Thursday, March 02, 2006

Fractured Teeth, Knocked out Teeth, and other Pediatric Dental Accidents

Here is a summary of the kinds of things that we see when kids injure themselves. Often these injuries are baseball related, bike wrecks, and the quite common bumping the head of another child. This is a big topic and I will attempt to address the basics here.

1. Tooth Knocked Loose: Sometimes the gums bleed some, the tooth seems loose, but is in the same position as before. Very common. Usually needs no treatment whether it is a baby tooth or a permanent tooth. Sometimes, if it is quite loose, we might place a splint to hold it in place while it heals. This looks kind of like braces that are worn for a few weeks. The outcome is usually good. Sometimes a baby tooth will turn dark. See here for more information: My Child's Tooth is Turning Dark!

2. Tooth Knocked Out of Position: This is more serious. Usually, repositioning the tooth is desirable, preferably the day of the accident. Sometimes front baby teeth get knocked backwards so much they interfere with biting properly. Repositioning is important here and is usually done the same day with finger pressure. Sometimes, with a permanent tooth, you can't easily reposition the tooth with finger pressure. Short term orthodontic repositioning is best for these cases. Sometimes a tooth (usually a baby tooth) is pushed up into the gum. This is called an intruded tooth. If the baby tooth is intruded less than 50% of the crown length (the part you normally can see), then it will very likely reerupt back into position with no problem. This takes a few months. If it is pushed up where you can't even see it, then it may or may not reerupt and may need some additional treatment even if it does. If it does not come back down, it may need to be removed. Sometimes there is such damage that it is best to remove it and not wait for reeruption if you think it may be harmful to the permanent tooth. The act of knocking the tooth up there may damage the developing permanent tooth bud. You never really know until the now tooth comes in what actually happened. Usually nothing happens, but the worst you may expect is some kind of blemish or spot (fixable) on the permanent tooth. I remember several patients where the parent thought the tooth was knocked out, but it actually was intruded.

3. Knocked Out Tooth: Well, if it is a baby tooth, just leave it out and place it under the child's pillow for the tooth fairy. It is not worth the risk to the developing permanent tooth to replant it. If you don't like the looks of a space there, we can make a little fixed appliance with a fake tooth, mainly for looks. Click here for more info on Pediatric Partials. Now, if it is a permanent tooth, you really need to follow these instructions carefully because you do want to save the tooth. First, find the tooth. Do not scrub it clean, just put it in a moist environment like milk. Call the dentist right away. He may direct you to rinse the tooth and put it back in right away. Most people don't like the idea of doing that, so your dentist can replant the tooth. It's fairly easy to do. The problem is that even though it is back in, you probably need a splint to keep the tooth in position while it heals. It is best to get the tooth back in as soon as possible. After several days the tooth will need a root canal to remove the now dead inside part of the tooth. There is one exception in that if the tooth is very new and has not developed a full root, it might heal on it's own.

4. Broken or Chipped Tooth: Quite common, especially in older kids. The little chips I often see in baby teeth are usually not much to worry about and can be smoothed out or left alone. Larger fractures might need a white filling to restore the lost tooth structure. By the way, it is usually not a great idea to try and reattach the piece that got knocked off although sometimes that can be done. I know it is quite distressing if a permanent tooth is fractured. Most of the time we can place a filling and the tooth looks good. Even if it is a large fracture, I like to place a filling at first. It may need a crown later as the child gets older, but the fillings usually do quite well and look good. Just remember that if there is a filling there, it might get knocked off with a smaller blow than before. If the fracture is into the pulp (nerve) getting it looked at is more time sensitive (yes, pun intended). There is a greater chance that the tooth may need a root canal the larger the pulp exposure and the longer it is exposed. The younger the tooth, the more likely you may see a good recovery.

5. Root fractures, and Various Other Bumps and Traumas: Root fractures might just need a splint or just observation. They can, however, be serious enough that you may need a root canal or even loose the tooth.

6. Lips, Gums, and Tongues: Well, the mouth has a really good blood supply and therefore bleeds a lot when it sustains a trauma. The good news is that good blood supply usually means rapid healing. Sometimes stitches are needed and most of the time not. It depends on the severity and location. A "Busted Lip" will swell quite a bit, but will usually heal on it's own.

