Ask the Pediatrician: Dr. Molly

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Category: Teeth

With tooth injuries, know when to call the dentist

Injuries to teeth are common in childhood. When the injury occurs it can produce permanent damage even if the tooth is a baby tooth. Here are the four major kinds of dental trauma and how to manage them:

• Chipped tooth: Most of the time this is not a concern. As long as the tooth (whether a baby tooth or a permanent tooth) doesn't hurt, the most that needs to be done is to see the dentist in a few days to have any sharp edges buffed or in the case of a permanent tooth to have a dental restoration done for cosmetic reasons. If the tooth is painful or sensitive to heat or cold, the pulp of the tooth could be damaged and exposed. If it is an adult tooth a root canal with a cap is done; if the tooth is a primary tooth, it needs to be removed within a couple of days. Either way, a chipped tooth is not a dental emergency. You can call your dentist in a day or two and be seen. If there is no pain and the edges of the chip aren't sharp, a baby tooth requires no treatment at all.
• Loose tooth due to trauma: When injury results in a loose tooth, significant trauma to the root may have occurred and a trip to the dentist within a day or so makes sense. If there is a question of trauma to the jaw bone, a trip to the emergency room is warranted. When you go to the dentist the next day, she will take an X-ray of the area and look for evidence of fracture. Some fractures need fillings or root canals while others need splinting (in the form of short-term braces) to ensure the tooth stays in good alignment while it heals. Primary teeth that are injured but don't require removal may turn gray after a week or so but this is not an indicator that the tooth needs to be removed.
• Tooth intrusion or "jammed tooth": When the trauma has resulted in a primary or baby tooth being displaced primarily upward, the dentist should be seen within a day to assess whether or not the permanent tooth has also been damaged. Sometimes the traumatized baby tooth will just descend back into place, but if it is potentially damaging the permanent tooth it may need to be extracted. If the jammed tooth is a permanent one, seeing the dentist within a day or so is also important to assess the damage to the tooth and determine if it can just descend on its own.
• Tooth avulsion or "knocked out" tooth: If the tooth knocked out is a permanent tooth, this is a true emergency. If you have the tooth, rinse it with water and jam it back in and dash to the emergency room for further treatment. If you are too squeamish to jam it back in or if that is just too painful, put the tooth in milk and dash to the emergency room. If you don't have milk handy (and frankly it isn't likely that you will have milk at your sporting event in your water bottle) have the injured person keep the tooth in his mouth in the pouch of his cheek and head to the ER. If the tooth knocked out is a baby tooth, these are never replaced. Just assess whether there is any additional trauma to other nearby teeth or bones and plan on the Tooth Fairy visiting later that night.

The bottom line is that the only dental trauma that mandates an emergency room visit is a knocked out permanent tooth. All other dental trauma can be managed by your dentist the next day.