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Pediatric - Tooth Injury

Tooth injury

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First Aid - Tooth - Transport in Milk
First Aid - Tooth - Transport in Milk

First Aid - Tooth - Knocked Out
First Aid - Tooth - Knocked Out

First Aid - Tooth - Transport in Saliva
First Aid - Tooth - Transport in Saliva

  • Injury to a tooth

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
First Aid:

First Aid Advice For Knocked-Out Permanent Tooth

  • To save the tooth, it must be reimplanted ASAP (2 hours is the outer limit for survival). Right away is best. If > 30 minutes away from dental or medical care, encourage the caller to 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.

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 < 12 years)
  • SALIVA TRANSPORT OPTION 2: Put the tooth in a cup and keep tooth moist with child's saliva (spit).
When to Call Your Doctor

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) --See FIRST AID
  • 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

  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 "Call Your Doctor" symptoms.

Disclaimer: This information is not intended 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: 1/19/2009

Last Revised: 6/27/2008

Content Set: Pediatric HouseCalls Online

Copyright 1994-2009 Barton D. Schmitt, M.D.

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