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Children are prone to accidents. The American Dental Association (ADA) estimates that one three boys and one in four girls will have suffered a traumatic injury to their teeth by the time they graduate from high school. In babies, tooth crowns are a lot longer than the tooth root. This is why baby teeth are a lot easier to knock out, and why a lost primary tooth often looks worse than it actually is. When your child comes to you with a bloody mouth and a completely knocked out (avulsed) baby tooth, do not panic. The last thing you need is to inadvertently damage your child’s mouth. Instead, stay calm and get informed.
Steps to take if your child knocks out a baby tooth
Here is what you need to do:
- Control the bleeding using a clean cloth and firm pressure
- Locate the tooth and handle it only by the crown
- Store the tooth in a container with a balanced salt solution
- DO NOT try to reinsert the tooth
- DO NOT try to clean or handle the tooth unnecessarily
- Contact the dentist as soon as possible
- Provide over-the-counter pain medication if your child requires it
Why an avulsed baby tooth is a dental emergency?
The immediate visit to the dentist is for pain and bleeding, and not usually for the tooth itself. Other damage caused by the fall, or accidental aspiration of the tooth, is far more urgent. The biggest concern is not to save the baby tooth, but rather to check the condition of underlying permanent teeth and take steps to maintain the space of the missing tooth if necessary. This is why you can get treatment for an avulsed primary tooth up to six hours after the accident and not change any long-term outcomes.
Studies show that if a baby tooth is knocked out after age five, there is an 18% chance it will impact the permanent teeth. If however, it happens before the age of two, there is a 95% chance the loss will affect the development of underlying permanent teeth. As such the treatment for an avulsed tooth largely depends on age and the stage of tooth and dentition development. It also depends on the willingness and ability of the child to cooperate during treatment. A few treatment options follow:
Manage bleeding and pain
Avulsed primary teeth are not managed the same as adult teeth. Out of concern for development of permanent teeth, a baby tooth will not usually be reinserted. If the child is close to six years old, and the deciduous tooth is already loose because the permanent tooth below, then you might simply welcome an early visit from the tooth fairy. A child’s mouth tissues and gums should heal remarkably fast. That said, still visit the dentist to make sure there is not extensive damage.
When you call your dentist he or she may tell you to come in for an x-ray. This helps the dentist determine if there is damage to the nerve, bone, or secondary tooth. The dentist also checks for any fragments from the missing tooth that might affect the development of secondary teeth. As long as the trauma is not severe, then the secondary tooth should erupt normally. You only need to mitigate pain and bleeding. The dentist will likely suggest you put your child on a soft diet for 2 to 3 days and continue with over-the-counter pain medicine.
Re-implant avulsed baby tooth
Posterior teeth (molars) hold a space for developing permanent teeth. If your child loses a primary molar prematurely, he or she is more likely to require orthodontic treatment later. If your child is three years old or younger, and would have to wait a few years for permanent teeth to come it, re-implanting an avulsed anterior tooth might be the best option. This treatment is something only a dentist should do, and only after you discuss the risks and benefits of treatment.
The dentist considers age and development, as well as how you stored the avulsed tooth and how it was transported to the treatment site. To save a baby tooth you must immediately store it in a balanced salt solution, like Save-a-Tooth, or milk if that is what you have on hand. Then get an emergency dental appointment as soon as possible. If you wait more than two hours the root cells on the outside of the tooth will die and the dentist will not be able to re-implant the tooth.
If you choose to re-implant the primary tooth the dentist can shorten the root and reduce the risk of damaging the developing teeth. But as with any surgery, re-implanting the tooth may cause infection, which could spread to the secondary tooth. It could also interfere with the timing, development, and projected path of a permanent tooth.
Pediatric partial (false baby tooth)
Other factors to consider include jawbone growth and speech development. If the baby’s canines have not come in, premature tooth loss can make the jaws smaller. In turn, this makes it more difficult for permanent teeth to erupt. In these cases the dentist might use a space maintainer to hold the place of the missing tooth. Or, if your child loses incisors (four front teeth) too soon, it can impede speech development. On these rare occasions the dentist might use a pediatric partial to replace lost primary teeth. Partials are difficult though, because there is not much space between the gums and teeth. Also children are rough on teeth. Many times the fake teeth get broken, causing more harm than good. This is why dentists will not use pediatric partials just for appearance’s sake.
If your child knocks out a baby tooth contact your dentist immediately. Most will have emergency contact information you can use for just such occasions. If you cannot get in touch with your dentist take your child to a pediatrician or to the emergency room—especially if you cannot find the missing tooth. Your child may have swallowed or aspirated (breathed in) the tooth, which is cause for concern.