Dental Injuries in Children: Knocked-Out and Broken Teeth

A child's smile can change in an instant—a fall on the playground, a collision during sports, or an accident at home. Dental injuries are common in children, and knowing what to do in those first critical minutes can make the difference between saving and losing a tooth.

Types of Dental Injuries AAP

Knocked-out tooth (avulsion):

• Tooth is completely displaced from the socket
• Time-critical for permanent teeth—act fast!
• Different approach for baby teeth vs. permanent teeth

Chipped or broken tooth (fracture):

• Piece of tooth breaks off
• Ranges from minor chip to major break
• May or may not be painful

Pushed-in tooth (intrusion):

• Tooth is pushed up into the gum
• Can damage developing permanent teeth
• Always needs dental evaluation

Loosened tooth (luxation):

• Tooth is loose but still in socket
• May be pushed sideways
• Usually stabilizes but needs evaluation

Tooth pushed out of position:

• Tooth is displaced but not knocked out
• May be pushed forward, backward, or sideways
• Needs repositioning and stabilization

Baby Teeth vs. Permanent Teeth AAP

The approach differs significantly:

Baby teeth (typically under age 6):

• Do NOT try to replant a knocked-out baby tooth
• Replanting can damage the developing permanent tooth underneath
• See a dentist, but it's not as urgent
• Focus on stopping bleeding and comfort

Permanent teeth (age 6 and older):

• Time is critical—replantation success depends on speed
• Try to replant within 30 minutes for best outcomes
• Handle tooth carefully (by crown only)
• Keep tooth moist

Not sure which type? If the child is 5 or under, it's likely a baby tooth. Age 6-12, it could be either. When in doubt, treat as permanent and see a dentist immediately.

Knocked-Out Permanent Tooth: Step by Step AAP

Time is critical—success rate drops significantly after 30 minutes:

### Step 1: Find the Tooth

• Look carefully—it may have gone into the lip or gum
• Handle only by the crown (white part)—never touch the root

### Step 2: Clean If Needed

• If tooth is dirty, rinse gently with milk or saliva
• Do NOT scrub or dry the tooth
• Do NOT use water, soap, or chemicals
• Leave any tissue fragments attached

### Step 3: Try to Replant (if possible)

• Hold tooth by crown
• Position correctly (smooth side facing out)
• Gently push back into socket
• Have child bite down on clean cloth to hold in place
• If successful, go to dentist immediately

### Step 4: If You Can't Replant

• Keep tooth moist—this is crucial
• Best: place in cold milk
• Also acceptable: in the child's mouth (between cheek and gums) if child is old enough not to swallow it
• Use saliva or saline if nothing else available
• DO NOT store in water—it damages root cells

### Step 5: Get to a Dentist or ER IMMEDIATELY

• Call ahead so they're prepared
• Bring the tooth in milk or saliva
• Time is the most important factor

Chipped or Broken Tooth AAP

What to do:
1. Rinse mouth with warm water
2. Apply cold compress to face/lip to reduce swelling
3. Save any tooth fragments in milk
4. See dentist within 24 hours (sooner if large piece broken)
5. Pain reliever if needed

Levels of fracture:

• Minor chip (enamel only): Not an emergency but see dentist
• Moderate break (enamel and dentin): See dentist same day; may be sensitive
• Severe break (exposing pulp/nerve): Emergency—tooth may be pink or bleeding

Signs of serious fracture:

• Tooth is very sensitive to temperature or touch
• Pink or red color inside tooth
• Bleeding from the tooth
• Severe pain

Pushed-In or Displaced Teeth AAP

For teeth pushed up into the gum:

• Do NOT try to pull it back down
• See dentist immediately
• X-rays needed to assess damage
• May need to wait for tooth to re-erupt naturally

For teeth pushed out of position:

• If still attached, dentist may be able to reposition
• Go immediately—don't wait
• May need splinting to other teeth

For loose teeth:

• Encourage soft diet
• See dentist to evaluate
• May need splinting
• Most heal on their own

Bitten Lip, Tongue, or Cheek AAP

These often accompany dental injuries:

What to do:

• Apply pressure with clean cloth to stop bleeding
• Apply ice wrapped in cloth to reduce swelling
• Clean area gently once bleeding stops

Seek medical care if:

• Bleeding doesn't stop after 10-15 minutes
• Cut is deep or gaping
• Wound is on the border of the lip (may need stitches for cosmetic result)
• There's debris embedded in the wound

Preventing Dental Injuries AAP

Sports protection:

• Mouthguards reduce dental injury risk by 60x
• Custom-fitted guards offer best protection
• Boil-and-bite guards are acceptable
• Required for: football, hockey, lacrosse, boxing
• Recommended for: basketball, soccer, baseball, skateboarding

Home safety:

• Avoid running with objects in mouth
• Remove tripping hazards
• Supervise active play
• Use stair gates for young children

Car safety:

• Proper car seat use
• No objects in mouth during car travel

When to See a Dentist vs. ER AAP

Go to the dentist for:

• Chipped or broken teeth (unless severe)
• Loose teeth
• Teeth pushed out of position (if dental office is available quickly)
• Follow-up after any dental injury

Go to the ER for:

• Knocked-out permanent tooth (if dentist unavailable)
• Severe facial trauma
• Suspected jaw fracture
• Heavy bleeding that won't stop
• Signs of head injury or concussion
• After hours when dental office is closed

After Dental Injury Treatment

What to expect:

• Splinting (wire stabilization) for 1-4 weeks
• Soft diet during healing
• Follow-up appointments to monitor
• Root canal may be needed later
• Watch for signs of infection or complications

Long-term considerations:

• Injured teeth may darken over time
• Root damage may not be apparent immediately
• Some teeth may need crowns eventually
• Baby teeth injuries can affect permanent teeth underneath

Signs of problems after treatment:

• Increasing pain
• Swelling
• Fever
• Darkening of tooth
• Pimple on gum above tooth
• Loose splint

Baby Tooth Injuries: Special Considerations AAP

While baby tooth injuries are generally less urgent:

Still see a dentist if:

• Tooth is pushed into gum
• Baby is having difficulty eating
• Tooth becomes discolored
• There's swelling or signs of infection
• Tooth doesn't fall out naturally at expected time

Damage to permanent teeth:
Baby tooth injuries can affect the permanent teeth developing underneath. Your dentist may want to monitor the area over time.

Dental Emergency Kit

Keep these items accessible:

• Dentist's emergency contact number
• Save-a-Tooth (tooth preservation kit)
• Small container for milk
• Clean cloth or gauze
• Cold pack
• Pain reliever (age-appropriate dose)

The Bottom Line

For a knocked-out permanent tooth, every minute counts. Handle by the crown, keep it moist in milk, and get to a dentist immediately. For baby teeth, do NOT replant—just see a dentist for evaluation. Mouthguards prevent most sports-related dental injuries and are a worthwhile investment. When in doubt about any dental injury, see a professional.

Clara can help you assess dental injuries and find emergency dental resources in your area!