How common are dental injuries in children?
According to the 2020 guidelines of the International Association of Dental Traumatology (IADT), dental injuries are most common in children and young adults and make up 5% of all injuries. The guidelines state that a quarter of all schoolchildren experience a dental injury. According to the IADT guideline on baby teeth, injuries to the primary teeth are most common between the ages of two and six.
Two questions decide what to do. Is the injured tooth a baby tooth or a permanent tooth? And has it broken, been loosened or pushed out of place, or been knocked out completely? With a knocked-out permanent tooth in particular, what you do in the first minutes affects the outcome.
How can I tell whether it is a baby tooth or a permanent tooth?
According to the American Dental Association’s (ADA) tooth development chart, the first permanent front teeth come through at around 6–7 years in the lower jaw and 7–8 years in the upper jaw, and the lateral incisors erupt between 7 and 9 years. So in a child younger than six, an injured front tooth is most likely a baby tooth, while between six and nine, baby teeth and permanent teeth can be in the mouth at the same time.
The difference matters because the first aid is different. The NHS, the IADT and the American Association of Endodontists (AAE) advise against putting a knocked-out baby tooth back in. According to the IADT guideline, the reasons are the risk of harming the permanent tooth developing underneath and, above all, avoiding a medical emergency if the tooth were inhaled. For a permanent tooth, on the other hand, the IADT recommends putting it back in its socket immediately at the scene of the accident. If you are not sure which kind of tooth it is, do not try to put it back; keep it in milk and go to a dentist straight away.
What should I do in the first minutes if a permanent tooth is knocked out?
According to the IADT, the chance of saving the tooth is highest within the first 20 minutes after the accident; the AAE recommends treatment within 30 minutes if possible. The advice of the NHS and the IADT can be summarised as follows:
- Hold the tooth by the crown: hold the white part that shows in the mouth, and do not touch the root.
- Rinse it briefly if it is dirty: rinse it gently in milk, saline or saliva, without scrubbing the root.
- Put it back in its socket: gently try to put the tooth back, even if there is bleeding. If it goes back in, ask your child to bite gently on a clean piece of gauze or a handkerchief to hold it in place.
- If you cannot put it back, keep it moist: carry the tooth in milk or in saliva that your child has spat into a container. According to the IADT, water is not a good storage medium, but it is better than letting the tooth dry out.
- Go to a dentist immediately: the NHS advises asking for an emergency dental appointment even if the tooth cannot be found.
The IADT guideline explains why time matters so much. After 30 minutes out of the mouth in dry conditions, most of the cells around the root are no longer viable, and the long-term outlook is markedly worse for teeth that have been dry for more than 60 minutes. The guideline states that even then, putting a permanent tooth back is almost always the right decision, because it keeps future treatment options open. A replanted tooth is usually attached to the neighbouring teeth with a flexible splint for two weeks.
What should I do if a baby tooth is knocked out or pushed in?
A knocked-out baby tooth is not put back, but your child should still see a dentist without delay. If you have found the tooth, bring it with you. If it cannot be found, the dentist first checks whether it has been pushed up into the gum. Where the tooth cannot be found at all, the IADT recommends referring the child to an emergency department for a medical assessment, in case it has been swallowed or inhaled.
A knock can push a tooth up into the gum, and sometimes the tooth can no longer be seen at all. The IADT’s patient information says the first few hours are critical in this situation: place a piece of gauze between the front teeth, keep the mouth closed and go to a dentist or an emergency department straight away. According to the IADT guideline, a baby tooth that has been pushed in is usually left to come back down by itself; this usually happens within six months, but sometimes takes up to a year. If a permanent tooth has been pushed in, the AAE says the dentist moves it back into position and stabilises it.
The permanent tooth develops just beneath the baby tooth. According to the IADT, changes in the shape of the permanent tooth, teeth that remain buried and problems with eruption are most often seen after injuries in which a baby tooth was pushed in or knocked out. After such injuries, the guideline recommends checking the eruption of the permanent tooth at around the age of six.
What should I do if a tooth is broken?
According to the NHS, a chipped, broken or cracked tooth is often not serious, but it should be seen by a dentist. The IADT also says that a broken tooth does not mean a trip to the emergency department, but that treatment should not be put off and you should get an appointment as soon as possible.