*If a young child has hit his mouth, there is lots of blood especially on his upper teeth lip area, look and see if it might just be a torn maxillary frenum. That's the little piece of tissue that connects the upper lip to the gum between the two front teeth. If it was tight and gets hit and stretched too much it will tear. It bleeds a lot at first, but will likely be fine after 20 minutes or so. Usually no stitches are necessary. In fact there may be no treatment needed at all. This is a very common injury in preschoolers.

Bottom line on all injuries is to see your dentist to get information that is specific for your child.

More info here:
Accidents, Dental Trauma

When to Call the Dentist, When to Go to the Emergency Room

More info here: APDA Dental Emergencies Reference Page

81 comments:

angieland68 said...

My five-year old son knocked his tooth back a bit against a die-cast car. It was also loosened a bit. We called the dentist right away and she said by the sound of things that it could wait a couple of days until she could see him (accident happened on a Friday, she couldn't see him until Monday). An x-ray showed a fracture of the root and was recommended to have it extracted. I am not very comfortalbe with this and was wondering if this the only option. I was told that if not removed an infection could arise there affecting his permanent teeth coming in. My son is not in any discomfort and can eat and sleep well and hasn't really complained about it. There is no redness in the area and it looks good to the naked eye. Do I have any other options??

Dr. Dean Brandon said...

Root fractures right at the end of the root usually don't need any treatment, but if it's further towards the middle of the root, it is possible that the best treatment is removal. BTW (I presume the upper front tooth) usually falls out at 7 yrs of age. Your dentist saw the tooth and the x-ray, etc., so I have to say her recommendation is probably the best option. I have seen cases where , if the tooth is in the right place and not knocked backwards or something, and the tooth is not 'unusually' mobile or loose (in otherwords just a little loose), you can sometimes monitor closely and not remove it right away. If you had to get it out, it's usually not as big a deal as some think and some people get a little partial made with a fake tooth just for looks. However, most decide it looks ok after all is said and done. Good Luck!

angieland68 said...

Dr. Brandon,

Thank you so much for taking the time to respond. I really appreciate it. It is one of the upper front teeth. If we lived in Alabama we would come to see you straight away! We are just a little far in Ontario, Canada ;-)

God bless.

angayla said...

My 2 year old son fell at the park and fully intruded his upper front tooth. We went to the dentist asap and she did xray and said his tooth is chipped - wait and see what happens, come back in 2 months. He was also put on antibiotis for 5 days, as he has a heart defect. The night of the accident he did get 101 fever but has been fine since. This was 7 days ago. Gums look nice and clean now, no pain anymore either. Do you think my dentist's recommendation to wait 2 months is a good recommendation? Thanks!

Dr. Dean Brandon said...

Seems like a reasonable time frame. If the tooth were chipped just a little, then there is no rush. A larger fracture, well depends if he's comfortable and there's no pulp exposure. I would go on what your dentist said. In that two months you might see a darkening of the tooth (see my post on that). If the tooth was really intruded (and not just fractured which looked like an intrusion) you need to wait to see if it comes back down which takes abut 6 weeks or so and it might need to be removed (or not). Of course I am sure they would see you if something came up sooner. Good Luck.

BTW it's pretty good they got an x-ray on a 2 yr old. That's not always possible.

angayla said...

Thanks Dr. Brandon. Nice to hear that you agree with my son's dentist. re:the xray, he had slept for the whole exam up until the point the bite thing was put in his mouth for xray, so dentist and I held him tight and got it done!

Carolyn said...

My 10 year old son fell on some ice and hit his face hard and his front tooth (#8). The tooth was pushed back by the fall but there was not a lot of bleeding. His pediatric dentist referred us to an Endodontist who did a cold test on #8 and my son had no feeling of the cold at all. Therefore, the Endodontist told us that he would need a root canal as the nerve is dead. My son has no other symptoms or pain and eats everything normally. Could the nerve regenerate at this age? Can the nerve die in 5 weeks? We have been told absorption will take place if the root canal is not done. Should we give this any further time or move ahead with the root canal?

Dr. Dean Brandon said...

Well, again, I am not his dentist and I didn't see what the situation really is, so don't go on what I say, but in general:

-If it was displaced, it is possible the nerve is "dead".
-A tooth right after an accident doesn't respond accurately to tests, but after a while it does.
-If the tooth is "dead", the nerve will not regerate.
-The endodontist is the expert there.
-There is a risk of external resorption if not treated, so don't wait too long...They usually go in from the back side and either do a full root canal or place some calcium hydroxide for a while. Good Luck.

angayla said...

