Friday, March 12, 2010

Broken tooth

When a child falls or generally is rough-housing, sometimes, they fracture a tooth. Ugh, why does it have to the be the front teeth, the ones everyone sees? Almost every Monday, we receive a call from a parent with a child or teenager that fell over the weekend and chipped, broke, or otherwise fractured a tooth. Teeth can sustain a lot of force, but a sharp hard force concentrated in one spot can cause a fracture or "broken tooth". Now, baby teeth often have multiple small chips on the edges or facets from "normal" wear and tear. Of course, a fracture in a permanent tooth can be cause for concern.

Fractures are classified as to location and basic level of severity with the Ellis classification system:

Class 1--Chips or fractures in the outer enamel layer only
Class 2--Fractures into the dentin layer
Class 3--Fractures into the pulp of the tooth
Class 4--Fractures onto the root often vertical fractures

What to do?

Well, sometimes baby teeth are handled differently than permanent teeth. In general, the principles are the same:

Class 1--Well, they may look bad, but are usually not sensitive. If it is very small, we often just smooth off the edge. It is very difficult to do a very thin filling on the edge of a tooth. You can, but it will chip off again in a heartbeat. If the chip is larger, you often have to do a composite filling (bonding). It's the same material we use for white fillings. It is "bonded" onto the tooth -sort of like gluing something onto a flat wall.

Class 2--Larger fractures. Very common and sometimes sensitive to cold water/air, -at least for a while. A composite restoration is indicated to cover the sensitive dentin and for looks. A very large fracture may eventually need a crown or porcelain facing, but in growing children a more conservative approach is often indicated till growth and orthodontic treatment is completed. Although it often looks pretty good, a composite can be difficult to match existing tooth structure with all the minor enamel inclusions and shadings. So, if you are looking at the photographs below and think, "wow, that's not too bad", you are correct, but most results are not this good. With most repairs, if you look really close, you can see where the tooth ends and the filling begins. That's why porcelain work is often indicated later on.


























Class 3--Always needs attention as bacteria are entering into the pulp. In adults this often means a root canal will be needed. This is not often the case in young permanent teeth. The more vigorous pulps with a better blood supply can often recover quite well. If most of the crown of the tooth is missing, a root canal may be indicated just to create something to hold a crown.

Class 4--Not common, but difficult to treat, and often need removal. Dental heroics may be needed to save such a tooth. Treatment may include orthodontic extrusion, a root canal, post and core, and a crown--if you are lucky.

Once teeth are restored, there still may be problems later on due to the initial trauma. The tooth may abscess or have other problems.

Treatment is sometimes different for a baby tooth. Often parents want whatever it takes to "save" a baby tooth that is not of any real consequence other than appearance. We are much more likely to just remove a severely damaged baby tooth rather than do a "baby tooth root canal". The main objective is protecting the developing permanent tooth. Small fillings in front baby teeth are more difficult to retain without doing a crown. Having said this, we still try and "fix" fractured baby teeth if we can. The age of the patient can dictate what you are able to do (or not). A chip in the tooth of a two year old may be handled differently than that of a 5 year old. Behavioral considerations, the need for sedation, and how much root is left on the baby tooth will influence the ultimate decision.

There is more on the blog on trauma (and I know you want more info on this one):

Fractured teeth, Knocked out teeth, and other pediatric dental accidents

When to call the dentist, when to go to the emergency room


72 comments:

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Dentist Torunn Birkeland said...

If the child has lost a piece of the tooth (permanent tooth!) and has brought it with her/him to the dental office, it is possible to bond it to the tooth again. Obviously it depends on whether the pulp is involved or not. Sometimes one can bond the piece to the rest of the tooth with a small drop of Ca(OH)2+ facing the axial wall towards the pulp, and reinforce the bonding by using an extra amount of resin on the palatinal side of the tooth (if it's not troublesome for the occlusion). This should not be done with baby teeth, due to the risk of breakage of this little part, which can lead to aspiration.

Dr. Dean Brandon said...

I find that bonding back a tooth fragment does not work as well as you would think. I have actually done this, but don't do it often. The chance of the fragment breaking off I find, is higher that a composite bonded on there. Of course, it depends on how you do it and the shape sixe of the fracture.

Anonymous said...

