How to Deal With Child Tooth Trauma: A Guide for Parents (FREE Download)

Dental trauma can happen to anyone at any time, but it’s especially common with children. With so much energy and so little coordination, accidents are bound to happen—and as any parent can tell you, they absolutely do! 

Yet despite how common child tooth trauma is, few parents or caregivers know what to do if a child knocks out a tooth. Should you rinse it off with water if it gets dirty? Where do you keep it until you’re able to get help? Can the tooth even be saved? These are all great questions, and knowing the answers can not only help you keep calm when it happens, but also quite literally make the difference in saving your child’s tooth.

So let’s spend some time talking about what to do if you or your child knocks out a tooth, including the exact steps you should take and the most important points to remember to ensure the tooth can be saved. My hope is that this information will empower you to act with confidence and be able to give your child the support and care they need!

A Tale of Child Tooth Trauma

Before we talk about what you should do when your child knocks out a tooth, let’s start by having a discussion about what NOT to do! To demonstrate, let me share a tooth story about a young boy who avulsed his tooth (avulsion is when a tooth is completely dislodged from its socket). 

I like telling this tooth story because it provides a great example of the exact types of decisions that parents (and sometimes dentists) make that, unfortunately, negatively impact the outcome of the tooth. The point is not to scare or shame you, but rather to show you why I’m so passionate about sharing this vital info with parents like you!

The Scene of the Accident

Our child tooth trauma story begins with two young boys doing what children do best: play! They were playing some game, spinning around and around, when suddenly one of them let go. BAM! The other boy’s face hit the ground and knocked out tooth #8, which is the incisor in the upper right side of the mouth.

As you can imagine, the injured boy’s mom was frantic. Her first thought was to put the tooth back in his mouth, which was actually a good call! (We’ll talk about why later.) But when she couldn’t find a dentist to see her son on the same day, she was worried he might accidentally choke on the tooth while sleeping. Ultimately, she decided to take it out and place it in milk overnight, hoping it would sustain the tooth until they could get some help.

Unfortunately, when the boy’s mom tried to put the tooth back in his mouth the next morning, a clot had already formed in the socket, preventing her from securing the tooth in place. So she put it back in some milk and headed to see the dentist with her son later that day.

The Dentist’s Office

When the boy and his mom got to the dentist’s office, the dentist reimplanted the tooth and splinted it in place with ortho wire (the same kind of wire used in braces). Then, they sent the boy home and scheduled a follow-up appointment a month out in order to see if the tooth had healed on its own.

SPOILER ALERT: It didn’t!

Instead, when the boy returned a month later, his radiograph looked like this:

Do you see the shadows where the arrows are pointing? Those are evidence of inflammation and bone loss. That poor boy!

It was at this point that the boy was referred to my office for evaluation and treatment, because when inflammation and bone loss like this are present, it means that bacteria has entered the tooth and a root canal is needed.

Fortunately, we were able to start the boy’s treatment right away. We immediately removed the splint, cleaned out the bacteria from the tooth’s canal, and then medicated the tooth so we could address the infection before proceeding with the rest of the treatment.

What Went Wrong?

While I’m so grateful that we were able to save this boy’s tooth, I still get fired up thinking about how much stress and suffering he and his mom could have avoided if things had been handled differently. This is why it’s so incredibly important to educate both parents AND dentists about what to do in the case of child tooth trauma! 

But rather than simply vent my frustrations, I prefer to use these kinds of missteps as learning opportunities. When we know better, we do better, right? So, let’s talk about exactly what went wrong in this scenario before moving on to what you should do instead if you find yourself in a similar situation.

Issue #1: The Tooth Was Out of Its Socket for Too Long

When your child knocks out a tooth, the most important thing to understand is that time is of the essence. When a tooth is out of its socket for too long—any longer than an hour—the chances of saving it decrease dramatically. Therefore, the best thing to do is exactly what the boy’s mom tried to do in the first place: put that baby right back in place!

Unfortunately, though, because they weren’t able to see the dentist the same day and she was concerned her son might choke on the tooth, she backtracked and placed it in milk instead. Now, had it only been for a short time, this actually would have been a good call. Low-fat milk or a Hank’s sterile saline solution (which is different from the kind you use for contact lenses!) can sustain the tooth if you’re not able to put it back in its socket right away. The problem is, it only buys the tooth about 6 hours—far shorter than the amount of time that passed before the boy and his mom could go to the dentist.

