Broken Tooth? What to Do After a Dental Injury
From Halloween candy to playground falls, dental injuries to front teeth are common in children and teens. They can range from a small chip to a displaced or a completely knocked out tooth. While some injuries can wait for a dentist, others need immediate attention.
"The more severe the dental injury, the more difficult it is to manage," says Zaher Jabbour, DMD, MSc, PhD, an associate professor of dental medicine at Columbia. "But knowing what to do in the first few minutes can help protect the tooth and improve the chance of saving it. It is best to consult with a dentist as soon as possible"
Dr. Jabbour explains which injuries need what kind of care—and how to help prevent accidents in the first place.
What should you do if a tooth breaks after a trauma?
First, stay calm and look at the broken tooth. Fragments could be scattered in the surrounding area or embedded in the lip or cheek. Rinse the mouth gently with water. If there is bleeding, apply gentle pressure with clean gauze.
Call your dentist and describe what happened; they may want to schedule an in-person exam as soon as possible.
If you can find the broken piece of tooth, save it in a wet or moist environment, such as saline, milk or saliva, and bring it to the dentist. In some cases, the fragment may be useful during treatment.
A small chip may not require emergency care, but a larger fracture can expose the inside of the tooth, including the pulp, which contains nerves and blood vessels. This may cause sensitivity to temperature or touch, pain, or even bleeding.
What if a tooth is loose or has moved?
A blow to the mouth doesn't always break a tooth. Sometimes a tooth is pushed sideways, farther into the gum, or partially out of its socket.
Don't try to force the tooth back into position yourself, especially if it is a baby tooth. Contact a dentist as soon as possible. The tooth and surrounding tissues need to be evaluated, and the dentist may take x-rays and reposition or stabilize the tooth with a splint or a wire, if necessary.
Even when a tooth looks normal after an accident, it can still be injured and need periodic evaluation.
"Some damage isn't immediately visible, which is why it's important to have a significant dental injury evaluated and monitored over time," says Dr. Jabbour.
What if a permanent tooth is knocked out?
A completely knocked-out permanent tooth is a dental emergency. Ideally, try to see a dentist within an hour. Some dental offices are open for extended hours, in the evening or in the weekends. Alternatively, visit urgent care if you cannot communicate with your local dentist. Acting quickly can increase the chance that the tooth can be saved.
Pick up the tooth by the crown—the white part you normally see in the mouth—not the root.
If the tooth appears dirty, gently rinse it without removing the attached tissue surrounding it. Try to keep the tooth moist. Pharmacies have a Hank's Balanced Salt Solution (HBSS) to preserve teeth for a short period until you see a dentist. If HBSS is not available, store the tooth or cold milk; don't put the tooth in a dry napkin or tissue paper.
Never replant a baby tooth that has been knocked out because doing so can potentially damage the developing permanent tooth underneath it.
When is a dental injury an emergency?
If you are unsure whether an injury is an emergency, call your dentist or medical office. In general, seek immediate dental or medical attention for:
- a knocked-out permanent tooth
- a loose or displaced tooth
- uncontrolled bleeding
- significant facial injury
- severe pain or swelling
A child who has suffered a significant blow to the head or face should also be evaluated for a concussion, especially if there are symptoms such as blurred or double vision, loss of consciousness, vomiting, confusion, or worsening headache. For more involved trauma, consider going directly to seek emergency care.
Can dental injuries be prevented?
Not every accident can be avoided. But children who participate in contact or collision sports should wear a properly fitted mouthguard.
In terms of food, remind kids not to crunch especially hard candies, ice, or other edibles that can put excessive pressure on teeth.
Most importantly, know who to call before an accident happens.
"Have the dentist's contact information readily available and know where to seek emergency dental care. Although no one can be fully prepared for a sudden injury, a quick action and timely dental care may help protect a child's smile for years to come," says Dr. Jabbour.