Dental injuries are common. In young children, they can be due to poor coordination and falling. In older children, car and sporting accidents are more common. Dental injuries can range from a small chip to knocking a tooth out of its socket. Every parent should know beforehand the steps to take should their child's tooth become injured or knocked-out. Knowing ahead of time how to properly care for a knocked-out tooth and knowing which injuries require immediate attention can affect how salvageable a tooth is and what treatment options are possible.
A chipped tooth is when only the enamel, the white, outer-most layer of the tooth, has been broken off. The tooth should have no increased sensitivity because the tooth's living tissue, the pulp, has not been injured. If the tooth's edges are sharp and uncomfortable, dental wax can be applied until a dentist can be seen. Depending on how much of the tooth is chipped, a crown or cap may be necessary for aesthetics and function. Your child's dentist should be called but most likely an urgent visit is not necessary and an appointment in the next day or two should be fine.
A tooth fracture is when a larger part of the tooth has been lost. Under the enamel is a yellow layer called dentin. The enamel and dentin surround the living tooth tissue, called pulp. A serious tooth fracture exposes dentin and possibly pulp. Fractures to both permanent and baby teeth require a dentist's evaluation as soon as possible. When a baby tooth is fractured, the goal of treatment is to minimize damage to and preserve the developing permanent tooth.
When a tooth is loose following an injury or is knocked in, or to the side, a dentist should be called immediately. These injuries can cause damage to the tooth's ligament, its socket or, in the case of a baby tooth, to the immature tooth below. Treatments may include repositioning, splinting or extraction. If repositioning the tooth is possible, it should be done as quickly as possible.
The most serious injury is when a permanent tooth has been knocked out, or avulsed. For the best chance of salvaging the tooth, it should be re-implanted in less than five minutes. Do not handle the tooth by the bottom, or root. If necessary, rinse the tooth but do not scrub it clean. Place the tooth back in its socket as quickly as possible. Hold the tooth in place while going immediately to the dentist or ER. If you are unable to re-implant the tooth, due to extensive injury either to the jaw or tooth, place it in a glass of milk as soon as possible. If milk is unavailable submerge the tooth in saliva. The guidelines advise that the tooth be submerged in liquid, in less than fifteen minutes. Survival of the tooth depends on the extent of injury and how quickly the algorithm is followed. Baby teeth should not be re-implanted as it can damage the developing tooth below.
Reacting quickly to dental injuries will ensure the greatest chance of salvaging the tooth. Parents should discuss with their child's dentist what they should do in the case that a dental emergency occurs when the office is closed. Your dentist may have an on-call service or may refer you to a local ER that has an on-call dentist. Knowing before hand who to call and what to do will allow you to remain calm and to provide the best care until a dentist is seen.
For more information regarding dental injuries and treatment decisions, The American Academy of Pediatric Dentistry provides a wonderful comprehensive article on their website.