Hi again Dr. Brandon, re my above post, my sons gums are now a little swollen and a dark red colour,its not bugging him too much but it is starting o bug him - of course it friday night, should I call his dentist monday if things are the same? I will call if things are worse of course!
Thanks for your advice!

Dr. Dean Brandon said...

If the tooth was intruded, the "bulging" might just be the tooth up there. However, if he is getting swelling that wasn't there before, then it could be infection. If it's bothering him I'd get it checked out. After about a week the gums should be healing pretty good. It's always best to get it looked at if you are not sure.

angayla said...

thanks again Dr. Brandon, I'll probably call his dentist next week.

Dr. Dean Brandon said...

Hey guys, just wanted to let you all know I am not trying to practice dentistry over the internet. Do not ask me any question with which you base any important decisions. I have not examined the patients, etc. and I am probably not licensed in your area. If I do not respond to a question, I either do not feel I can accurately do so, or more likely I am just too busy. Please don't feel offended. See my post on disclaimers.

angayla said...

Thanks for your info Dr. Brandon - I think we all realize your limits on the internet!! My son's tooth is coming down now. Yeah!!!
Thanks again for your advice - it is appreciated.
Angie

Anonymous said...

My 6-year-old son fell off his bike and hit his two front teeth. They are his permenant teeth and are not all the way in yet. They are a little loose after the fall and his mouth bled after the impact. We put some ice on his mouth, which was also a little swolen, and plan to call the dentist tomorrow. Any suggestions?

Dr. Dean Brandon said...

Looks like you are probably doing the right thing. If the teeth are just a little loose, there is more chance of a good outcome. I would be more concerned if the teeth were displaced. You are probably ok till tomorrow when you can talk to his dentist. Better that they are not in all the way than if it had happened, say if he was eight. Most kids go through this kind of thing (mine too).

Bike accidents are, unfortunately, quite common and can be quite damaging. A "busted lip" is pretty ugly, but recovers well. Cold the first few hours limits the swelling (which can get quite large). (I was just about to turn off my computer for the evening when your message came through). Good Luck.

Anonymous said...

My four-year old daughter fell and knock loose one of her front teeth. We went to the dentist ASAP and he said there is nothing he can do. He took an x'ray and it revealed that the nerve was dead. He told us that the tooth could tighten up within 4-6 weeks and to watch out for signs of infection. It has been four weeks and it is still loose with no signs of infection. The dentist told us the tooth could remain in for 3-6 months maybe12 months before falling out. I have noticed that the tooth has dropped down slightly. We asked about a pediatric partial and my dentist did not recommend this? I don't understand why not because my daughter just turned 4 and she could be without a tooth for 2- 3 years. Would you recommend a partial for one tooth. How do partials work do they cement in or latch on the back teeth. Do children usually tolerate partials well? Are there any other options? I asked me dentist about A Crown and he said it would not work in this case. Thank you in advance for your time in answering my questions.
Doris McGinley

Dr. Dean Brandon said...

Sorry to hear of the accident. If the tooth is in pretty bad shape it might need to be removed (ask your dentist). If so, you don't have to get a partial and even then sometimes they are difficult to do, but most anything I can say about pediatric partials can be found in my post on that subject:
"Fake Baby Teeth (partial)" listed in the sidebar. Please check that out. I think it will answer some of your questions.

Anonymous said...

My 2.5 year old slipped on something this evening and fell on his mouth. I checked his mouth since it was bleeding and saw that his 3 of this top front teeth were noticeably pushed back. I just about had a heart attack!! I thought they would fall out! I gently touched one of them and felt it moved slightly so i gently pulled it forward a bit and now it is in the "normal" position. The other 2 are still somewhat recessed. He is no longer bleeding and not in any pain, plan to see our pediatric dentist tomorrow, but just wondering if you had any thoughts on what his chances are of keeping these teeth? It doesnt seem I am easily able to move them now, and so I dont try, since I am fearful of making them looser... Thanks for any insights, I normally dont "blog" but was impressed with your concientious responses despite what must be a busy schedule!!