My granddaughter, age 6, has lost her upper and lower front baby teeth. One of the permanent lower teeth has come in behind where the baby teeth were, but of concern, is that her lower gum has "bubbled". It looks like a large air pocket, and she insists it doesn't hurt at all. We cannot get into the one pediatric local dentist for over a month. Is this an emergency?

Dr. Dean Brandon said...

I cannot say, but most things in pediatric dentistry are not "emergencies" other than a knocked out permenant tooth.

Timothy J. McNeely CFP® CIMA® said...

Thanks for the article. I enjoyed reading it.

Cosmetic Dentists Chandler said...

I've seen 4 class 4 cases in the past year alone. It is not that uncommon!

Anonymous said...

If you have a fractured tooth about like in that picture, and the adult tooth has been chipped before and has also had a Root Canale is it possible the dentist would think about putting a Crown on the tooth. Instead of a filling???????

Dr. Dean Brandon said...

Yes, a crown is often indicated. In children we try and do fillings till growth (and any orthodontic treatment) has completed.

dentist said...

a great blog, you've inspired me to consider a blog for my practice.

Anonymous said...

My 4 year old broke a lower incisor in a collision with her sister last week. We went to our pediatric dentist within 24 hours and he said that part of the break (it broke at an angle) may have gone into the "living tooth." My daughter is not what you would call a cooperative patient so the compromise was to bond the tooth. He said that in a different patient he might have done more to prevent bacteria, but it truly is not possible with my daughter. He also mentioned that we need to watch the tooth for any signs of abcess.

My questions are:

1. What are early signs of abcess and how likely is it in this kind of injury.

2. What is the best way to care for this bonded tooth? What to eat, not eat, brushing etc.

Dr. Dean Brandon said...

An abscess is usually associated with swelling some discomfort and or some sign on an.xray. I usually follow them over time just being reasonably careful. Many times (I am thinking on one case in particular) they can recover quite well. Younger teeth seem to recover better. Still even with a very small chip things can go south. A buildup is likely to come off at some point. But If it can be there at least 6 weeks, the tooth can recover better.

vanessa said...

My daughter who is 13 months old, chipped her top front tooth tonight. I am planning on taking her to the dentist. I have heard they can do bonding to make the tooth look normal, but we don't want her to be "put to sleep" or anything. We assume it would be better to wait until she is about 3 yrs old before we get it bonded so that she will be still. What do you think?

Dr. Dean Brandon said...

Ha, I'm on call tonight for our office, I didn't know I'd be on call on the internet too. Ha!

Sorry that happened. I see it often. Ask your dentist for options. If you read my posts on the blog (please do as there is a lot of stuff here), you will see it is complicated. Teeth can be restored, but behavior in very young children is complex. Sometimes we just smooth it off and other times you can place a filling or something. Most kids do fine whatever the diagnosis. It's us parents that have all the stress. Good luck.

mr kennedy said...

my 1 year old daughter slipped with her dummy in her mouth and has chipped a piece off her front tooth. there was quite a lot of blood is this something major? the piece is quite small but on such small teeth i can not help but worry

vivian said...

hi, my 17 month old broke her two front baby teeth,leaving her with these sharp edges on the corners of her teeth, is there anything a dentist can do to fix them even though shes this young?

thanks

Dr. Dean Brandon said...

As you can read in this post and others, there is not much that can be "easily" done. What we often do thought is smooth off the rough edges of a chipped baby tooth, that's not to hard to do on a little one and it helps it look and feel better. If the damage is severe, removal is sometimes indicated. Most of the time that is not needed. Fillings don't work so good in these cases. Little children chip their teeth all the time and mostly do not have any big problems with it other than us parents fretting over appearance. Talk to your dentist about alternatives. Also, watch for it turning dark in color 2 to 3 weeks after the accident. (See my post on that).

Anonymous said...

My 21 month old fell and chipped his two front teeth. We took him to a dentist who wants to etch his teeth and place a film on them. I have not heard of this before. Is that common? What is the benefit over bonding the teeth?

Dr. Dean Brandon said...

I'm not really sure what a "film" is. For a 21 month old, it could just be a fluoride varnish to protect the teeth. More likely though, it is etching and placing some flowable composite (white filling material), not so much to restore the area back to the way it was for looks, but to protect, smooth the area off and perhaps restore a little bit of the original form. Just be aware, anything you put on a very young child's tooth is likely to eventually chip off. Also, just etching and placing a flowable composite is fairly easy and does not involve preparation of the tooth (drilling).

Cynthia S said...

