Handling Dental Emergencies in Children
Dental injuries and emergencies, while often upsetting for both children and their parents, are surprisingly common. Approximately one-third of children experience some form of dental trauma, and even more encounter a dental emergency at some point.
There are two periods when children are at a higher risk for dental trauma: the toddler years (18-40 months) when they begin exploring their environment, and the pre-adolescent/adolescent years, when sports-related injuries become more frequent.
Below are some of the most common dental emergencies in childhood, along with helpful advice on how to handle them.
Common Childhood Dental Emergencies and What to Do:
Toothache
Common at all ages, usually with a cause. Trapped food can cause discomfort in young children and can be removed with a toothbrush, clean finger, or floss. If pain continues, contact the pediatric dentist. Common causes include fractures, decay, trauma, and wisdom tooth eruption (adolescence).
How you can help:
- Gently rinse the mouth with warm water. Avoid applying medication or heat to the affected tooth or gums.
- Check for and carefully remove any trapped food.
- Apply a cold compress to the area to reduce swelling.
- Contact the pediatric dentist for guidance.
Dental avulsion (knocked-out tooth)
If a permanent tooth is completely knocked out, immediate contact with the pediatric dentist is crucial. Replanting baby teeth is generally not attempted to avoid damaging the developing permanent tooth. However, replanting permanent teeth is usually attempted unless there is irreparable damage. Success is much higher if done within one hour.
How you can help:
- Find the tooth, handling it by the crown only (avoid touching the roots).
- Gently rinse off dirt with water, without scrubbing.
- For older children, try to gently place the tooth back in its socket or have them hold it in their cheek pouch. For younger children, place the tooth in a glass of milk or saliva (do not try to reinsert it to prevent swallowing).
- Keep the tooth moist during transport.
- Seek immediate care from the pediatric dentist (if possible) or the nearest Emergency Room – time is critical.
Dental intrusion (tooth pushed into jawbone)
Sometimes, trauma forces a tooth upwards into the jawbone. Less severe intrusions (under 3mm) have a better outlook, but each case is different. The impact can injure the tooth's supporting ligament and fracture its socket. Immediate contact with the pediatric dentist is essential for both baby and permanent teeth. Treatment may involve waiting for natural re-eruption or root canal therapy.
How you can help:
- Rinse the child's mouth with cold water.
- Apply ice packs to the affected areas to reduce swelling.
- Offer age-appropriate pain relief like acetaminophen (Tylenol).
- Contact the pediatric dentist if possible, or go to the Emergency Room.
Tooth Luxation/Extrusion/Lateral Displacement (Tooth Displacement)
Displacement can be a luxation (tooth remains in socket but at an odd angle), extrusion (tooth partly out of socket), or lateral displacement. Baby tooth extrusions may heal on their own, but displaced permanent teeth need dental treatment to save the tooth and prevent infection. Contact the pediatric dentist immediately if displacement is suspected.
How you can help:
- Apply a cold, moist compress to the affected area.
- Offer age-appropriate pain relief (e.g., Children’s Tylenol).
- Contact the pediatric dentist immediately.
Crown fracture
The visible part of the tooth is often injured. Fractures range from minor enamel cracks (not urgent) to pulp exposure (immediate treatment needed). A pediatric dentist can assess severity with X-rays. Any change in tooth color (pinkish or yellowish inside) is an emergency. Minor fractures may need sealant, while severe ones may need pulp treatment. Contact the pediatric dentist for any crown fracture, as jagged enamel can irritate tissues and cause infection.
How you can help:
- Rinse the child’s mouth with warm water.
- Apply a cold, moist compress to the affected area.
- Offer strong age-appropriate pain relief (e.g., Children’s Tylenol).
- See the pediatric dentist or Emergency Room depending on availability and injury severity.
Root Fracture
Caused by direct trauma, not visible. Requires X-rays to diagnose. Treatment depends on the fracture's location and the child's discomfort, ranging from monitoring to extraction.
How you can help:
- Apply a cold, moist compress to the affected area.
- Offer age-appropriate pain relief (e.g., Children’s Tylenol).
- Contact the pediatric dentist.
Dental concussion
A tooth that's been hit but not dislodged or fractured. Common in toddlers, it can cause temporary or permanent discoloration. Unless the tooth turns black or dark (indicating it's dying and may need root canal), it's not usually an emergency.
Injured cheek, lip or tongue
For cuts or bites causing bleeding, apply firm, direct pressure with a clean cloth or gauze. Use ice to reduce swelling. If bleeding is uncontrollable, go to the Emergency Room or call for immediate medical help.
Fractured Jaw
If a broken jaw is suspected, go to the Emergency Room immediately. Keep the child still and gently secure the jaw (e.g., with a scarf tied around the head and jaw for young children) to prevent movement.
Head injury/head trauma
If the child has experienced head trauma, go to the Emergency Room immediately to rule out serious complications, even without loss of consciousness.
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