about 10 min.

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What to do if your child has a dental injury

Treatment depends upon the type of injury and whether the injured tooth is a primary or permanent tooth. How do you know if it is a primary tooth or a permanent tooth? Permanent teeth are not present before 6 years of age, and primary teeth are smaller and whiter than permanent teeth.

child's primary teeth: what to do if your child breaks or loses a tooth
Primary teeth
permanent teeth: what to do if your child breaks or loses a tooth
Permanent teeth

What to do if your child has a chipped or broken primary tooth

This is the most common dental trauma when falling or playing – it can even happen in the bath. Normally it is not an emergency, but do consult with a dentist, who will determine if the tooth’s blood vessels and nerve could be damaged. Treatment may involve anything from smoothing the rough edge, to repairing it with tooth coloured restoration, leaving it as is or an extraction.

A consideration might be that the child is too small to sit still for a repair, and the dentist might advise to leave it until the child is a bit older and is able to sit still to have it repaired. Sometimes the trauma of forcing the child to sit in the dental chair at a very young age is worse and not worth it.

When the break is through the enamel and the dentine is exposed, it is advised to have it filled immediately to prevent further decay. Don’t try to make the call. Ask professional advice. If the tooth needs repair, and the child is too young to sit in the dental chair, the dentist will advise taking the child into theatre for a general anaesthetic to repair the tooth.

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What to do if your child has a dislocated or loose primary tooth

The most common dislocation is of the front teeth and management of these injuries focuses on preventing future damage to the permanent teeth. In most cases, a loose tooth will heal without treatment. If the injured tooth is very loose, it may be necessary to remove the tooth if there’s the possibility that the tooth could fall out and cause the child to choke.

If a primary tooth is knocked out completely and it still has its full root, it should be placed back into the tooth socket. But sometimes replacing the tooth might affect the growth of the permanent tooth and is often not worth the risk so it’s recommended that you consult with your dentist. If the dentist advises not to replace the tooth back into the socket, and it is going to be a while before the permanent tooth erupts, a spacer can help keep the teeth from crowding.

Chewing should not be a problem and sooner than you think, the gap will be filled by the permanent tooth. If the primary tooth’s root has already started to resorb and only a short (or no) root is left, there is no need to try and push it back into the tooth socket.

If they have a loose or dislocated tooth, your child may:

  • experience some bleeding from the gums around the affected tooth
  • have some swelling or bruising from the force of the blow
  • complain of pain
  • have trouble chewing with the loose tooth.

These are normal symptoms and it’s advised that you encourage your child to eat soft foods and stop them from playing with the tooth until it resettles and heals. Still consult with the dentist, because there might be deep nerve damage or damage to the permanent tooth, especially if the baby tooth is forced upwards into the socket. An x-ray will determine whether or not there is any damage.

dislocated primary tooth: what to do if your child breaks damages or knocks out a tooth
Dislocated primary tooth

What to do if your child has a broken or chipped permanent tooth

A broken permanent tooth can usually be repaired successfully but you should try to see the dentist within two days after the injury. A broken tooth that is sensitive to hot or cold needs to be treated urgently.

child covering her mouth: what to do if your child breaks damages or knocks out a tooth

What to do if your child has a loose permanent tooth

A loose permanent tooth that is interfering with the child’s bite also requires prompt treatment. In most cases, the tooth can be returned to the correct position and monitored over time but this might require anaesthesia, stitches or a splint (to hold the tooth in place). Again, it’s recommended you see a dentist as soon as possible.

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What to do if your child has a dislocated permanent tooth

If a permanent tooth is knocked out, it should be considered a dental emergency and requires prompt treatment. The tooth should be placed back in the tooth socket as soon as possible – ideally within 15 min and up to one hour (if stored in cold milk) after the accident. At least 85% of teeth that are put back into the tooth socket within 5 min survive, compared to teeth that are stored dry and re-implanted after an hour. These are the recommended steps:

Dislocated permanent tooth
  • Handle the tooth at the top (the crown). That is the part normally visible in the mouth, above the gum.
  • Remove debris by rinsing gently with saline or tap water – DO NOT scrub on the root of the tooth or try to sterilise the tooth.
  • Use your hand to place the tooth back into the socket.
  • Keep the tooth in place by having the child bite on a clean towel.
  • See the dentist as soon as possible.

It is best to try and insert the tooth back into the tooth socket as soon as possible. If this is not possible, store it in sterile saline, milk, coconut water or green tea. Do NOT store the tooth in water, alcohol or antiseptic solutions – and don’t wrap it in a tissue or a towel. It is also not a good idea to let the child keep the tooth in his mouth, because it can easily be swallowed. See the dentist as soon as possible. The likelihood that the tooth will survive is reduced the longer the tooth is out of the mouth.

reinserting a tooth: what to do if your child chips breaks or knocks out a tooth

Home management of minor mouth injuries in children

Minor injuries to the mouth or lips often bleed and can frighten the child (and parents!). To stop the bleeding, apply pressure for about 10 min. It is normal to still have a small amount of blood-tinged saliva afterwards – it will usually heal within 3 days.

Hygiene and diet after a tooth injury

After an injury to the mouth or teeth, continue to keep it clean. This includes brushing twice a day with a soft toothbrush. Occasionally a mouth rinse will be advised to aid in cleaning if rushing is not possible. Have a soft diet for a few days afterwards and if possible chew on the opposite side of the injury.

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Potential complications and concerns after tooth injury in a child

Most of the time healing occurs quickly and all is well but this will depend on the promptness of treatment and regular follow-up. But in some cases, complications can occur, including:

Damage to a permanent tooth: 

This includes complete loss of the tooth, discolouration of the tooth, or sensitivity to hot or cold. If it was a permanent tooth that was successfully placed back into the socket, it will often require a root canal treatment and placement of a crown.

You might notice that the damaged tooth turns grey or brown shortly after trauma. Think of the discolouration as a bruise – the increased blood flow to the broken vessels in the tooth leads to the greyish tinge. Sometimes it will fade, but many times the tooth will stay darker. Keep watching the tooth for signs of trouble but even if the colour doesn’t fully return, the tooth could be perfectly healthy, and with good oral hygiene will remain that way.

In other cases, the pulp (nerve) can die as a result of the injury and the reduced blood flow to the tooth. An abscess might form. This is painful and your treatment choices are either a root canal treatment or an extraction and consideration needs to be given to the expense and trauma that the child needs to go through.

Signs of a tooth abscess:

  • High fever
  • Gum and facial swelling
  • Pain

An abscess is a medical and dental emergency and the infection can spread and infect tissue throughout the body. Treatment will most likely include a round of antibiotics to clear the infection and will be followed by either a root canal treatment or an extraction.

Scarring: 

Wounds to the mouth or lips may heal, but leave a scar. Unfortunately, tears to the tongue might not always heal properly and can affect speech and swallowing.

Infection: 

Either of the teeth or gums following an injury.

Preventing tooth injuries in children

  • During sports activities a custom made mouthguard can be worn. Consult with your dentist or hygienist to have one made for your child.
  • Don’t allow children to run with objects in their mouths.
  • Always let a child sit down while eating or chewing.
Sarie Liebenberg, dental hygienist and lecturer
Sarie traded a glamorous career as a lecturer at a finishing school for a new adventure as a dental hygienist and lecturer when she went to university to retrain at the age of 31. Sarie found her passion in helping people, saying ‘it’s much more than working on someone’s mouth, it’s restoring confidence, creating opportunities and being part of making it all happen, not only for the patient, but also for myself.’ A mom of one herself, Sarie has a special interest in working with children.