When Children Have Dental Emergencies

It seems like a long time ago. An upset mother called around midnight on Christmas Eve. Her young daughter was waiting for Santa and fell down a flight of stairs. A couple of hours later, the teeth were straight again, the bleeding stopped, and the young family and dentist went home. Most childhood dental emergencies are not this exciting. Most emergency dental phone calls do not even lead to a visit to the dental office. Most dentists, including the author, rarely if ever find that it is necessary to ask their patients to meet them at the office outside of regular office hours.

The most common concerns of parents relate to their discovery of normal growth and development. For example, adult (succindaneous) teeth may erupt (grow in) before the deciduous tooth (baby tooth) is ready to come out. Parents see the adult tooth behind the deciduous tooth and become worried. Deciduous teeth will start to exfoliate (fall out) on their own schedule. That may or may not be in time for the succidaneous tooth to erupt in its expected location. Alternately, parents may worry when deciduous teeth exfoliate early. Teeth begin to exfoliate as early as four and as late as 8 years old. When deciduous teeth are late to loosen, that may be a sign of a problem. However, this is not a dental emergency.

Facial swelling can be serious. Take the child's temperature. A swelling and a fever may indicate a serious infection. Call the child's dentist or an oral surgeon first. Take the child to a physician or hospital emergency room if the dentist is not available.

When a child injures their mouth and teeth, examine them before calling the dentist. Are the lips bleeding? Are the teeth whole or broken? Have the teeth moved? Does the child's jaw move normally when opening and closing? Do all of the teeth fit together normally? Are any of the teeth broken, missing, loose, or shifted? The dentist will need to know the answers to all of these questions. The dentist may ask the age of the child and if any of the loose or missing teeth are baby teeth. Tell the dentist if you do not know the answers to these questions. This is not a time to guess.

If the child does not appear fully alert after a head injury, Dr Stanley Alexander, Chairman of the Department of Pediatric Dentistry of Tufts University School of Dental Medicine, recommends taking the child to a hospital emergency room. Choose a nearby hospital that specializes in the care of children when possible.

Loose or broken deciduous teeth may not need treatment. It is alright if a child looses a baby tooth a year or two early. The dentist may take an X-ray image of a bloody lip to find out if there is a piece of tooth inside the wound. A shard of tooth left in the cut will cause a scar. A loose adult tooth might be pressed back into its original position by the dentist. This requires a dentist to see the child right away; ideally within 30 minutes.

When a child or adult falls and hits their tooth on a hard surface, the tooth may seem fine at first. Later, the tooth may change color. A gray tooth may have a damaged pulp or blood supply. The dentist will test the tooth and take an x-ray image to determine if the tooth needs treatment. Pink may indicate that the pulp is becoming larger. Pink teeth that are salvageable will need root canal treatment.

Rarely, the child falls in such a way that a tooth becomes intruded, pushed back into the gum. If a deciduous tooth is intruded, there might be damage to the second tooth. When this happens to a new succidaneous tooth, the tooth usually grows in again. Otherwise, a dentist will use braces to reorient the tooth.

Many older children wear braces to straighten their teeth. Braces are uncomfortable immediately after an appointment. The orthodontist replaces the arch wire, the wire that connects all of the teeth with a stiffer wire. Teeth move to follow the curve of the new stiffer wire. This kind of discomfort usually passes in a day or two. Over the counter pain relievers such as Tylenol or Motrin will make the child more comfortable.

Sometimes, children will become uncomfortable when a wire becomes loose or a point sticks out. It is alright to carefully snip a wire that sticks out with a clean nail clipper. Alternately, many orthodontists supply patients with soft wax to cover wires and metal projections.

Prevention is always the best medicine. Many children prevent dental accidents by wearing a mouthguard for sports. Custom fitted sports mouthguards are comfortable and can fit over braces. Properly fitted guards do not interfere with normal speech or breathing. Young children and older children who wear braces will need a new mouth guard for every season. Adults and teens may be able to wear the same mouthguard for a year or more. Mouthguards prevent injuries to teeth, lips, tongue and the TMJ or jaw joint. There is evidence that wearing mouthguards improves sports performance.

What is the best thing to do when your child has a dental emergency? Call your child's dentist or consult their office web site. Almost every dentist has instructions on what to do in case of emergency to reach them or another dentist who is covering for them. Most dentists are available to return an emergency call within a few hours. Hospital emergency rooms are another choice; most large, teaching hospitals such as Tufts Medical Center and Massachusetts General Hospital have dental and oral surgery residents on call.