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Dental Emergencies

Although dental injuries and dental emergencies are often distressing for both children and parents, they are also extremely common.  Approximately one third of children have experienced some type of dental trauma, and more have experienced a dental emergency.

There are two peak risk periods for dental trauma - the first being toddlerhood (18-40 months) when environmental exploration begins, and the second being the preadolescent/adolescent period, when sporting injuries become commonplace.

Detailed below are some of the most common childhood dental emergencies, in addition to helpful advice on how to deal with them.

Toothache

Toothache is common in children of all ages and rarely occurs without cause.  Impacted food can cause discomfort in young children, and can be dislodged using a toothbrush, a clean finger, or dental floss.  If pain persists, contact the pediatric dentist.  Some common causes of toothache include: tooth fractures, tooth decay, tooth trauma, and wisdom teeth eruption (adolescence).

How you can help:

  1. Cleanse the area using warm water.  Do not medicate or warm the affected tooth or adjacent gum area.
  2. Check for impacted food and remove it as necessary.
  3. Apply a cold compress to the affected area to reduce swelling.
  4. Contact the pediatric dentist to seek advice.

Dental avulsion (knocked-out tooth)

If a tooth has been knocked-out of the child’s mouth completely, it is important to contact the pediatric dentist immediately.  In general, pediatric dentists do not attempt to reimplant avulsed primary (baby) teeth, because the reimplantation procedure itself can cause damage to the tooth bud, and thereby damage the emerging permanent tooth.

Pediatric dentists always attempt to reimplant avulsed permanent teeth, unless the trauma has caused irreparable damage.  The reimplantation procedure is almost always more successful if it is performed within one hour of the avulsion, so time is of the essence!

How you can help:

  1. Recover the tooth.  Do not touch the tooth roots! Handle the crown only.
  2. Rinse off dirt and debris with water without scrubbing or scraping the tooth.
  3. For older children, insert the tooth into its original socket using gentle pressure, or encourage the child to place the tooth in the cheek pouch.  For younger children, submerge the tooth in a glass of milk or saliva (do not attempt to reinsert the tooth in case the child swallows it).
  4. Do not allow the tooth to dry during transportation.  Moisture is critically important for reimplantation success.
  5. Visit the pediatric dentist (where possible) or take the child to the Emergency Room immediately –time is critical in saving the tooth.

Dental intrusion (tooth pushed into jawbone)

Sometimes, dental trauma forces a tooth (or several teeth) upwards into the jawbone.  The prognosis is better for teeth that have been pushed up to a lesser extent (less than 3mm), but every situation is unique.  Oftentimes, the force of the trauma is great enough to injure the tooth’s ligament and fracture its socket.

If dental intrusion of either the primary or permanent teeth is suspected, it is important to contact the pediatric dentist immediately.  Depending on the nature and depth of the intrusion, the pediatric dentist will either wait for the tooth to descend naturally, or perform root canal therapy to preserve the structure of the tooth.

How you can help:

  1. Rinse the child’s mouth with cold water.
  2. Place ice packs around affected areas to reduce swelling.
  3. Offer Tylenol for pain relief.
  4. Contact the pediatric dentist where possible, or proceed to the Emergency Room.

Tooth luxation/extrusion/lateral displacement (tooth displacement)

Tooth displacement is generally classified as “luxation,” “extrusion,” or “lateral displacement,” depending on the orientation of the tooth following trauma.  A luxated tooth remains in the socket – with the pulp intact about half of the time.  However, the tooth protrudes at an unnatural angle and the underlying jawbone is oftentimes fractured.

The term “extrusion” refers to a tooth that has become partly removed from its socket.  In young children, primary tooth extrusions tend to heal themselves without medical treatment.  However, dental treatment should be sought for permanent teeth that have been displaced in any manner in order to save the tooth and prevent infection.  It is important to contact the pediatric dentist if displacement is suspected.

How you can help:

  1. Place a cold, moist compress on the affected area.
  2. Offer pain relief (for example, Children’s Tylenol).
  3. Contact the pediatric dentist immediately.

Crown fracture

The crown is the largest, most visible part of the tooth.  In most cases, the crown is the part of the tooth that sustains trauma.  There are several classifications of crown fracture, ranging from minor enamel cracks (not an emergency) to pulp exposure (requiring immediate treatment).

The pediatric dentist can readily assess the severity of the fracture using dental X-rays, but any change in tooth color (for example, pinkish or yellowish tinges inside the tooth) is an emergency warning sign.  Minor crown fractures often warrant the application of dental sealant, whereas more severe crown fractures sometimes require pulp treatments.  In the case of crown fracture, the pediatric dentist should be contacted. Jagged enamel can irritate and inflame soft oral tissues, causing infection.

