Childhood Dental Emergencies: What Every Parent Needs To Know
Childhood injuries are frightening, and certainly no one wants to see a child having pain; but in the heat of the moment it is sometimes hard to know what constitutes a dental emergency and what can wait until Monday. The truth is that it is often a judgment call, but having some guidelines can alleviate anxiety, help with on-the-spot decision making and may prevent a manageable problem from becoming a big one.
A head injury can be life-threatening and it may have resulted in a jaw or facial fracture. Both situations require immediate medical attention. Never leave a person unattended if they have suffered a head injury, and remember that the emergency medical team can often reach you faster than you can get to the hospital.
Soft-tissue injuries of the tongue, cheeks, gums, and lips are very common and they result in bleeding which is often very profuse- and very frightening – both to parents and to the injured person, making it difficult to tell how severe an injury actually is. The most important first step is to control it:
- Rinse the mouth with a mild, warm (not hot) salt-water solution.
- Use a moist piece of gauze or tea bag to apply pressure to the bleeding site. Hold in place for 15 to 20 minutes.
- Hold a cold compress to the outside of the mouth or cheek in the injured area for 5 to 10 minutes. This will control bleeding and reduce pain.
- Call your dentist right away for an evaluation; but don’t wait for an appointment if the bleeding doesn’t stop – go the hospital emergency room. Continue to apply pressure on the bleeding site with the gauze until you can be seen and treated.
Facial swelling is usually a sign that infection may be present and it is a true dental emergency. An abscessed tooth or other oral infection can become life threatening if left untreated. Call the dentist immediately and use a cold compress (ice or ice-pack wrapped in a cloth) on the area of swelling. Because the cold may helps keep the infection from spreading.
Toothaches have many different causes. They are not necessarily emergencies, but could easily develop into one so call your dentist as soon as possible if your child complains of pain. Over the counter pain medications that are given according to the manufacturer’s instructions may provide some temporary relief but it is important to realize that pain relief from home remedies may be masking a serious underlying problem. Never apply an aspirin or other tablet directly to the painful area because this can cause severe burns to the tissue.
A permanent tooth that is knocked out is a true dental emergency, because the faster the tooth is replaced, the better the chances that the tooth can be saved. Try to find the tooth and rinse it off gently without scrubbing any debris off of it, which can damage the surface. Never use soap or any cleaner for that matter; even mouthwash or toothpaste can be damaging! The ideal place to transport the tooth is in the mouth where it is in contact with saliva, but this may be impractical, especially if the child is likely to swallow it. Place the tooth in cold milk – never water – and get to the dentist’s office (or emergency room) immediately. Permanent teeth that are placed back in the socket within an hour have the best chance of survival.
When a baby tooth is knocked out, contact the dentist as soon as possible. Baby teeth are not reimplanted because here is a potential to damage the permanent tooth developing under it. However, the dentist may feel that it is wise to place a small device to hold the space for the permanent tooth. Furthermore, it is very important to examine the child for any fractures or oral injury that may have resulted from the trauma.
A tooth that is chipped or fractured may be an emergency, especially if the nerve has been exposed. It is a good idea to call the dentist immediately. Rinse the mouth with cool clean water and apply a cold compress to the mouth and lip if it was injured. A fracture leaves the tooth extremely sensitive to temperature change, so avoid placing ice directly on the broken tooth.
Broken braces or wires are fairly common. They seldom represent dental emergencies, but should be addressed as quickly as possible to avoid delays in treatment progress. As always, bleeding or pain is a signal to seek immediate attention. Broken wire or brackets that are irritating the cheeks, lips or tongue, should be covered with a piece of cotton or wax to protect the tissue until the orthodontist repair them. Never try to cut or remove brackets or wires, because doing so creates a risk of swallowing or inhaling these sharp objects.
Lost fillings or crowns are not usually an emergency, but you should call the dentist for an appointment as soon as possible because they can cause sensitivity. More importantly, the newly exposed tooth is particularly vulnerable to decay.
While waiting for your appointment, a loose crown can usually be slipped back over the tooth. Cement it in place using temporary dental cement (available over the counter at the drug store) which will help prevent swallowing it. Cover a lost filling with a piece of cotton gauze to alleviate sensitivity, but severe pain is a signal that there is something else going on that may require more urgent attention.
Of course, it is often said that prevention is the best medicine. Most dental emergencies can be minimized by following a few simple suggestions:
- Schedule regular dental check-ups to prevent or treat cavities early, before they cause an emergency.
- Protective gear, including a mouth guard should always be when children and teens participate in sports, and it is particularly important for children who wear braces. A custom fitted mouth guard made in the dental office provides the best protection and a new one is usually required each season because the child’s jaws are still growing and new teeth may be erupting which changes the fit.
- Always use an age appropriate car restraint – a car seat for young children and seat belts for everyone else.
- Child-proof your home to prevent falls.
When the unavoidable happens, don’t panic. Examine the child’s mouth and teeth as best you can before calling the dentist or doctor, and be prepared to answer some key questions that may be asked of you: Is there any bleeding and can you tell where it is coming from? Are there any broken or shifted teeth? Are they baby teeth or permanent teeth? Does the jaw seem to move normally when opening and closing? Tell the dentist if you are unsure of the answers to these questions so he has as many details as possible when giving a recommendation.
A good rule of thumb for both children and adults is that when in doubt, or when pain, bleeding or facial swelling are present, it is best to seek the advice of the dentist or physician right away. These are usually signs of a problem that is not likely to go away by itself; the right decisions can mean the difference between saving or losing a tooth … or even a life.