Dr. Dean Brandon said...

The fact you were able to move one of them back into position is probably good, but I can't tell you if they can be saved. Of course let your pediatric dentist take a look. Good luck.

Anonymous said...

My daughter, who turns 1 year old in a couple days, fell face forward onto our hardwood floor. There was a lot of bleeding and her lip got very big. It looks as though she cut up the inside of her lip good. But also, one of her front teeth got pushed back up into her gum. It also looks like the gum next to that, where another tooth was just about ready to cut through, was skinned away. Will her teeth go back to normal as this heals? Does she need to see a dentist, being she's so young? Thank you so much for your response.

Dr. Dean Brandon said...

Usually young children heal quite well from accidents. It is not too soon to have a pediatric dentist take a look. We actually encourage the first visit around one year of age. Good Luck.

Anonymous said...

My Girlfriend fell and knockered here teeth on the pavement. One of them went a little wobbly but has seemed to re-root itself well. We have been to see a dentist and all seemed to be fine until the other day where the tooth has started to turn Red. Any idea what this may be?? Thank you

Dr. Dean Brandon said...

Well, I don't know, but I'd get it checked out. Sometimes problems surface weeks or months later with traumatized teeth.

Anonymous said...

I am an adult who's front tooth was knocked a little loose about a week ago when my 6 year old jumped up to kiss me. It doesn't seem to be as loose as it was before, but I am noticing that my bite is a little off, it feels like my bottom tooth is touching the tooth that was knocked loose. Will it go back into place in time or do you have another suggestion?

Dr. Dean Brandon said...

I'd get it looked at. Some "bumped" teeth are just inflammed/loose from the trauma and some are actually displaced necessitating some kind of treatment. Even if things get better it is good to get it evaluated and/or get an x-ray, etc.

Anonymous said...

My 10 year old son had a tooth filled last year. The tooth is now extremely loose and about to come out. He is trying to wiggle it out with his tongue. What should we do about it?

Dr. Dean Brandon said...

Most kids can "wiggle" out loose teeth on their on with their tongue or fingers. If a new tooth is coming in and the old one hasn't fallen out, then there might be a concern.

Anonymous said...

My 10 years daughter fell from her bike and chipped her front two teeth on Friday. I took her to the dentist on Monday and they did x-ray and found no problems in the root. They filled her teeth to make it look nice. After one week we started seeing the one of her tooth started turning red. We took her to dentist again and they told us that we need to monitor it for few months but since she doesn't have any pain or her tooth is not loose there is a good chance of recovery.
She doesn't have any gum swelling or pain. However she is very gets some sensation when she tries to bite any food using one of tooth (the one which is turning red).
Will her tooth regain color? Does this indicate rooth damage? Do we need to do anything to make sure that there are no further damage to the tooth.

Regards

Dr. Dean Brandon said...

I can't comment on your particular situation, but I'd have your dentist follow it closely. You might find this post helpful too:

Link to post on "my child's tooth is turning dark"

Gisela Hanson said...

My four year old daughter knocked out two of her upper front teeth (1 front and 1 lateral next to each other) on a very bad fall on the corner of a table 5 days ago. The teeth came completly out from the root. There was a lot of bleeding and swelling. We took her to the emergency room and they prescribed an antibiotic and instructed to rinse her mouth with listerine and water until seen by a dentist. The pediatric dentist will see her next week. Even though the sweeling is gone, I noticed that her gums have white spots (like blisters) above the remaining front tooth as well as above the empty sockets gum area where the teeth that fell out used to be. Is this normal? Is it too long to wait a week to be seen by a pediatric dentist?

Dr. Dean Brandon said...

In general, I usually recommend a quick (emergency) visit if there is facial swelling (you know like into the cheek, under the eye/nose), or something like that. It takes several days for gums to heal (and I have no idea if that's what happened)-just what I've noticed. In general, antibiotics have been shown to help prevent infetions in the meantime. Still, don't go by what I say, let your dentist take a look. I can't diagnose over the internet. Ha!

bethie333 said...

My i.5 yr old daughter fell off a chair. Big fst lip and nasty gash on the gums above the teeth. My wife just took her to ER as it is 9 PM. At this age is she in danger of bad perm front teeth someday?

Also, do lips always go back to normal. I could swear my fat lip i had as a kid never went all the way back.

