Charity Snyder, mom to boys C.J. and Jared, can still remember three-year-old Jared pretending to be Evel Knievel and hitting the table with a closed mouth. "He ended up bumping his tooth, and after a call to the doctor he told us to watch so that it didn't get wigglier," recalls Charity. In cases where a child is injured and the situation is not life threatening, Dr. Lee says parents should first examine the face and mouth with clean hands to evaluate the situation.
Symptoms: Check your child's mouth for bleeding and swelling. A tooth may be loose, bumped out of place, or misplaced.
Treatment: "Use a clean washcloth pressed on any bleeding sites and gently clean dirt or debris from the injured area," advises Dr. Lee.
When to Call the Doctor: "If the parent sees the child fall or get hit in the mouth and they get up crying and the worst injury appears to be oral trauma, then the person to call first is the family dentist," says Dr. Lee. "If the parent or guardian is not sure about the extent of injury or wasn't present when the child was injured, a call to the child's pediatrician could help steer the parent to the proper place of treatment. The pediatrician will ask questions about how the injury occurred and how the child is responding and will be able to triage the situation when things are not clear," adds Dr. Lee.
If the child's tooth is out, parents of older children (who aren't at risk of choking on the loose tooth) can either place it back into the socket, assuming it is free of dirt or debris, or bring the tooth to the dentist with the child. "Preferably the tooth will be in a small container with [your child's] spit, or some milk or water" (in descending order of preference), adds Dr. Lee.
At that point, a pediatric dentist will try to replace the tooth in the socket and splint it into position with the other teeth. Dr. Lee explains that a tooth's response can be unpredictable after trauma. "Many permanent teeth need root canal therapy, and most of the primary teeth either require pulpotomies (removal of nerve tissue) or removal sometime after the injury."
Dr. Lee also says, "It is important to try and save the tooth because premature tooth loss allows shifting of other teeth and severe orthodontic and esthetic problems can result if a tooth is removed and a space maintainer is not placed. My best advice is to call the family dentist immediately and never ignore a trauma problem," she adds.
Injuries to teeth often require several visits for an in-depth look at the problem with X-rays and examinations as well as close monitoring of the situation.
Prevention: Monitoring your children during playtime and discouraging rough play decrease chances of injury. Dr. Lee adds that mouth guards can protect teeth and gums during sporting events. "Your dentist can advise you about the type of mouth guard best suited for the sport your child is involved in—they vary depending on sport, age of child, and level of physical contact. Research has shown that a well constructed and excellent fitting mouth guard can not only save teeth, but also can lessen the severity of head injuries during sports play," says Dr. Lee.