child's tooth knocked out

This is never a great position to find yourself. You or your child had a bad fall/was playing a sport/had one too many… and you find yourself with a tooth (or part of one) in your hand. Is this a dental emergency? Who do you call? What should you do?


Baby (Primary) Tooth:

Under the age of ~12 (or if you have a retained baby tooth), there’s a good chance that the tooth that has been injured is a baby tooth. Sometimes it’s easy for you to tell, sometimes it’s not. It’s important to make that distinction because what you do when trauma occurs can be different for a baby tooth. This chart may help you make that distinction:

when do you lose your baby teeth

Now, if it is a baby tooth read on. If not, skip to the next section.

Is it an IMMEDIATE emergency?

Typically, with a baby tooth, most trauma cases are not emergencies in the sense that you need to get in to see your dentist RIGHT AWAY. Treatment will be the same if the dentist sees them at midnight or in two days, and children are generally upset or in pain and won’t let the dentist perform any treatment or even take a look in some cases.

Who do I call?

Your general dentist, or if your child is seeing a pediatric specialist, will be your best bet. Give your dentist a call and set up an appointment to see them soon. You definitely want someone to take a look at the area, likely take a radiograph (x-ray), and possibly recommend or perform treatment. If there are any teeth knocked out, or pieces broken, bring those with you to the appointment whenever possible.

What do I do?

That depends on what happened. Find your case below…

If the tooth was hit and is NOT Moving and often not missing any pieces:

  1. We call this concussion if the tooth was hit but is not moving, not out of position, and there’s no bleeding. You should see your dentist who will likely take a radiograph for a baseline image and monitor the tooth. Future issues such as nerve damage or nerve death are possible and your dentist will know how to deal with these.
  2. We call this lateral luxation if the tooth was hit but is not mobile though it is out of position. You should see your dentist who will likely take a radiograph for a baseline image, closely monitor the tooth, and possibly recommend trying to move it back in position likely with anesthesia, allowing the tooth to naturally reposition, adjusting the bite, or extracting the baby tooth early…it all depends. Future issues such as nerve damage or death as well as infection are possible and your dentist will know how to deal with these.

If the tooth was hit and IS Moving and often not missing any pieces:

  1. We call this subluxation if the tooth was hit and is moving, possibly with bleeding. You should see your dentist who will likely take a radiograph for a baseline image and monitor the tooth. Future issues such as nerve damage or death are possible and your dentist will know how to deal with these.
  2. We call this root fracture if the tooth was hit and it looks like the tooth is moving. This time, though, it’s moving because the root is fractured. You should see your dentist who will likely take a radiograph and likely recommend repositioning and splinting for a few weeks followed by close monitoring. Future issues such as nerve damage or death as well as infection are possible and your dentist will know how to deal with these.
  3. We call this alveolar fracture if the tooth was hit and it looks like the tooth and the bone around it are moving. This time, though, it’s moving because the jaw bone is fractured. You should see your dentist who will likely take a radiograph and likely recommend repositioning and splinting for a few weeks followed by close monitoring. Future issues such as nerve damage or death as well as infection are possible and your dentist will know how to deal with these.

If the tooth was hit and is KNOCKED IN or OUT of the Gum:

  1. We call this extrusion if the tooth was hit and is moving out of position and it looks like the tooth is going to fall out. You should see your dentist who will likely take a radiograph for a baseline image, closely monitor the tooth, and possibly recommend trying to move it back in position, allowing the tooth to naturally reposition, or extracting the baby tooth early. Future issues such as nerve damage or death as well as infection are possible and your dentist will know how to deal with these.
  2. We call this intrusion if the tooth was hit and it looks like the tooth has moved into the bone. You should see your dentist who will likely take a radiograph for a baseline image and either recommend allowing the tooth to naturally reposition and closely monitoring or extracting the baby tooth early so as not to cause further damage to the adult tooth. Future issues such as nerve damage or death as well as infection are possible and your dentist will know how to deal with these.

If the tooth was KNOCKED OUT:

  1. We call this avulsion if the tooth was hit and is knocked out of the mouth. You should see your dentist who may take a radiograph for a baseline image or to make sure the tooth isn’t lodged in the bone (especially if you can’t find the tooth) and likely recommend palliative care if needed and monitoring especially for any problems with the adult tooth. Future issues such as problems with the adult tooth are possible and your dentist will know how to deal with these.

IT IS IMPORTANT TO NOTE THAT, UNLIKE IN AN ADULT TOOTH, YOU SHOULD NOT TRY TO RE-IMPLANT THE TOOTH IN THE MOUTH.

A baby tooth that is knocked out should stay out.

If the tooth is chipped or part of it is broken:

  1. We call this fracture if part of the tooth is missing. Whether it’s a small chip or a bigchip where the nerve is exposed, or the crown of the tooth is gone and the root is left, you should see your dentist. The larger the chip or fracture, the more urgent it is to see them right away. Your dentist may take a radiograph and then recommend treatment that can range from something as small as smoothing and monitoring the tooth to a filling or to something as major as a partial baby root canal and build-up to an extraction. It really depends on how big the chip is, what parts are broken, and if the nerve is involved. You’ll want your dentist to check this out.