Thanks!

Dr. Dean Brandon said...

Busted lips usually heal well, although they get quite large especially the first 24-48 hours. There is always the risk of damage to permanent teeth with a facial trauma, but usually not a very large chance.

sraines@comcast.net said...

My 6 year old son fell face first down a slide yesterday morning. One of his front top teeth (baby)was bleeding most of the day and very loose. This morning the bleeding is stopped. The tooth is loose and is painful to bite with and his gum above the tooth is swollen and purple. Can he wait to see his dentist on Monday morning, since he luckily already had an appointment? Is there anything else I should be doing? I have been giving Tylenol for the pain. Do I need to be watching for any other symptoms that would require emergency treatment?

Dr. Dean Brandon said...

I wouldn't be surprised if a front baby tooth on a 6 year old was knocked loose quite easily as they often have very little root left. Most soft tissue injuries heal quite well. Let your dentist check it out.

Anonymous said...

Dear Dr Brandon
My 10 year old daughter suffered a fall 7 days ago from her bike. She chipped one tooth and took a blow to one of her front teeth so it became a little loose. We took her to the emergency dentist that night. He put a temporary filling on the chipped tooth and he took an X Ray of the front tooth and said there was no apparent root damage. He did say that hopefully all would be well and the tooth should be ok. He did also say that sometimes there can be complications when the 'shock absorbers' can become melded to the tooth after and accident and this can mean that the tooth doesn't grow downwards any more. My daughter is getting on and off bouts of pain in the front tooth-is this to be expected and how long should we expect such pain for? I'd appreciate any thoughts or perspectives..Thank you, regards V

Dr. Dean Brandon said...

He is talking about ankysosis I think (not erupting anymore, etc.). I seldom see that in children from a trauma.

Have your dentist followup on any trauma. Things can happen down the road, even a year later.

Anonymous said...

Dear Dr. Brandon,

My four year old daughter fell the other day and hit her two front teeth on the bedroom nightstand. There was some bleeding and we applied cold compresses for a couple of hours. Her gums above her teeth are red and somewhat swollen, with a medium degree of mobility. We took her to see a pediatric dentist who advised us to wait and see whether an infection develops.

Question - would it make sense to have our daughter rinse with an antibiotic rinse (they sell some "new" products that kill bad bacteria while keeping the good) to minimize the chance of infection.

Question - Woudl a dental bridge or splint have any value?

Thanks for any insight you could give me.

Dr. Dean Brandon said...

I can't give a recommendation for your child, but I can say I don't usually recommend any kind of rinse. You can always ask your pediatric dentist-I'd trust his/her recommendations for your particular situation.

Anonymous said...

Well in march i was givin my boxer (dog) a bath and i was drying her off and she heard someone come in the door. and she bucked up and hit me in the mouth and it knocked a tooth loose. it was sore for a couple days. and everyone said it would tighten back up. i didnt have money to go to the dentist so i left it alone with no treatment. and now its still loose and sometimes it feels like it's pushed against my bottom tooth (its a front tooth. and only one of them) and im just wonderin if it will ever tighten back up my mom said that if u swish with proxide it would tighten back up and she just told me this so i've been trying it. but will it ever go back to normal?

Dr. Dean Brandon said...

I'm sorry to say that peroxide has no effect on the tightening of a loose tooth. You need to see a dentist and see if you have a root fracture a displaced tooth or something else.

Yady N. said...

Dr. Brandon:
My 4 year old son hit his top front teeth and knocked them loose about 6 weeks ago. We took him to the dentist the same day. On that day the doctor asked us to wait and see if the teeth would tighten up again. Today, we had a follow up appointment. The tooths are still a little loose, but the doctor says that there is hardly no root left, and that he will loose his teeth within the next six months. Is there something that can be done to prevent this from happening? Why is the root disappearing? Thanks.

Dr. Dean Brandon said...

I don't know your particular situation, but I have seen cases where young children have very short roots (on their upper front two incisors particularly) and there is no apparent reason. If the're short to begin with, it's easy to knock them loose.

Jess said...

Hi Dr, my son is 3 and a half years old. a week ago he fell and knock his front teeth on the floor. it was bleeding and when i check one of his front tooth, it was a little loose. it has been a week, i check his tooth yesterday and found that it's still a little loose. he is fine and there seems no pain bothering him except that he cannot bite his food using his front teeth. may i know would his tooth tighten up ?