- Find the broken piece: the IADT advises taking the fragment to the dentist in water or milk, and the NHS in milk or saliva, so that it does not dry out. In some cases the fragment can be bonded back onto the tooth.
- If the nerve is affected: according to the NHS, severe fractures that expose the nerve may need root canal treatment. In children the approach can be different: according to the AAE, in teeth whose roots are still developing, stem cells in the pulp can help the root to finish forming. The IADT also recommends avoiding root canal treatment in teeth with immature roots unless there are signs that the nerve has died.
- Baby teeth: according to the AAE, broken baby teeth can be repaired for appearance. The IADT guideline notes that for small fractures limited to the enamel, smoothing the sharp edges may be enough.
- Do not put medicines on the area: the AAE advises against applying oral pain-relief gels or ointments to the injured area, and against placing tablets containing acetylsalicylic acid on the tooth or gum.
When should you go straight to an emergency department?
The IADT advises watching for associated injuries such as head injuries and facial fractures. According to the NHS information on head injuries, get emergency help without delay – call your local emergency number – if, after a blow to the head, your child:
- has been knocked out and has not woken up, or cannot stay awake
- has a fit (seizure)
- has problems speaking, understanding, walking or with balance
- has clear fluid coming from the ears or nose, or is bleeding from the ears
- shows a change in behaviour
- has fallen from a height of more than 1 metre or five stairs
The NHS also advises getting urgent medical advice if your child is sick (vomits) after a head injury. According to the ADA, if you suspect a broken jaw, apply something cold and go to a dentist or a hospital emergency department immediately; if bleeding from the tongue or lip does not stop, go to an emergency department.
If the wound has been in contact with soil, tetanus protection also matters. The IADT says that a tetanus booster may be needed in this case and recommends seeing a doctor within 48 hours if in doubt, so check your child’s vaccination record.
What should you watch for in the days after the accident?
The advice the IADT guidelines give parents can be summarised as follows:
- Clean the injured area gently after meals with a soft toothbrush or a moist cotton bud.
- Avoid putting strain on the injured teeth when eating; after a permanent tooth has been replanted, soft food may be preferable for up to two weeks.
- If the dentist recommends it, use an antiseptic mouthwash without alcohol for as long as advised.
- After a permanent tooth has been replanted, take a break from contact sports for a while.
- Tell the dentist if you notice swelling of the gum, a tooth becoming looser or a small blister on the gum that discharges.
A baby tooth may change colour after a knock; according to the IADT, the colour may fade over weeks or months and the tooth may return to its original shade.
Check-ups should not be skipped. According to the IADT, a replanted permanent tooth is checked at 2 weeks, 4 weeks, 3 months, 6 months and 1 year, and then once a year for at least five years. The AAE also recommends regular check-ups for up to five years so that problems such as root resorption can be spotted. The IADT points out that growing children are more likely to develop complications after a dental injury. As a preventive measure, the ADA recommends a mouthguard for sports and similar activities.
How do we assess dental injuries in children at Rönesans?
Paediatric dentistry and endodontics (root canal treatment) are among the areas of treatment at our practice. At the examination, we look at the injured tooth and the surrounding tissues and take X-rays when needed. Decisions such as putting a tooth back, splinting it, repairing it or monitoring it depend on whether it is a baby tooth or a permanent tooth and on the type of injury, and are made at the examination. If treatment is needed, you know from the start which of our dentists will look after your child, and you receive a written treatment and cost plan showing the procedures and the unit and total costs. Costs are confirmed after the examination, based on the treatment plan. Follow-up after treatment runs through a defined process at our practice.
Our practice is in Serdivan, Sakarya, and is open Monday to Friday from 10:00 to 22:00 and on Saturday from 10:00 to 19:00 (Türkiye time). It is closed on Sundays and on the days of Ramazan Bayramı and Kurban Bayramı. If your child is injured near Serdivan during our opening hours, call or message us on WhatsApp without delay, or use our contact page; we answer messages in English and German within 15 minutes during opening hours. Outside our opening hours, or if you are not near the practice, do not wait for a reply: go to the nearest dentist or hospital emergency department, and call your local emergency number if there are signs of a head injury.