Pediatric Dental Emergencies

Knocked-out tooth (avulsion): what to do right now

Time matters. A permanent tooth that is re-implanted within 30 to 60 minutes has the best chance of long-term survival. Baby teeth are not re-implanted because doing so can damage the developing permanent tooth underneath.

1. Find the tooth. Pick it up by the white crown only, never by the root.
2. If the tooth is dirty, rinse it for 10 seconds in cold milk, saline, or your child's saliva. Do not scrub it. Do not use soap or tap water.
3. If your child is calm and old enough to cooperate, gently push the tooth back into the socket the right way around. Have your child bite down on a clean cloth to hold it in place.
4. If you cannot re-implant it, store the tooth in cold milk, saline, or in your child's cheek pouch (if old enough not to swallow it). Do NOT store in tap water.
5. Call us immediately at (517) 787-1022 and head to the office. If we are closed, go to the nearest emergency department.

Broken or chipped tooth

A small chip is usually not urgent and can wait until the next business day. A larger fracture, especially one with bleeding from the tooth itself or with the nerve visible (a pink or red spot), is urgent and should be seen the same day. Save any tooth fragments in milk; we may be able to bond them back on.

1. Rinse your child's mouth with warm water
2. Apply a cold compress to the cheek to reduce swelling
3. Save any tooth fragments in cold milk or saline
4. Give age-appropriate ibuprofen for pain (see dosing below)
5. Call us at (517) 787-1022

Severe toothache or facial swelling

A toothache that wakes a child at night, throbs, or comes with facial swelling usually signals a tooth infection (abscess). Untreated dental infections can spread quickly in children. We treat dental infections the same day they are reported. Facial swelling that involves the eye or extends down the neck is a true emergency.

1. Rinse the mouth gently with warm salt water
2. Apply a cold compress to the outside of the face for 15 minutes on, 15 minutes off
3. Give age-appropriate ibuprofen on a schedule (every 6 hours; not as-needed) for the most predictable pain control
4. Do NOT place aspirin on the gum tissue; it causes chemical burns
5. Call us at (517) 787-1022 immediately. Do not wait for a regular appointment slot.

Tongue, lip, or cheek injury

Cuts to the lip, tongue, or cheek bleed dramatically because the mouth has rich blood supply. Most stop with direct pressure within 10 minutes. Apply gauze or a clean cloth firmly to the bleeding area for a full 10 minutes without lifting to check. If bleeding does not stop after 10 to 15 minutes of firm pressure, or if the cut is deep or gaping, head to the emergency department for stitches.

Pain medication dosing for kids

Use weight-based dosing per the package label. Ibuprofen (Advil, Motrin) at 10 mg/kg every 6 hours is the most effective single agent for dental pain. Acetaminophen (Tylenol) at 15 mg/kg every 4 to 6 hours can be alternated with ibuprofen for severe pain. Never exceed the maximum daily doses on the label. Do not give aspirin to anyone under 18 due to Reye's syndrome risk.