Now, let me be clear: This is not the mom’s fault! She had some great instincts and did what she thought was right at the time. The responsibility here falls on us dental professionals to educate parents on what they should do in the case of child tooth trauma. Education goes a long way in preventing mistakes like this from happening.

Issue #2: The Splint Was Done Incorrectly

Another misstep that led to the tooth becoming infected was the way the dentist chose to splint the tooth. Unfortunately, the material they used for the splint—ortho wire—keeps the tooth too tightly in place. A better choice of material would have been a monofilament fishing line, which allows for some movement of the periodontal ligament, or the fibers that attach your tooth into the bone. In addition, the dentist should have only splinted the tooth for about two weeks—definitely no longer than four. Giving the tooth some flexibility and splinting for a shorter period helps prevent inflammatory resorption like this boy experienced here. 

Issue #3: The Root Canal Was Delayed for Too Long

The final issue that contributed to the boy’s condition was that there was too long of a delay before the root canal treatment. Had the dentist done the root canal in 10–14 days, they could have helped prevent the inflammatory resorption.

Now, once again, I think it’s important to mention that I don’t blame the dentist for what happened here. They clearly thought they were doing what was best for the patient. But a situation like this just goes to show how critical it is that everyone has access to information about what to do in the case of child tooth trauma.

What to Do When Your Child Knocks Out a Tooth

I think we can all agree that what happened in this tooth story wasn’t ideal. Teeth are such an important part of making someone who they are—especially in the case of a child like this one. Losing his front tooth would have had a huge impact on his self-esteem! Not only that, but the mother also underwent a lot of stress trying to figure out what to do for her son. Had she known exactly what steps to take in that situation, it would have saved everyone a lot of grief!

So, that begs the question… What would have been an ideal scenario? What should you do if your child knocks out a tooth?

Let’s walk through it step by step:

1. Find that tooth! Of course, to save a tooth you have to find it first! Unless it’s a baby tooth, in which case you can let it be, you’ll want to find it as quickly as possible. The longer the tooth spends outside of your mouth, the more it dries out, which will negatively impact the final outcome for that tooth.
2. Pick the tooth up by the CROWN. It’s extremely important not to pick up a tooth by the root, because you risk touching and damaging the periodontal ligament fibers—the tiny little fibers that anchor your tooth into your bone. They’re super important if you want to save the tooth!
3. If the tooth looks dirty, rinse it with Hank’s Balanced Salt Solution or low-fat milk. Do NOT rinse with saline solution for contacts OR with water! Water contains certain properties that can cause cell death, or necrosis, of those precious periodontal ligament fibers, which will result in the loss of the tooth.
4. If you can, put the tooth back in its socket. While it may make you uncomfortable, the best thing you can do is put the tooth back. Studies show that if you can get it back into the socket within 30–60 minutes, your body is more likely to accept it as if it never left. That said, if you’re really having trouble, leave it soaking in the sterile saline or low-fat milk.
5. Hold the tooth in place. Once the tooth is back in the socket, use gauze, a clean washcloth, or even a tissue to hold it in place—whatever you can bite down on to keep it stable for the time being.
6. Go to the dentist. Bypass the emergency room and go directly to your general dentist, who will guide you through the process of what to do next. Why? Because time is of the essence! In the time it takes to wait for a doctor at the ER, you will have lost your chance to save your child’s tooth. So head straight to the dentist—and don’t forget the tooth if it’s not already in the socket!

What happens after you go to the dentist?

Typically, when there’s child tooth trauma and the tooth is knocked out completely, the nerve gets severed, and your child will need a root canal to repair it. The dentist will schedule a follow-up appointment within 10 to 14 days to begin the procedure, and it’s extremely important you keep that and any subsequent appointments. When you defer treatment or miss these appointments altogether, your child could end up with inflammatory resorption, just like the boy in the tooth story. Not good!

So remember: Keep those appointments! They can truly be the difference between losing the tooth and saving it—keeping your child’s smile healthy and happy!

Keep Calm in a Crisis With My Downloadable Guide

When a crisis like child tooth trauma occurs, you might not have time to reference a blog post. That’s why I created a free downloadable infographic for what to do when your child knocks out a tooth. That way, you can keep calm and be prepared to act at any moment!

– Sonia