For a knocked-out permanent tooth: hold it by the crown, rinse it gently, put it back in the socket if you can, and reach a dentist within an hour. A knocked-out baby tooth is never replanted. Call us either way.
Dental emergencies with kids are rarely convenient and almost never calm. What follows is the short version you can act on now, organized by what actually happened, plus what our team will do once you reach us.
Anything involving uncontrolled bleeding, facial swelling, a knocked-out permanent tooth, or a child in pain that will not settle should be treated as urgent. Most everything else can be stabilized at home and seen the same or next day.
A suspected concussion, a possible broken jaw, an injury with loss of consciousness, or bleeding that cannot be controlled belong in an emergency room before a dental office. Teeth can be dealt with afterward. Head and airway injuries cannot wait.
A small chip with no pain, a lost filling or crown, a loose baby tooth, food wedged between teeth, or mild sensitivity after a fall. Call anyway so we can decide together rather than leaving you guessing.
Pick the tooth up by the crown, not the root. If it is dirty, rinse it briefly with milk or saline, or water if that is all you have. Do not scrub it, and do not dry it. If your child is old enough to cooperate, slide the tooth back into the socket and have them bite gently on a clean cloth. If replanting is not possible, transport the tooth in cold milk, or in your child's own saliva. The first hour matters more than anything else you will do.
Do not put it back. Replanting a knocked-out baby tooth risks damaging the permanent tooth developing underneath. Control the bleeding with gentle pressure and call us — we will check whether a space maintainer conversation is needed so the neighboring teeth do not drift.
Baby teeth are smaller, whiter and have short, often partly dissolved roots. Permanent teeth are larger with a long, solid root. If you are not sure, act as though it is permanent, keep it moist, and bring it with you.
The four injuries we see most, and what each one needs.
A chipped tooth with no pain is the least urgent: rinse with warm water, save any fragment you can find, use a cold compress for swelling, and get in within a few days. A cracked tooth, or pain when biting, needs a cold compress, soft foods and no chewing on that side, and should be seen the same or next day. A toothache is handled the same way on timing: rinse with warm salt water, floss gently in case food is trapped, use an age-appropriate pain reliever, and call sooner if there is swelling or fever.
A bitten lip, tongue or cheek usually looks far worse than it is. Clean the area, apply firm pressure with gauze and use a cold compress; call us if the bleeding is still going after ten to fifteen minutes.
Never place aspirin against a child's gum tissue, and skip numbing gels containing benzocaine for young children unless a clinician has told you otherwise. A cracked tooth that hurts on release is often a tooth that needs a crown rather than a simple filling.
We check the injured tooth and the teeth around it, look for injury to the developing permanent teeth, take an image when it is warranted, and test whether the tooth is loose, displaced or fractured below the gumline. Injuries that look identical from the outside can need very different treatment.
An injured, frightened child is not the same patient as one arriving for a routine cleaning. Our board certified pediatric dentists are trained specifically to work with kids in exactly this situation, and sedation options are available when an injury needs more treatment than a scared child can manage awake.
Traumatized teeth are watched for months, not days. A tooth that darkens weeks later, or an abscess that shows up after the panic is over, is common enough that we schedule recheck visits as part of the plan rather than waiting for a second emergency.
The majority of the sports-related tooth injuries we see happen in kids who were not wearing a mouthguard. A properly fitted guard is the single highest-value thing you can do, and it matters just as much for scooters, skateboards and trampolines as for team sports.
Our number, your child's dentist name, and the milk-not-water rule for a knocked-out tooth. Emergencies are usually handled by whoever is nearest, and that is often not a parent.
A large untreated cavity is the most common reason a child ends up in a middle-of-the-night toothache. Regular cleanings and exams catch those while they are still routine.
Swelling is the symptom we want to hear about fastest. A pimple-like bump on the gum, a puffy cheek, or a child who suddenly will not chew on one side usually means infection rather than simple injury, and infections in children move quickly.
Pain from an abscess often fades once the nerve inside the tooth dies. Parents reasonably read that as improvement. The infection is still there, and it is still spreading. Treatment for an infected baby tooth is usually straightforward when it is caught early and much less so once swelling involves the face.
Depending on the tooth and how much structure is left, options range from cleaning out the nerve chamber and covering the tooth with a crown to removing the tooth and planning for the space. Antibiotics alone do not resolve a dental infection; something has to be done to the tooth itself.
Most orthodontic problems are uncomfortable rather than urgent, and nearly all of them can wait for regular hours.
A poking wire can be tucked down with the eraser end of a pencil and covered with orthodontic wax. A loose bracket that is still on the wire can be left alone until your appointment. Rinse with warm salt water for general soreness.
A wire embedded in the cheek, a lost or swallowed appliance, or a bracket injury that came with a blow to the mouth needs an appointment. If your child is in braces or clear aligners and something breaks during a sports injury, we check the teeth and the appliance in the same visit.
Assembling this once takes ten minutes and removes most of the scrambling later.
Coaches, grandparents and babysitters are frequently the adults present when a tooth gets knocked out. The two things they need to know are: save the tooth, keep it in milk, and call. Everything else can be sorted out once you are here.
Aim to be in a dental chair within an hour, with the tooth kept moist the whole time. Milk is the best readily available transport medium; plain water is the worst.
Not an emergency, but it needs an appointment. Darkening means the tooth's nerve was affected by the injury. Some settle on their own and some need treatment, and only an exam will tell you which.
ER first for head injuries, suspected broken bones, uncontrolled bleeding or spreading facial swelling. Dentist first for isolated tooth injuries.
Call our office number and follow the instructions for after-hours emergencies. You can also reach us through our contact page for anything that can wait until morning.
