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What to do in a Dental Emergency

Children find a way to get their mouth and teeth injured despite our best preventative measures as parents. It's part of growing up.

There are all kinds of dental related injuries. You can always call the dentist if you are worried, but most dental "emergencies" are not really emergencies. There are some things that are serious and need attention right away, but with most things, you can call the dentist tomorrow. Here is a guide to common concerns:

Do We Go to the ER?

Your child just fell riding his bicycle. There is lost of blood. His mouth is a mess. Who do you call? What do you do? Some oralfacial injuries are serious and some are nothing to worry about. How do you tell? Well, here are some guidelines. 

If there is lots of blood, don't panic. Any injury to the mouth bleeds a lot. Check out the situation; hold a cloth (if you can) with pressure to slow the bleeding. Most bleeding stops within 10-15 minutes whether you do anything or not. Once your heart stops racing so much and the child is not in such a state, look and see what the problem is. First, look and see is if there are facial cuts or lacerations, fear of a broken jaw, possible head trauma causing loss of consciousness (concussion), multiple knocked out and displaces teeth (and oral surgeon may need to see you at the hospital), or if you just are not too sure, then you need to go to the ER. They can stitch up any facial lacerations and take major X-Rays to check any other medical repercussions of the incident.

Now, if you don't have those bad things, you still might have a scary mess to deal with. I there is a broken tooth, the ER is not likely to be able to do much. If you go to the ER, you are likely to sit there for two hours and then they will call your dentist anyways. You can call your dentist first and he may be able to save you the trip to the ER.

Call the Dentist ASAP

If a permanent tooth is knocked out, you really need to follow these instructions carefully because you want to save the tooth. First, find the tooth. Do not scrub it clean, just put it in a moist environment like milk. CALL THE DENTIST RIGHT AWAY. He may direct you to rinse the tooth and put it back in right away. Most people don't like the idea of doing that, so your dentist can replant the tooth. It's fairly easy to do. The problem is that even thought it is back in, you probably need a splint to keep the tooth in position while it heals. It is best to get the tooth back in as soon as possible. If you can't get it back in, keep it moist in milk or water. The dentist can put it back in if it is possible to do so. After several days the tooth will need a root canal to remove the now dead inside part of the tooth. There is one exception in that if the tooth is very new and has not developed a full root, it might heal on its own.

If it is a baby tooth that was knocked out, just leave it out and place it under the child's pillow for the tooth fairy. It is not worth the risk to the developing permanent tooth to replant it. If you don't like the look of a space there, we might be able to make a little fixed appliance with a fake tooth, mainly or aesthetic purposes.

The ER sometimes can put a knocked out tooth back in as well, but you may still need a dentist to splint the tooth.

Other Dental Emergencies

Swollen face- Call your dentist. This may be a dental abscess that has spread into the facial tissues causing swelling. Usually, this is managed by antibiotics and removal or treatment of the offending tooth. Don't Wait to get this examined.

Broken or Chipped Tooth- Probably one of the most common concerns. This is quite common, especially in older children.

Baby Teeth- The little chips I often see in baby teeth are usually not much to worry about and can be smoothed out or left alone. Larger fractures might need a white filling to restore the lost tooth structure. If the fracture is severe, the tooth may need to be removed.

Permanent tooth fracture- I know it is quite distressing if a permanent tooth is fractured. Most of the time we can place a filling and the tooth looks good. Even if it is a larger fracture, we like to place a filling at first. It may need a crown later as the child gets older, but the fillings usually do quite well and look aesthetically pleasing. Just remember that if there is a filling there, it might get knocked off with a smaller blow than before. If the fracture is into the pulp (nerve) getting it looked at is more time sensitive. There is a greater chance that the tooth may need a root canal the larger the pulp exposure and the longer it is exposed. The younger the tooth, the more likely you may see a better recovery. Most fractures can wait until the next day to be seen and diagnosed by your dentist.

Tooth Knocked Loose- Sometimes the gums bleed more often, the tooth seems loose, but is is the same position as before. Usually needs no treatment whether it is a baby tooth or a permanent tooth. Sometimes, if it is quite loose, we might place a splint to hold it in place while it heals. This splint looks kind of like braces that are worn for a few weeks. The outcome is usually good. Sometimes a baby tooth will turn dark.

Tooth Knocked Out of Position- This is a much more serious occurrence. Usually, repositioning the tooth is desirable, preferably the day of the accident. Sometimes front baby teeth get knocked backwards so much they interfere with biting properly. Repositioning is important here and is usually treated the same day with finger pressure. Sometimes, with a permanent tooth, you can not easily reposition the tooth with finger pressure. Short term orthodontic repositioning is best for these cases. Sometimes a tooth (usually a baby tooth) is pushed up into the gum. This called an intruded tooth. If the baby tooth is intruded, less than 50% of the crown length (the part you normally can see), then it will very likely re-erupt back into position without any problems.This takes a few months. If it is pushed up where you can not see it, then it may or not not re-erupt and may need some additional treatment, even if it does. If it does not come back down, it may need to be removed. Sometimes there is such damage that it is best to remove the tooth and not wait for re-erruption if you think it may be harmful to the permanent tooth. The act of knocking the tooth up there may damage the developing permanent tooth bud. You never really know until the new tooth comes in what actually happened. Usually nothing happens, but the worst you may expect is some kind of blemish or spot (fixable) on the permanent tooth.

Other Bumps and Traumas

The mouth has a really good supply of blood and therefore bleeds tremendously when it sustains a trauma. The good news is that good blood supply usually means rapid healing. Sometimes stitches are needed and most of the time they are not. It depends on the severity and location. A "busted lip" will swell quite substantially, but will usually heal on it's own.

* If a young child has hit his mouth, and there is a substantial amount of blood, especially on his upper teeth/lip area look and see if it might just be a torn maxillary frenum. That is the little piece of tissue that connects the upper lip to the gum between the two front teeth. If it was tight and gets hit and stretched too much it will tear. It bleeds a lot at first, but will likely surpass after 20 minutes or so. Usually no stitches are necessary. In fact there may be no treatment needed at all. This is a very common injury in preschoolers.

Bottom line on all injuries is to see your dentist to get information that is specific for your child.

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