Trauma to baby teeth is no fun, and yet it's a part of almost every toddler's life. As little ones become mobile and learn how to cruise, walk, run, and jump, they are bound to injure their mouth and teeth at some point, and usually even more than just once. It's always hard as a parent to see your baby injured, especially when there is a bloody mouth involved, but never panic. Comfort your child, know what what you're looking for, and seek professional help when appropriate. Here's a little guide on trauma to baby teeth and what to do.
Let’s start with the most extreme case. This is the one that’s most likely to almost give you a heart attack. Thankfully this doesn’t happen often, but it’s important to be prepared if you find yourself in this situation.
Occasionally, the force from a fall or some type of blow to the mouth is substantial enough to cause a tooth to get knocked out of the mouth completely. The official term for this is avulsion. As startling as this is, don’t freak out. This only makes the situation worse for you and our child. Stay as calm as you can, and if there are other associated injuries that have created a bloody mess, deal with the bleeding first. The best way to stop bleeding is to apply firm pressure. If you can quickly cleanse the area with some water to get a better look at the source of the bleeding, that’s great, and then just grab a washcloth and try your best to press down at the source. Pro tip here: avoid a white washcloth, because it will seem like there is a lot more blood than there really is, and that will make the whole situation more unnerving for you and your child. Have a few dark washcloths in your house for any “special occasions” like kiddie injuries.
Once you’ve calmed and comforted your child, look around and see if you can find the tooth. The reason this is helpful is to establish for sure whether the tooth actually was knocked out, or if it was actually completely pushed up into the gums, which CAN happen. It’s not as common, but it’s possible, and if you can’t find the tooth, a dental x-ray will be needed to check for a possible complete intrusion (disappearance of the tooth into the gums). The other option (again, rare!) would be that the tooth was actually swallowed or inhaled (aspirated). If you cannot find the tooth, all those options need to be ruled out.
If you’re able to give your child some Children’s Motrin, that’s really great, because it will help with pain and also with the inflammation that will follow, and this way you can reduce the swelling a little bit. The lip tends to get pretty swollen in most instances of oral trauma.
No, no, no! Do NOT re-insert the knocked out baby tooth back into the empty socket. This is so important! It’s worth saying it again. Please do NOT put a knocked out baby tooth back into the tooth socket.
With a permanent tooth, you would want to (and you'd want to do so asap), but with a baby tooth, it’s a big no-no, because you will be putting the developing, immature permanent tooth at great risk of developing a defect, so it's not worth it. Also keep in mind that the nerves and blood vessels that connected the tooth to the surrounding bone have been ripped apart, so the baby tooth itself will not be vital if re-inserted. It will be a dead tooth, and it will become a source of infection.
Quick side note: why is it ok to re-insert a permanent tooth and not risk infection? A re-inserted permanent tooth will need something called "root canal therapy" within 1-2 weeks of re-insertion. The dead nerve tissue from inside the tooth is removed and replaced with a specialized filler material. This procedure is most typically performed by a different type of dental specialist, named an endodontist.
So whether you find the tooth or not, set up an appointment with a pediatric dentist. Why should you specifically see a pediatric dentist? We have years of additional and specialized training in all things relating to oral and dental issues in children, and we all have dealt with tons of trauma in our residencies. Pediatric dentists are best equipped to handle this type of situation and the required follow-up care. You want someone skilled and knowledgeable handling your child’s trauma, both the clinical aspects, as well as the emotional ones .
Now why didn’t I say to call a pediatric dentist right away before you do anything else? You could certainly call right immediately after the accident, but it’s also important to give yourself and your child the chance to calm down after the shock of the actual event, and since we aren’t trying to re-implant the tooth, this type of trauma is not as time-sensitive as some other types. If you don’t find the tooth, however, it’s best to be seen as soon as possible.
With a permanent tooth, every minute outside of the mouth matters, and the tooth should be re-implanted ASAP, so you’ll want to call your dental office right away to make arrangements, but with the knocked out baby tooth situation, it’s fine to take your child in for an evaluation within 24 hours, give or take, unless you're concerned about aspiration.
