In my dental practice, I have seen many of my school-aged patients with front teeth painfully reshaped by monkey bars, the school’s tile floor, or even another child’s head. So what is a parent to do when you get that call from the school?
TOOTH KNOCKED OUT:
If your child’s entire permanent tooth has been knocked out, hold the tooth by the crown portion and rinse the root off if it is dirty. Do NOT scrub the tooth or remove any tissue fragments. If possible, try to place the tooth back into its socket. Otherwise, place the tooth into a cup of milk or hold it in your mouth next to the cheek to try to maintain a normal pH and keep the root from drying out. If the tooth is a primary (baby) tooth, do not try to reimplant it without your dentist’s recommendation as it may damage the underlying permanent tooth that is developing. In any case, see your dentist as soon as possible! The tooth may need to be stabilized with a splint, and root canal therapy (removal of the tooth nerve) may be necessary.
If a portion of your child’s tooth has broken, call your dentist immediately to see what his or her recommendations are. A tooth that has been chipped from a hard blow to the mouth can possibly suffer unseen nerve damage. Larger fractures of the teeth may expose the underlying dentin, which can be sensitive to cold, heat, or air, or may even expose the nerve of the tooth requiring root canal treatment. Sometimes during the injury, the tooth will penetrate the lip. Your dentist will take x-rays to check for root fractures and make sure no pieces of the tooth have broken off inside your child’s lips, cheeks, or tongue.
If an injury only loosens a tooth, the tooth should still be evaluated by a dentist, even if it is just a baby tooth. Sometimes a tooth can be struck in such a way that the root or even the bone fractures beneath the gums which will make the tooth seem loose. Also, loosening the tooth can damage the nerve of a tooth. Even if no evidence of nerve damage is seen immediately, a loosened tooth will need continued monitoring over several months for the development of an abcess. Any abcess that forms over the injured root of a nerve-damaged baby tooth can potentially cause defects in the underlying permanent tooth.
For most active children, it is almost impossible to prevent accidental injuries at school, so having a dentist available you can call on a moment’s notice is critically important. Be sure your entire family has a relationship with a dentist who examines your teeth and mouth every six months and call him or her immediately after any type of tooth trauma.