Dr. Dean Brandon said...

Most baby teeth when knocked loose tighten up in a few weeks (2-4). However, each caseis different . See your Pediatric Dentist.

Christy said...

Hi -- My son (curently age 4 1/2) hit his mouth resulting in a fractured root (lower left incisor) when he was 2 1/2. The tooth tightened up and stayed white, and his DDS has just been monitoring it. Today, he was complaining that it hurts, and all of a sudden it is loose w/ some bleeding around the gums and a little bit of a "blister" type thing at the gum line. I will call his DDS on Monday. My questions is -- if it falls out or has to be extracted, will his permanent tooth come in undamaged and healthy, or will he have life long problems with this tooth due to the root fracture?

Dr. Dean Brandon said...

Sometimes a sore place is just an ulcer, sometimes it is an abscess...

If a baby front tooth is lost early, say knocked out, removed due to abscess,etc. it usually does not affect the permanent teeth. An untreated abscess might or something related to the original trauma might as well. I've seen not much in the way of problems in that area over the years.

Like you said, get it checked out.

Anonymous said...

I know that you should put a knocked out tooth back immediately, pr within 1/2 hour.

If tooth was kept with saliva and milk, what are the chances of the tooth surviving after 3 hours?

Dr. Dean Brandon said...

I've seen them replanted even longer than that with success.

jb said...

I've read through all of these knocked out tooth posts, but I still have a question. My four year old knocked a front lower tooth loose yesterday and by this morning it came out. It's been a long time since I've seen a baby tooth, how can I tell if the root came out or if the tooth broke off at the surface?

Dr. Dean Brandon said...

A complete baby tooth has a long root that gets progressively shorter with age till it normally gets loose and falls out. At age four I would not expect much root there. Even then, I almost never see a baby tooth like that broken off with a root fragment left. Easy to check though with an x-ray.

Anonymous said...

I noticed today that my 13-month-old daughter's left 2nd incisor is growing in at a right angle toward her front teeth. The right front incisor has been in for about 2 weeks and the left front incisor is just starting to erupt (along with its crooked friend). About a month ago, she fell and suffered a split upper lip and I noticed later that her gum over her left incisors was a bit swollen and bruised looking but I didn't think to have it checked since her teeth were safely inside the gums. So my question is this: can an un-erupted baby tooth become 'intruded' or displaced due to a fall causing it to erupt incorrectly?

Dr. Dean Brandon said...

I have not ever seen such a thing.

Anonymous said...

Hi my 8yr old daughter fell and fractured front tooth and chipped tooth next to it. dentist was great put temp crown on and did xray didnt identify any root damage. We are very worried about her talking as she sounds lispy and keeps dribbling even though says not in any pain. we are worried about her state of mind has become very weepy and quiet and withdrawn.

Anonymous said...

Hi-
My 9 year-old daughter knocked out her top front permanent tooth on Monday. We were able to rush her to the pediatric dentist within 25 minutes where he re-implanted the tooth and wired it to the other front teeth. We went to the endodontist to get a root canal, but he told us that since her teeth had no roots yet that he wanted to wait two weeks to see if the nerves would reattach themselves after the trauma and swelling subsided. Is there another dental nerve specialist that we could go to to help those little nerves? During our visit we also discovered that the neighboring upper front tooth was non-vital during a nerve test. What are the chances of nerves reattaching by themselves?
Thanks,
Michelle

Dr. Dean Brandon said...

The Endodontist is the specialist on those little nerves. It's hard to tell if they will heal well or not. Chances are greater with a tooth where the root is not fully formed. Looks like you did all the right things so far. Good Luck.

Dawn said...

my 16 month old son fell off the stairs and knocked off his two lower front teeth. what damage can it do on the development of his permanent teeth?

Dr. Dean Brandon said...

Any trauma might cause problems. I'd ask your dentist.

Anonymous said...

A 10 year old student knocked his front tooth out. It took about about 15 mins to find the tooth. The teacher wrapped the tooth in baby wipes and brought it to the nurse in the school's clinic. I immediately stored the tooth in milk. The student was so traumised and the gum was so damaged he would not allow me to see his mouth. It took abaout one hour to one and half hour before his mon came to get him. The dentist was unable to reattach the tooth. I now feel bad that maybe I should have re-inserted the tooth. Am I responsible for the tooth not being viable?