How you can help:

  1. Rinse the child’s mouth with warm water.
  2. Place a cold, moist compress on the affected area.
  3. Offer strong pain relief (for example, Children’s Tylenol).
  4. Pack the tooth with a biocompatible material.
  5. Visit the pediatric dentist or Emergency Room depending on availability and the severity of the injury.

Root fracture

A root fracture is caused by direct trauma, and isn’t noticeable to the naked eye.  If a root fracture is suspected, dental x-rays need to be taken.  Depending on the exact positioning of the fracture and the child’s level of discomfort, the tooth can be monitored, treated, or extracted as a worse case scenario.

How you can help:

  1. Place a cold, moist compress on the affected area.
  2. Offer pain relief (for example, Children’s Tylenol).
  3. Contact the pediatric dentist.

Dental concussion

A tooth that has not been dislodged from its socket or fractured, but has received a bang or knock, can be described as “concussed.”  Typically occurring in toddlers, dental concussion can cause the tooth to discolor permanently or temporarily.  Unless the tooth turns black or dark (indicating that the tooth is dying and may require root canal therapy), dental concussion does not require emergency treatment.

Injured cheek, lip or tongue

If the child’s cheek, lip or tongue is bleeding due to an accidental cut or bite, apply firm direct pressure to the area using a clean cloth or gauze.  To reduce swelling, apply ice to the affected areas.  If the bleeding becomes uncontrollable, proceed to the Emergency Room or call a medical professional immediately.

Fractured jaw

If a broken or fractured jaw is suspected, proceed immediately to the Emergency Room.  In the meantime, encourage the child not to move the jaw.  In the case of a very young child, gently tie a scarf lengthways around the head and jaw to prevent movement.

Head injury/head trauma

If the child has received trauma to the head, proceed immediately to the Emergency Room.  Even if consciousness has not been lost, it is important for pediatric doctors to rule out delayed concussion and internal bleeding.

If you have questions about dental emergencies, please ask your pediatric dentist.

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Testimonials

My mother is in a nursing home in Harrisville Michigan. She dropped her dentures and broke a tooth. The entire staff was in her room trying to find the broken tooth, but it must have fallen into the heat register or something. Anyway it never turned up. My brother, Rick, went to visit and called to tell me about it. "We have to do something," he told me. "I can't stand to see mom looking like this." He was planning to take a few days off and take me up north to see about getting her to the dentist to get her plate fixed. I went online and called several dentists in the area. They could not help me with the problem. Then I found Dr. Gregg Resnick DDS in Alpena. He said he could fix them and have them ready by the next day. I had our friends, Shirley and Tom Harmon, pick up the plate and take it to his office. The doctor called me (I live over 200 miles from where my mom is). Dr. Resnick was concerned that he might not be able to grind the tooth properly and that my mom wouldn't be able to chew properly. You see he was under the impression she had a full set of dentures and didn't realize that she had some lower teeth. He told me that although the tooth was broken mom would not have a problem chewing with it that way. "But, we do have a problem," I told him. "My brother can't stand to look at her with that broken tooth." He sighed and said, "Let's do it then." I could have hugged him through the phone. I promised him that if mom had a problem chewing that I would bring her handicap van and get her to his office the next day. Well, mom got her plate today. She ate dinner and said that she could chew just fine. I have Dr. Resnick to thank for this. He did me a favor and it worked out just fine. I wish there were more dentists like him. He and his staff gave me 5 star service.

Sandra C.

My name is Brad Boehm. I am a local physician in Alpena, Michigan. I had an erosion problem with my teeth that made them appear yellow and deformed. I went to see a cosmetic dentist in Atlanta, Georgia. The repair work to my teeth including veneers was over $70,000. I came home very depressed. While at a routine cleaning I discussed this with Dr. Gregg Resnick, my new dentist. He formulated a treatment plan that was identical to the plan from Georgia at less than one-third the cost. I am sure the cost in Georgia included partial rent payment for the mansion the clinic was located in.

I chose to have my teeth fixed by Dr Resnick and I truly could not be happier! During the treatment process minor adjustments were made. This required a quick end of the day visit to see Dr. Resnick instead of a day or two wasted flying to Atlanta. My family and friends comment all the time about my teeth and how I smile so much more. I would recommend Dr. Resnick to anyone who wishes to improve their smile.

Dr. Boehm

I first met Dr. Resnick 20 years ago when referred by a friend for emergency care. Now Nancy and I are thankful he has been our dentist ever since. We think of our appointments as going to an office where we will be treated as friends, not only by him, but also by the staff.

Dr. Resnick is always calm, patient, encouraging and knowledgeable in dental care. His staff reflects his demeanor. Furthermore, he is an interesting guy.

He is always interested in patients as individuals outside of the office. I remember telling him of impending surgery and later he called me at home to encourage and wish me well.

We recommend him to all our friends.

Robert and Nancy Sloan

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