Hello! I am so glad that I found your blog! My 4 year old daughter fell at preschool and knocked in her 4 front lower teeth. They weren't knocked out but they are really, really loose. We took her to the dentist and he said to watch them and if they don't tighten up then they will need to pull them. How long would it take for them to tighten back up if they are going to? We have her on a liquid diet & very soft food. She really wants to eat normally since her teeth don't hurt but I don't want her to lose the teeth. If she loses the teeth, will her permanent teeth come in earlier than normal? I am not worried about how it will look if she loses them...she will think it is cool. I am more worried about speech & eating. Should I be concerned about this?

Dr. Dean Brandon said...

Most loose teeth tighten back up in about a week or two unless they have some other kind of damage or have short roots to begin with. If I had to pick which teeth I would have knocked loose (or out) it would be the lower primary front teeth. If teeth do not tighten up after a while, they might need to be removed. Front teeth lost early do not effect speech or eating.

Anonymous said...

I'm so glad that I found your blog. My 17 month old daughter fell on about 6 days ago and hit her mouth. She chipped her front top tooth. I took her to the dentist. He just smoothed the tooth and took an xray to make sure everything was ok. Well today myself and her were at the store and she fell and hit the same area. Only this time the tooth next to the chipped one has cracks. She has an appt for tomorrow. What can the dentist do for the crack running straight across? I'm terrified that she might hit this and it fall out. Can he put something on her teeth to make them stronger or prevent it from breaking?

Dr. Dean Brandon said...

Well a crack is not a fracture with a big chunk gone. Just because there is a line or crack on the enamel does not necessarily mean a big problem.fRyers is bot much to be done to reinforce she of a crown or something. Off course each case is different. Sorry for your situation. I know it's extra worrying when they are so young. Usually it's the boys rough housing that gets the chipped tooth.

Dr. Dean Brandon said...

Sorry a little typo there. I'm doing this from my iPhone.

Anonymous said...

I guess why I'm worrying so much is because the first tooth that chipped off had a crack in it and that's where it broke off at. These cracks are the same but higher up on her other tooth. I'm concerned because I don't want this one to break off like the first. It's always her mouth everytime she falls. I never had this issue with my first. Is this common with toddlers? So there is no type of treatment that he can put on the outer part of her tooth to make it stronger or prevent it from breaking?

Dr. Dean Brandon said...

A sealant is often placed or painted on the grooves of back teeth to prevent decay but there is nothing really you can just paint on a damaged tooth to prevent further damage. Extensive damage may benefit from a filling or a crown. I wish there was.... Kids are often pretty rough on their teeth. That must be why God gave us a second permanent set.

Saira said...

Hello, my my 15 months old girl fell down yesterday broken her two front teeth. They are half broken and the ends are very sharply and we are afraid that she hurt herself, we are so worry but wouldn't take her to the dentist because can not afford one and she don't have dental insurance. Where we can apply for one, or where can we find someone who can help us. We don't know what to do, please help us. We are so desperate.

Dr. Dean Brandon said...

As you can read, some young kids with broken teeth just need the edges smoothened off. Even with larger fractures baby teeth often do not need restoration except for cosmetic purposes. I would advise seeing a dentist, however. Yes, it is difficult to fine someone to do free treatment . There are programs like Medicaid for children with limited income. The main concern with traumatized baby teeth is the possibility of abscess later on--that's something to watch for.

Kristen Marlin said...

I once had a girlfriend who had a Class 1 fracture on her incisor. She was bothered by it every time she ate or drank anything. She decided to leave it along, but it only got worse. We had to see a dentist to get it fixed.

Anonymous said...

My daughter fell off the stairs at school and hit he teeth on the wall.Her front tooth was severly chipped and I took her to the dental hospital.As it was a adult tooth and we had saved the fragment by putting it in milk the dentist was able to glue the piee back on.The dentist said that the nerve was completly damaged however thought there was a chance of it repairing itself.My daughter is very upset and wants to know if the root (which is still alive) could join on to the fragment? thankyou

Dr. Dean Brandon said...