Dr. Dean Brandon said...

I wouldn't feel that way, if I were you. Hey, traumatic injuries are difficult to handle and each case is different. If the dentist could not get it back in, then you certainly could not be expected to do so. IMOP.

Anonymous said...

I had a question, My son fell and broke his front baby tooth in half, but it is still attached, you cant even tell it is broken, He isin't complaining about pain, does he need to get it pulled out? I took him to the dentis already and I'm waiting for another dentist appointment, but it is taking so long and he is not in pain or complaining that I'm starting to wonder if it is necessary to get it pulled out.

Anonymous said...

Today at Chester Middle School, Chester, SouthCarlina, I had to come home becasue to boys push me into my locker and part of my permanent tooth came right out. What should I do? Im gonna be stuck this way foreveer. Please what will then dentist do??

Dr. Dean Brandon said...

Don't worry. It is likely easy to patch up. However, you should go to your dentist and let him decide shat is best.

Anonymous said...

I got into a car accident and I hit myself below my nose and above my lip on the steering wheel. My lip has been swollen for two days now. When will it go down? Will it ever go down? Should I go to the dentist to get it checked? I am a little worried.

Dr. Dean Brandon said...

Most lip swelling due to trauma goes down after a few days (two or three). It may be nothing, but I would get it checked out to see of you sustained any other injuries.

Bekah said...

My son had a filling this morning @ 7am. The school called me at 3:30 telling me he had a fever and was feeling sick. I got there and his lip was so huge and swollen with a giant white blister. He had been sucking on it all day! I put ice on it but he told me that it was still numb. Is this normal? I called the dentist and she said to take him to urgent care. I don't want to over react however I am concerned about this blister. He tends to get canker sores easily. This one would be enormous. Thank you for your help! Your site is very helpful.

Dr. Dean Brandon said...

I don't know. Sounds like he bit his lip while it was numb. The symptoms you describe match that exactly. Still, don't go on what I say. If it is a bit lip, the swelling would go down after a few days, usually with no long term problems. Get appropriate followup care.

By the way, I chipped my back tooth tonight. I'm going to the dentist tomorrow too (one of my fellow dentist business partners).

JJ Pham said...

Dr Brandon,

My six-year old daughter pulled out her loosed lower front tooth (her permanent is coming out right behind it). However, when I examined her pulled tooth, part the root is missing and probably is still in her gum. She seems to be doing ok but I wonder if it would cause any problems later on. Thanks

Anna said...

Dear Dr. Brandon: I have a 16-month old grandson that still takes the bottle. He "was" taking 1 or 2 bottles during the night, which consisted of either milk or 1/2 juice-1/2 water. Unfortunately, we have noticed that his front teeth are beginning to deteriorate already. The one next to the big teeth in the upper top looks like the enamel has chipped off part of his tooth. What would a dentist do? I read where a metal crown might be needed, but "how" do they keep a 16-month old child still or calm while doing this type of procedure?
I plan on looking for a child's dentist tomorrow. Thank you for your response.

Anna

Anonymous said...

Hello, I have a 2.5year old that 8months ago fell and killed the nerves in her front tooth (it turned greeny/grey). Yesterday I noticed a white pimple (absess) on her gumline above this tooth. I took her into the pediatric dentist and they gave an Xray. She has a fracture. Immediately they wanted to extract the tooth stating there was no way of saving the tooth. I refused at that moment to have it done for I wanted a second oppinion. Later I contacted another Dr, emailed him the Xray and he feels that he can clean out the tooth, do the baby root canal and possibly save the tooth. I am so happy to hear this, but at the same time I am fearful of this being too good to be true and her ultimately losing the tooth. I know it is a lot of trauma to her, but I want to salvage her beauty as much as I can. What would you do?

Dr. Dean Brandon said...

I cannot advise nor say what you should do. I do know if there is an abscess (the pimple), there is a possibility of damage to the permanent tooth from infection. Also, you may want to consider how they are going to get a 2 year old to cooperate enough for an intricate procedure.

amanda said...