The 2nd type of trauma I want to review is called a luxation injury, and that means the tooth has been pushed backward, forward, downward or sideways, and it’s no longer in its original position. Depending on the severity, sometimes those teeth need to be repositioned, and sometimes they can be left alone and monitored. Repositioning is not typically a DIY project, so it's best to get your child into a pediatric dental office asap for evaluation.
Management of this type of injury is a bit more time-sensitive, as it can be hard to reposition a tooth when a big blood clot has formed. There can also be associated fractures in the surrounding bone, which adds a little bit of complexity to the management. Luxated teeth that are manually repositioned will need to be splinted for several weeks, and the splint will later need to be removed, so this would require quite a bit of cooperation on the part of the child. It’s not always realistic to do this even if, in the ideal world, we’d like to. Some types of luxation injuries may reposition themselves over time even without any intervention.
Giving your child some Children’s Motrin is always a good idea. You’d also want to reassure them and let them know everything will be ok. Try to avoid speculating or setting any expectations as to what will or won’t be done at the dental office visit, but try to instill confidence that you’re taking them to someone who will know what to do and how to help them get better.
Lastly, and this is by far the most common scenario, is getting a chipped tooth, which can range from minor and barely noticeable, to significant, and even include nerve exposure. The minor versions of this type of trauma happen left and right. The little chips tend to happen without any type of major accident. They can easily be the result of biting down on a metal utensil or a hard plastic toy, or any number of otherwise seemingly harmless things.
A more significant chip tends to happen from a fall or a run-in with something or someone, and the management there is highly dependent on several factors. Those factors include how much of the tooth broke off, whether there is nerve exposure, whether there are sharp edges to worry about, your child’s age and expected cooperation for treatment, and so on. The actual intervention options, therefore, are very case-specific, but again, a pediatric dentist can review appropriate options and help you.
It’s VERY COMMON to see discoloration of baby teeth after trauma. The colors can range from pink, to gray, to brown, or even to yellow. Discoloration within days or a couple weeks after trauma without any other issues is not necessarily cause for concern. However, if there are other signs or symptoms indicating the tooth is not able to recover from the trauma and to remain healthy, then some follow-up care is needed. Examples of other signs or symptoms here would include painful chewing/biting or a loose tooth that does not "tighten back up".
A yellow discoloration, or “a golden tooth”, as I like to call it, typically has a fairly good prognosis. The other colors are a little bit more iffy and require more careful monitoring.
Also, keep in mind that we get quite a bit of information regarding the health of teeth from dental x-rays, which is another reason you’d want to seek professional help in cases of trauma. It's helpful to look at a baseline image shortly after trauma and use that to compare and monitor for unfavorable changes going forward, so that timely intervention can take place if needed.
On a final note, in just about any case of trauma, there’s always something that you need to regularly monitor at home, and that is the possibility of abscess formation. An abscess is a localized infection that would develop if the nerve tissue inside the tooth ultimately dies (as a consequence of the trauma incident). Sometimes this happens a few weeks after the injury takes place; sometimes it takes years. And, of course, just because a tooth has been traumatized once, doesn’t mean it can’t get traumatized again. Repeat trauma in young kids is also pretty common. The more often a tooth gets injured, the more likely it is that the nerve inside just won’t survive.
The best way to check for an abscess (localized infection) is to lift up the lip and look for something that would look like a bubble or a pimple on the gums above the tooth/teeth that sustained the injury. If that happens, the next step is usually extraction, aka “giving the tooth to the tooth fairy”. As undesirable as that may sound, it’s something we can usually take care of pretty easily in our office. Best practice in this case is typically still not to “prepare” your child that the dentist will remove the tooth, because that can be a very anxiety-provoking concept. Please let us gently explain the procedure to your child with our modified vocabulary.
If your little one has had trauma, we can help. You can call our office and set up an appointment by talking to one of our friendly team members, or you can schedule directly online by clicking the “Schedule Now” button on our website. Trauma can be unnerving, but we are well equipped to help and (metaphorically) hold your hand to get you and your little one through it.
In Health and Happiness,
Dr. Bana Ball
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