Tooth emergencies: what to do in the event of a trauma

Meaghan O’Keeffe, RN, BSN, is a mother, writer and nurse. She worked at Boston Children’s Hospital for nearly a decade,  in both the Cardiac Intensive Care Unit and the Pre-op Clinic.  She is a regular contributor to Thriving.

One glorious evening, my 3-year-old son, Tommy, wiggled like crazy while I attempted to undress him for his bath. He took a misstep, assuming I was holding his weight. I wasn’t. He fell mouth first onto the bathtub edge.

I’m a nurse who’s seen my fair share of bodily fluids and cardiac arrests. There isn’t much that fazes me. But there’s one thing I can’t handle.

I don’t do teeth.

I have my own completely irrational fear of the dentist. The sound of drilling sends me to my knees, and the idea of injuring a tooth gives me such heebie jeebies that it pains me to write this.

I grabbed my son, who was in hysterics, and tried to look in his mouth, intermittently holding him and repeating that everything was going to be okay, even though I was thinking everything is not going to be okay.

In the end, he was lucky. His two front teeth had chipped, the enamel ground into a white powder I could wipe from the side of the tub. But the break hadn’t approached the root of the tooth, which would have caused us much more grief. I called the pediatrician first, because I hadn’t established my son with a dentist yet. It was six o’clock. After the nurse practitioner asked a few questions, she confirmed what I had suspected: We didn’t need to go to the emergency room and could wait until the next day to be seen by a dentist.

His teeth hurt enough that he couldn’t drink from a sippy cup and didn’t want to eat. I worried he would need dental work and fretted that this would set him up for a lifelong dental phobia.

Fortunately, the damage didn’t require any intervention. The dentist said the slightly ragged edges would smooth over time with regular use of his teeth. Tommy and I both left smiling, albeit one of us with slightly altered pearly whites.

Many families have similar stories. According to the American Academy of Pediatrics, 30 percent of children experience dental trauma before 14 years old.

Here are some guidelines to follow for the prevention and treatment of a tooth injury:

  • A large number of tooth traumas occur between 2 and 3 years old, according to the American Academy of Pediatric Dentistry. Make sure safety gates are installed and secure, especially around stairs.
  • Stay aware of tripping hazards.
  • Mouth guards should be worn in any sport where a child may be at risk for a collision, a fall or contact with hard equipment.
  • Early dental intervention is important to save the tooth and prevent infection.

If tooth trauma happens:

  • Rinse the mouth with water and apply a cold compress to help reduce swelling.
  • A baby tooth will not be replaced; you can focus on comforting your child, rather than finding the tooth. (A dentist still needs to see your child, however.)
  • If a permanent tooth is knocked out, rinse it in cold water and try to replace it in the socket, holding it with a washcloth. If you’re unable to do that, place it in a clean container with cold milk, which can help preserve the tooth.
  • If a tooth is chipped or broken, rinse the mouth and apply a cold compress. If you’re able to find a broken tooth fragment, bring it to the dentist—and don’t forget the child!
  • Ibuprofen or acetaminophen may be appropriate to help ease any discomfort related to the dental injury.
  • If your dentist prescribes antibiotics, be sure to complete the full course.
  • Tooth discoloration can indicate damage to the tooth’s pulp; watch for signs of it over the days after the initial injury.
  • Follow a soft diet and avoid hot and cold temperature extremes for several days (or as long as your dentist recommends) as the tooth heals.

Above all, try to stay calm. Not that I’m one to talk. But while I might have lost my cool internally, I did manage to at least pretend as if everything was under control. Do the best you can.

And remember, eventually, this will be just another childhood tale to tell in the years to come.

Have a dental question? Feel free to reach out to the pediatric dental experts at Boston Children’s Department of Dentistry. Visit their website or call 617-355-6571.