My 7 yr old son fractured his front adult tooth about a 6 weeks ago. Our dentist in Athens (Greece)felt that the root had not been damaged and inserted a pin into the remaining tooth and made a resin filling. It looked pretty good and I heaved a deep sigh of relief. Back home on the island, he started complaining (on & off)2 days ago that it was hurting. We visited the local dentist yesterday who said the nerve may be damaged, but as my son wasn't in pain at that moment, to wait. Well, we rushed in this evening in huge pain - indeed the filled front tooth looks like it his 'dropped'- it is now lower than it's neighbour. The local guy immediately suggested a root canal. My Greek is pretty good, but I can't remember what his diagnosis was - something about the nerve pushing out the tooth? As my son was extremey traumatised (too many visits recently) he drilled into the back of the tooth & said to leave it for a few days. He explained that the nerve will now relax. What can I expect next? Is root canal the only option? If so, what prosthetic work can be done at this age? Will the remainder of his tooth blacken? Are there any dangers with an open hole in the back of th tooth?

Dr. Dean Brandon said...

I can't really say, but I have seen cases where a hole is made in a tooth to allow it to drain (infection to drain and not build up pressure). You wouldn't want it that way too long--those cases would likely need a root canal or calcium hydroxide to allow an immature root to continue to form (if it isn't formed yet). A "dead" tooth with a non vital pulp might turn slightly darker in color, but you can cover that up later --might need a crown there when he is older. (at least that is what I sometimes see).

Anonymous said...

My 6 year old has had a bad grinding problem for the past year. When it was brought up at her last dental appointment last year they said it was normal ans she would grow out of it. 1 Year later she grinds her top two teeth until they are numbs, also one of the front teeth is loose. I thought within a couple of days it would come out, but she grinds it overnight and it is pushed over to her other front tooth. It does nto seemd to wiggle and can not be pushed back. Should I worry? Do I need to contact the dentist?

Dr. Dean Brandon said...

Baby teeth do weird things when they are about to fall out. Sometimes they move to the side or change color. I don't really view it as a problem unless I see the new tooth coming in and the baby one is not getting out of the way in time, or if it simply is bothering the patient too much. Ok to get it looked at anytime however.

alisun said...

My 4 year old son just slid on our floor and fell face first into the door frame. His 2 front teeth were pushed back (couldn't close his mouth b/c of positioning behind his bottom teeth) They were bleeding and we were trying to decide what to do (b/c we are having an ice storm outside...wouldn't ya know...)and he stuck his fingers in there and popped them back forward?! Literally I heard a popping sound! He said that they aren't wiggling right now but he did say they hurt. We've given him Tylenol...do you think we'll be ok till MOnday? I don't even know if we can get up our street till monday!?!?!?! HELP!!! I'm so nervous about it!!

Dr. Dean Brandon said...

Funny, I just turned on the computer this morning and there is snow on the ground here too! My kids are building a snow man. I cannot really give advice over the internet, but let me say, if I had a child who knocked back teeth in much the way you described, I would try and "pop" them back into place with finger pressure. If I was able to do that, that's all I could really do for now. The only real advice I can give is to have your dentist take a look when he can.

Anonymous said...

Im not sure if my other message went through,my computer froze. Last weekened my 4 year old daughter knocked two of her teeth loose at a birthday party!! :-[ TALK ABOUT HEART ATTACK!!!!! She went to the dentist and he said that they we're noticably loose but not much and should heal.Its been 9 days and I dont really see much of a difference.She keeps thrushing her toung against them out of curiousity..could this delay the process?? Thanks for your time doctor!!! :-]

alisun said...

Thanks! He hasn't seemed to be bothered by them at all today! Even ate a banana which he had to bite with his front teeth. They were a bit scabby and bloody this morning, but tonight I was brushing his teeth and told him that I needed to check them. I tried to wiggle them to see if they were loose, but they didn't move at all! We're still taking him on Monday...Thanks for this blog! It really put my mind at ease last night just reading other stories! It's soooooooo scary when it happens!!! :]

Dr. Dean Brandon said...

re: Anon...I'd get a followup visit with the dentist. It's always a traumatic experience, more so for us parents it sometimes seems.

Dr. Dean Brandon said...

I am temporarily putting the comment section for this post on hold. I haven't as much time to devote to answering questions here. We have over 80 comments now! I hope you can find the answer to your question here or elsewhere on the blog. Thanks,

Dr. Dean Brandon