Nerves do not connect with anything. They can however become traumatized or infected with bacteria leading to the need for removal (root canal). Your dentist will know best and usually a time of observation is necessary to know.

rkmunsell said...

hi, was wondering if you thought a tooth could be bonded if only about 1/4 was left showing. My son broke his tooth yesterday with a small spot of the pulp visible, thankfully he found the piece and the dentist bonded back on today but didn't think it a permanent fix and recommended a root canal as well. After that we could just wait until he was older to do anything permanent. but my question is couldn't it be bonded with composite if the piece falls off, at least until he's done growing. He's 11 now. The dentist didn't think composite would work and I am not sure I totally understand why. thanks

Dr. Dean Brandon said...

Actually, most of the time we use bonding (composite filling material) to replace lost tooth structure. Occasionally, you can rebond the fragment, but either way, it usually is the case that the bigger the fracture the more likely any replacement can get knocked off. Large fracture often need a crown. Pulpal health is also an important consideration in traumatized teeth.

Anonymous said...

My 9 yr old has a 'pink' baby tooth that we've been watching. Our dentist suggested waiting for it to come out naturally since the permanent tooth is ready to come out. Tonight it cracked in half. My concern is that it may get infected & the dentist may be closed tomorrow. Maybe we just wait & let it fall out naturally. . Thoughts?

Dr. Dean Brandon said...

I see that all the time, that is the baby tooth turning pink and coming out in pieces. Good that you go them to take a look though.

Anonymous said...

Thanks so much!

gmcj said...

My 20 month old haS a level two fracture and the dentin is exposed. Dentist wants to seal the dentin,but my son seems ok when he is eating. He cried so much just through the exam and xrays I dont want to put him through any unecessary procedures.

Dr. Dean Brandon said...

As you can see here, leaving a broken baby tooth with observation is sometimes an option--especially if cooperation for procedures is an issue. Read more on a child's behavior in the dental office.

How Children Behave In The Dental Office

Anonymous said...

Hi Dr.,
I'm so glad I found your blog as there is limited information on pediatric dentistry in the country where I live. My 17 month old just lost her two upper front teeth last week due to really bad decay (the decayed part fell off by itself when she ate) and I couldn't sleep for three nights thinking how ugly she'll look in the next four to five years. She has about may be only 1/4 of the teeth left. I know you said it wouldn't impair her speech or permanent teeth but if I really want to have them restored, what should be the earliest age to have it done? Can the teeth be crowned with only 1/4 of the teeth left or they have to be removed completely and put partial on? Some people say the remaining parts will grow a bit longer, is it true? Grateful for your advice.

Dr. Dean Brandon said...

If a baby tooth is crumbling due to decay, that's a sign it's pretty extensive decay, which often needs tooth removal. You really need to see a pediatric dentist, who can assess the individual situation. If there is good tooth structure left after you remove the decay, a filling or crown can be placed. It gets worse pretty fast, so, I would not wait too long to see a dentist. Other problems can occur like a dental abscess. good luck.

Anonymous said...

my fiancee's 3 year old has broken a part of one of his back teeth, should we get this looked at? could it get infected?

thank you

Dr. Dean Brandon said...

I don't see broken back baby molars that much unless there is decay there. An infection can result from the decay. There a lots of kids with a chip in their tooth (usually a front tooth, but sometimes a back molar) that have no problems with infection or decay. We just monitor the chipped area if it's small and of no consequence otherwise.

Its' a good idea to get it checked out by your pediatric dentist to catch problems before they get worse. Sometimes things aren't even a chip but part of the normal anatomy.

Anonymous said...

Hi I'm amber and I'm 18 years old. I know this is for "pediatric dentistry", however I need some help! I'm freaking out. I had a pretty large sized filling in my top front tooth and it just fell out while I was brushing... I called my "on call" dentist, but no one has called back. I'm really scared and there is a large hole in my front tooth.

Dr. Dean Brandon said...

If a large filling came out, there was probably a large loss of tooth structure (a hole) to begin with. Fillings fall out because of trauma, new decay that undermines the old filling, or sometimes just wear and tear over time loosens the bond, especially with front teeth fillings. I am sure you will be ok if you just contact your dentist. Not much in dentistry is a time sensitive emergency that can't wait 24 hours or so other than a knocked out permanent tooth.

Momoftwo said...

Good Morning. I have a 12 month old who fell an broke her front tooth. It starts on the bottom of the tooth then heady towards the gums at an angle. About 1/4 of the tooth had broken off to where you can see a small portion of the tooth peeking out from her gums. She does not act like she is in any pain. There was no blood. She has been eating and drinking like normal. Do I need to take her to a dentist and get bonded or capped?

Dr. Dean Brandon said...

