I received a message via Facebook Messenger this weekend from someone living in my neighborhood…her son, three years old, had fallen and banged his front tooth. Her pediatric dentist wasn’t available, so she asked me “What do I do now???”

Childhood injuries are so common, and the front teeth are involved in these injuries an awful lot. Here’s some guidelines of what to do when this happens to you!

A baby front tooth was broken

  • If the child doesn’t complain when eating, or it isn’t sensitive to temperatures, no treatment is needed.  If it’s rough, it can be easily smoothed. If it is emotionally upsetting to you, the parent, it can be fixed with tooth-coloured filling material but many very small children aren’t really happy sitting still enough to build up a front tooth! There is no harm, as long as it is not painful, to leave it chipped and un-repaired.
  • If the child does complain when eating, or the tooth is sensitive to temperatures, it will need to be repaired with filling material. If the tooth is chipped so much that there is bleeding from inside the tooth (not the gum), the tooth will need further treatment. If the child is 5 or older, a good decision might be to have to tooth removed slightly early to eliminate the need for extensive dental work on a baby tooth.
  • If the tooth is pushed up into the gum, or moved into a different position, there isn’t any treatment needed (this was the condition of my neighbor’s son). Most of these teeth will return to their usual position over a few days to weeks. If the tooth is completely lost from the injury, there isn’t any treatment needed, although the tooth was lost sooner than the parent might like!
  • After any injury to the baby front tooth, monitoring by the parents should be done. The tooth may change color over time (gray, brown, black) which means the nerve of the tooth has died. There is no treatment needed in these cases unless the child begins to have pain. The parents and dentist should also periodically check for a bubble or “pimple” on the gum under the lip which would indicate infection. If this is noticed, the tooth would need to be removed early to prevent further damage to the developing adult teeth.
  • Naturally, if the lip is split in the fall, a trip to the local emergency room will be needed to seal that! Afterwards, some ice, Tylenol, and time will take care of any discomfort.

An adult front tooth was broken

  • If the child doesn’t complain to eat, or isn’t sensitive to temperatures, there is no rush to get to the dentist. If it is slightly rough, it can be smoothed. However, most chips to adult front teeth will be repaired with tooth-coloured filling material.  These repairs can break repeatedly over time and be quite frustrating to parents (understandably). These teeth are often broken when they are very prominent, during periods of lots of growth, and the front teeth remain a “target” for future injuries.
  • If the tooth is sensitive, see a dentist sooner just for comfort.  If there is bleeding coming from inside the tooth, it is best to seek dental treatment quickly.  In some cases these teeth can be simply repaired, but more often there will have to bemore involved treatment to the nerve of the tooth. The type of treatment will depend on the stage of development of the tooth; sometimes final treatment will have to wait until the tooth root is fully formed.
  • If the tooth is push up or moved out of place, see a dentist fairly quickly. The dentist will likely freeze the area and reposition the tooth, securing that position temporarily with orthotdontic wire.
  • If the tooth is completely lost and still in one piece, you, the parent, should start the treatment! Get ready…studies show that putting the tooth back into position within 30 minutes gives it the best chance of survival…the parent should try to be the dentist! You are too afraid? Put the tooth into a baggie or cup with some milk, call the dentist right away, and try to get to the dental office ASAP. Can’t get to the dentist? The emergency room is your next best bet. Regardless of who puts the tooth back into place, it will also have to be stabilized with orthodontic wires for a while. Most of the teeth treated like this do need root canal treatment later on.
  • If an adult tooth that was injured changes color, that tooth will need to have root canal.  This is different than with a baby tooth! The root canal should be started fairly soon after noticing the color change.

Any serious facial injuries should be followed up first in the emergency room of your local hospital.  Most hospitals have a dentist or oral surgeon on staff to oversee any dental issues, but a medical doctor would have to repair any major cuts, take xrays to check on the health of the skull, and evaluate the child for concussion or other serious injuries.

Dr. Andrea Stevens is a cosmetic and family dentist in practice in Kanata, Ontario. If you have dental questions, you can call her at 613-271-7091 or visit her at drandreastevens.com Please also feel free to leave comments or questions below, and Dr. Stevens will be happy to answer.