IMPORTANT TO NOTE: Teeth that are chipped or broken can also have further root or bone issues, one issue noted above does not mean there aren’t other issues as well. You should also keep an eye out for discoloration of the tooth which could mean nerve damage or death, as well as for an abscess (a “pimple” on the gums) by the traumatized tooth and let your doctor know right away if you notice these changes or your child complains of sensitivity or pain. You should also note that baby tooth trauma can sometimes affect the developing adult tooth underneath it, so other issues may be noticed when the adult tooth erupts. 


Adult (Permanent) Tooth:

If you, or your child, are/is over the age of 5 or 6, there’s a chance that the tooth that has been hit, broken, or fallen out is an adult tooth.

Is it an emergency?

Typically, with an adult tooth, minor trauma cases are not emergencies in the sense that you need to get in to see your dentist RIGHT AWAY. However, typically, timing is more important so you should schedule to see your dentist as soon as possible, even if that is in a day or two.

Emergencies requiring treatment as soon as the trauma occurs include: a tooth that has been knocked out or a chipped tooth where the nerve is exposed – timing here is critical!

Who do I call?

Your general dentist will be your best bet. You definitely want someone to take a look at the area, likely take a radiograph (x-ray), and possibly recommend or perform treatment. If it is an emergency and you can’t get a hold of your dentist quickly enough, call an office that is open or has an emergency line and go see them for your trauma care. Follow up with your dentist after.

What do I do?

That depends on what happened. Find your case below…

IMPORTANT TO NOTE: In an adult, radiographs are generally always taken because, unlike some kids, you can sit still enough for them. They are important in making decisions long-term and determining if there have been any changes during follow-up appointments.

If the tooth was hit and is NOT Moving and often not missing any pieces:

  1. Concussion – similar to above. See your dentist within a few days to closely monitor.
  2. Lateral luxation – similar to above. See your dentist soon! See your dentist who will take a radiograph and likely recommend trying to move it back in position likely with anesthesia and stabilize with a flexible splint for a few weeks.

If the tooth was hit and IS Moving and often not missing any pieces:

  1. Subluxation – similar to above. See your dentist who will take a radiograph and possibly recommend a flexible splint for a few weeks.
  2. Root fracture – similar to above. See your dentist soon! Repositioning and splinting for a few weeks to a few months is common. The options and prognoses of this fracture depend on where the fracture is on the root. Long-term this may mean root canal therapy or even extraction.
  3. Alveolar fracture – similar to above. See your dentist soon! Repositioning and splinting for a few weeks followed by close monitoring. Long-term this may mean root canal therapy or even extraction.

If the tooth was hit and is KNOCKED IN or OUT of the Gum:

  1. Extrusion – same as above. You should see your dentist soon who will likely take a radiograph for a baseline image, reposition the tooth, and stabilize it with a flexible splint for a few weeks. Root canal treatment is often needed as is regular follow-up. 
  2. Intrusion – same as above. Depending on the age of the patient’s tooth, either passive eruption or orthodontic/surgical repositioning stabilized with a flexible splint are recommended. You should see your dentist soon. Root canal treatment is often needed as is regular follow-up. 

If the tooth was KNOCKED OUT:

  1. Avulsion – same as above. THIS IS THE TRUEST DENTAL EMERGENCY. You should try to see your dentist – or any dentist available – WITHIN 60 MINUTES for the best long-term prognosis. If you really can’t get to your dentist or an emergency dentist within an hour or two, if it’s just not possible, be aware that your treatment plan may be different. Your treatment depends on when you are able to see the dentist and what your situation looks like.

WHAT YOU CAN DO TO HELP YOUR TOOTH SURVIVE BEING KNOCKED OUT:

what to do if your tooth is knocked out

IMPORTANT TO NOTEavoid storing your tooth in water! If you can’t find milk, saline, or Hank’s Balanced Salt Solution, use your spit or store the tooth in your cheek until you can see your dentist.

If the tooth is chipped or part of it is broken:

  1. Fracture – same as above. Whether it’s a small chip or a big chip where the nerve is exposed, or the crown of the tooth is gone and the root is left, you should see your dentist. The larger the chip or fracture, the more urgent it is to see them right away.Your dentist will take a radiograph (maybe not if the chip is really small) and then recommend treatment that can range from something as small as smoothing and monitoring the tooth to a filling or to something as major as a root canal and build-up with a gingivectomy to surgical or orthodontic extrusion to an extraction. It really depends on how big the chip is, what parts are broken, and if the nerve is involved. You’ll want your dentist to check this out.

If your chip is relatively large in size, bring it to your dental appointment. Sometimes that piece can be reattached and often is the nicest looking option in terms of replacement.

If you have any further questions, be sure to ask Dr. Stephan!