All depends on how big the fracture. Many little ones do quite well without any treatment other than maybe smoothing it off. I'd let them take a look as there are other things that could happen with a traumatized tooth.

Paula said...

My grandson fell and his front tooth it is not broken off what can we do?

Dr. Dean Brandon said...

Well, you can get more information here on the blog that might be helpful, but really, call your dentist or your child's dentist for a better assessment of the situation.

Chad said...

Hey DR Brandon,
I have a tough question about my 2 yr olds split tooth. His front tooth has cracked in half and we have seen a dentist that told us to have the tooth removed. I really don't want to do that because he does not cooperate in the chair and I am fearful to put him to sleep to have extraction done.
It is split pretty much in half and 1 piece does move back and forth some. It doesn't seem like it bothers him too much so I don't know if the nerve or pulp is exposed. The tooth did not bleed either when it happened.
Is there a way to clean out and fill the crack with something and hold it there for a few more years to help with his adult teeth coming in or is my only option to have it removed?

I would be greatful for any advise. Thanks

Dr. Dean Brandon said...

Each case is different but sometimes a tooth is just not restorable and it's best to take it out, or the pulp is involved requiring such extensive work it's just not practical. This is especially true with vertical fractures into the pulp or down to the root.

Anonymous said...

Hi My 19 month old, just chipped her tooth. She was standing behind the boor when my husband opened it. Her front tooth is almost half way gone. What can they do to help her at the dentist?

Dr. Dean Brandon said...

Sorry that happened, my 1 year old fell and chipped a tooth as well. I would not worry too much I am sure she will do fine. They will probably take a close look and decide what to do. Usually nothing much is urgent. Ask your pediatric dentist though.

tkostenko said...

Hello! Our 10 month old has had a chip in his lower front tooth almost since it came out of the gum a few months ago. We never noticed any trauma to have caused it. The neighboring tooth is growing/shaped normally. This week I noticed that the chipped tooth has darkened on the exposed/broken surface and there appears to be a brown thread-like structure shooting straight out of the top! His dentist can't see him for 10 days- please advise!

Dr. Dean Brandon said...

some teeth erupt with enamel defects called hypoplasia. I have no idea about "threads" other than maybe he chewed on a towel or something. Best thing is to let them take a look. Very few things like that are emergencies.

Anonymous said...

Hi, My 15 month old daughter appears to have translucent outlines around her two front teeth. I also just noticed tonight that she has chipped about a quarter of one of her bottom front teeth. Are these signs that she may have an issue with enamel weakness, or other underlying issue? I want her to visit a dentist, but I know she will not cooperate during the exam so I would like to know what treatments are available first. Thanks for your help!

Dr. Dean Brandon said...

You may want to peruse more of what is here on the blog. I have written many posts on behavior and what to expect. Yes, behavior (a young age) can affect which treatment options are available. Often treatment is postponed till a later age. Sometimes that is not the best option. Quick easy treatment can be done fairly easily, but more complex options sometimes need sedation or general anesthesia. It's best to talk with the dentist to see if it's really a big concern or not.

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Donna Bowman said...

Thanks for this information. My 10yo son was eating dinner and said a tooth "broke off". The fragment looks like the whole bottom of a molar, no root. Looking at the spot that was bleeding (not much), it's a premolar position and I can't see or feel any tooth at all in that spot -- no edges at all. There seems to be a molar coming in next door, with only part of it down, but that's not the space that's bleeding. My son says there's no pain. I'm wondering whether this is part of him losing a baby tooth, or whether it's an actual break. We'll try to get him to his pediatric dentist tomorrow.

Dr. Dean Brandon said...

Yep. back baby teeth do tend to come out or crumble at 1-12 years of age.

Anonymous said...

My 17 month old fell on the ceramic tile this morning and chipped his front tooth. Didn't bleed and doesn't seem to bother him. My concern is that the same thing happened to my nephew in the bathtub when he was this age and my sis didn't take him to get it looked at. A week later his face swelled and pus developed and he ended up having to have it pulled because of an abcess. She said his didn't bleed either and didn't seem to bother him at first. Is abcess common with this type of injury? We will be having him checked out this week but i just don't want him to have to have his tooth pulled!

Dr. Dean Brandon said...

