Knocked-out tooth
If a permanent tooth has been knocked out, it is optimal to get the tooth re-implanted within 30 minutes if possible.
Here is what to do:
• Hold the tooth by the crown, not the root. Do not try to clean the tooth or handle it unnecessarily.
• If the tooth is not dirty or fractured, put it back in the socket and have the child keep it there by biting on gauze or a clean cloth. Do not worry if you do not place it exactly right, because it is better to be in the socket than not.
• If the tooth is dirty, fractured, or if you can’t get it in the socket, put it in a cup with milk or the child’s saliva, and take the child and the tooth to the dentist as quickly and safely as possible. If the child is old enough, he can keep the tooth in his mouth to transport it.

While having a permanent tooth re-implanted within 30 minutes is the best course of treatment, there are many documented cases of successful re-implantations after the tooth has been out for a longer period of time. If, for any reason, you cannot make contact with our office within 30 minutes, or you are out of town, follow the instructions above and go to your nearest emergency room.

If a primary or baby tooth has been knocked out, we do not recommend saving it. Trying to re-implant a primary tooth creates too great a risk to the forming permanent teeth. We recommend that you take your child to the dentist as soon as possible to make sure that no additional damage has been done to other teeth or the jaw from the impact that knocked out the tooth.

Chipped or fractured tooth
If a tooth has been chipped or fractured, it is important to bring your child to the dentist as quickly as possible to evaluate the trauma, regardless if the tooth is primary or permanent. With a chip or a small fracture, the protective hard enamel of the tooth has been compromised, and it is possible for bacteria to enter the pulp and nerve of the tooth and cause infection. The tooth must be sealed to keep the bacteria away. For a larger fracture, the pulp may be directly involved and immediate treatment is required to maintain to vitality of the tooth. In most cases, the tooth is not completely restored after trauma as the objective is to protect the tooth from bacteria and to allow it to heal. After several weeks, another appointment is made to place an esthetic and functional restoration for the affected tooth. However, in situations where the displaced tooth fragment is available, the dentists can often bond it back to the broken tooth at the initial emergency appointment. This option is always preferred by the child, the parent and the dentist! So, if you are able to locate the tooth fragment, put it in a cup of milk or the child’s saliva and bring it with the child to the dentist's office.

Jaw injury
If your child has an injury to the jaw, take him or her to the emergency room for immediate care as necessary, and come to the dentist as soon as possible. The dentist will check for fractures in the jaw
and perform a dental exam to check for secondary fractures in the teeth. Depending on the extent of the injury, the dentist may need to consult with an oral surgeon.

Cut or bitten tongue, lip or cheek
If your child has cut or bitten her tongue, lip, or cheek, there can be bleeding, swelling and discomfort.
Here are our recommended actions:
• Apply direct pressure on the bleeding area using a clean cloth.
• If swelling is present, use a cold compress to reduce the pressure and reduce the discomfort – sometimes a popsicle works well for children.
• Take Tylenol® and Motrin® at age and weight appropriate dosages to reduce the swelling and relieve the discomfort.
• Check the area to see if there is a fractured tooth with a fragment possibly embedded in the cheek or tongue. If you need help checking the area, go to the dentist as soon as possible.

Toothache
If your child complains of a toothache, it is important that you check for the cause.

Here are our recommended actions:
• Check the area for a possible source of pain, such as food impaction, an erupting tooth or a “hole” or cavity in a tooth.
• If you think you see a cavity, come to the dentist as soon as possible. An untreated cavity that is causing pain can quickly develop into an abscess, which can cause serious medical problems if left untreated.
• Try brushing and flossing to dislodge any food that may be stuck between the teeth.
• Rinse the irritated area with warm salt water and place a cold compress on the face if it is swollen.
• To treat dental pain, ibuprofen and acetaminophen (Motrin® and Tylenol®) are the primary choices. Orabase® is a good over-the-counter medication for pain related to the gum tissue. You may have heard of applying aspirin directly to gums, but please DO NOT DO THIS, as the aspirin can cause severe burns
to the fragile tissue.

If you have any questions, please call the dentist for assistance. We are available to answer your questions even after business hours and on weekends.