What should I do if my child has a tooth knocked out?

We all wish they didn’t occur, but accidents do happen. Especially kids playing sports or playing at home. When a child gets hit in the mouth he can have his teeth knocked loose and even out. The question for parents and coaches is what to do when this happens.

First let’s talk about how teeth are held in place. Each tooth has thousands of tiny ligaments connecting the roots of his/her teeth to both the bone surrounding the tooth and to the gums. These ligaments can stretch and contract to a certain degree. Just like our ankles and wrist, our teeth can move to a certain point, and then the ligaments are over stretched or torn altogether. The gum tissue connected to the teeth by the ligaments can also stretch up to a point. This means that when a tooth is hit it can be knocked completely out of the mouth or simply knocked loose but still held in the mouth by the gum tissue ligaments. Let’s talk about what to do in each case and how to prevent the problem.

If a tooth is knocked loose but not out, the tooth will probably be OK, but a dentist needs to look at the tooth as soon as possible. Expect the gum tissue around the tooth to swell and bleed. This will go down in a few days by itself if the tooth has just been knocked loose. Have your child bite down gently to guide the tooth back into position. This may hurt a little. Once the teeth are together, have the child keep his/her teeth together for 30 minutes or as long as the child is comfortable. The gums will bleed around the tooth and clot. This clot will help stabilize the tooth. You may need to give the child a mild pain reliever.

While it may not look like a big deal it could be, the jaw itself or the bone around the tooth may be fractured. An x-ray will need to be taken to rule this out. Also, the nerve and blood supply to the tooth or teeth may have been traumatized. If this happens the tooth or even the teeth next to it may die and the dead tooth will start to turn grey and eventually may turn black, this may not happen immediately, I have seen teeth die after years of trauma. The dentist may want to splint the loose tooth to the teeth next to it stabilize it. If he is concerned about the tooth dying, he may choose to perform a root canal before the tooth dies and abscesses. But even if your dentist does a root canal the tooth may still turn dark. Don’t panic because this can be easily bleached back to its normal color. When we bleach teeth, it is common for us to also bleach the inside of a tooth that has had a root canal. If it is a baby tooth that has been knocked loose your dentist may choose to remove it at this time if the permanent tooth is close to coming out.

If the tooth has been knocked all the way out, this is a time sensitive situation. The cells around the root of the tooth will die if the tooth is not replaced in the mouth within 30 minutes. After 30 minutes, the tooth should not be placed back in the mouth. Once the tooth has been knocked out, the first thing to do is clean it. If it has been knocked out but still in the child’s mouth do NOT clean it. Just place it back in the jaw ASAP. If you cannot place it back in the jaw the best place to keep it is actually in the child mouth until you can get to your dentist ASAP. This does have some concerns though. The child may swallow it before the dentist can replace it. If the child is crying or frightened you may be better off keeping the tooth wet outside the mouth while hurrying to the dentist. Water or milk is a great solution to keep it in. Place the tooth in a plastic bag, bowl, Tupperware, etc with enough water or milk to completely cover the tooth. Remember that 30 minutes is all the time you have to get to the dental office and have the tooth replanted. Once the tooth has been replanted it will probably still die and require a root canal at some point. Your dentist will guide you on the best way to handle the tooth.

I see several cases each summer of teeth knocked out because the child was not wearing a mouth guard while playing sports. Leaving a space where a tooth was knocked out can cause problems with the remaining teeth shifting and affecting the child’s bite. This can be corrected with braces and retainers. Replacing the missing tooth is easily done but will certainly cost a lot more than a sports mouth guard.  If your child plays sports or is very active please consider having one made. It could save you a lot of money and your child a lot of pain.

Contact our office for more information on getting your child a sports mouth guard before next season.