A traumatized tooth does not usually abscess unless the trauma is in such a way as to damage the pulp tissue. It's more likely to have problems if the tooth is displaced (knocked out of position or intruded) or fractured into the pulp (nerve) exposing it to bacteria. The good news is that the younger the child, the less likely to have major problems because they heal quite well. Still, it's good to followup with the dentist regardless.

Anonymous said...

My 8yr old has a premolar or a molar that is now missing half the tooth including the pulp. He had routine care recently & was put on an antibiotic for that tooth so they could do a pulpectomy since it was already broken he has an appt tomorrow to have it done. Not bothering him or anything at all. Just wondering what they can do with this tooth now. Will they typically crown it or pull it and place spacers? Thanks for any help.

Dr. Dean Brandon said...

What they can do?--depends on how much tooth structure is left, if the pulp is abscessed or not (abscessed, they will likely remove- if a baby tooth), and how far till exfoliation, tooth structure, etc. These are the kinds of things the dentist takes into consideration. By the way an 8 year old would not have a permanent premolar, it might be a baby molar. An 8 year old may have a permanent 1st molar. Read more here on the blog about all these things.

Anonymous said...

My 3 and a half year old was dairy intolerant for the first two years of her life but has in the past year or so has been introduced again to dairy products and enjoys them so much her daily intake is probably double of her requirements. My query is her top four teeth are awful. We brush in the morning and at night plus she brushes them at nursery during the day too. We all go for regular check-ups at the family dentist also. Her teeth have been 'varnished' twice now but obviously wears off through time. I noticed whilst brushing the other day the tooth to the left of her front one was half missing and subsequently it has all but broken off today and i can see the slight beginnings of her front tooth next to it going the same way. The brownish/yellow discolouration and chipping on her teeth is at the gum 'end' and not crumbling from the bottom up. I have been advised there is not a lot I can do. My son who has very healthy straight white teeth has only very recently lost his first baby tooth at the age of almost 8 so I am thinking she will have another 5 years of what I can only imagine brown 'stubs. Is there ANYTHING you can recommend I go to my dentist and ask about?

Dr. Dean Brandon said...

From what you have said, there is no reason anyone should say, nothing can be done. Refer any dentist to this blog and to the American Academy of Pediatric Dentistry website for more information.

American Academy of Pediatric Dentistry website

Dr. Dean Brandon said...

Lots of relevant information here too:

AAPD guidelines and recommendations

laticia said...

My daughter (9), chipped her adult top tooth in late Nov early Dec. Tonight, she chipped the same tooth with bondage for the 4th time since. Is there a more permanent fix that I can discuss with the dentist that is covered on Medicaid?

Dr. Dean Brandon said...

Composite filling material (bonding) often comes off with normal wear and tear that kids seem to have. Larger fractures that keep having problems sometimes need a crown.

Anonymous said...

Hello,

My 2 year old had very decayed front teeth. he fell on his face and both the teeth broke and fell off. HE has stumps remaining with the pulp exposed. It has been 2 days now and we have not been able to find a dentist. I live in Yemen (3rd world)
He is in occasional pain. Today he bumped his mouth on my shoulder and the stumps started to bleed again.
I was about to wean him but I have decided to continue breastfeeding until we deal with his teeth because he is not able to eat much and also because I was told it would help prevent infection.
Please advise. I am originally from Australia and would you recommend leaving and getting his mouth seen to there?
Regards

Anonymous said...

Hi,

My 3 1/2 year old fell down and broke one of her upper front tooth. The tooth fell off completely in one form. I have it in ziplock. Since it is Sunday, we took her to ER and the doctor said my daughter will grow her permanent teeth when she is 6 or 7 yrs old and they can do nothing now to fix it. My daughter is yet to start with her preschool, she keeps crying to get back her tooth. I am wondering is there anything can be done or she need to wait another 3 years to get permanent tooth. Thanks

Dr. Dean Brandon said...

I've been out of the country for a few days. Sorry for the delay posting, but I bet after a few days she was less upset than at first. If a baby tooth is totally knocked out--root and all, it's best to leave it out. If the tooth was fractured, that is, broken off at the gumline, I'd get a pediatric dentist to see of there is some root or tooth structure still in there. Might need treatment. If there is some tooth left, in other words enough to put on a crown, that is sometimes possible, but from shat you said, not much there to work with.

Dr. Dean Brandon said...

Well, there are 1000 ways to answer questions, but because the best way is to get a thorough dental examination by your pediatric dentist, I'll leave this post closed to further comments. There is a lot of information here--good luck.