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Dental Injuries & Dental Emergencies

Dental Injuries and Dental Emergencies

Although dental injuries and dental emergencies are often distressing for both children and parents, they are also extremely common.  Approximately one third of children have experienced some type of dental trauma, and more have experienced a dental emergency.  We encourage families to take their children to see a Pediatric Dentist for a dental examination by their first birthday.  This way a “dental home” is established. In the event there is an injury or emergency, families already have a relationship with a Pediatric Dentist and the children are not seeing a stranger when they are in pain.  Also, it is important to know that many Emergency Rooms do not provide dental services.


Pediatric Dentists receive additional training in dental trauma during their residency programs.  Dr. Renzi and Dr. House have taken emergency call at local hospital Emergency Rooms for decades. They also currently supervise the USC Pediatric Dentistry residents at CHOC Children’s Hospital as Attending Dentists for emergency call. Dr. Renzi trained at Harbor-UCLA Medical Center, a Major Trauma Center in Los Angeles County.

Most traumas to primary (baby) teeth happen between age 2 and 3, while children are developing their motor coordination.  Trauma to permanent (adult) teeth usually happens during a fall. Traffic accidents, violence, and sports are other common sources of injuries to permanent teeth.  Custom mouthguards can help protect teeth against sports injuries by distributing forces.  At Orange County Pediatric Dental Group, we are able to make custom mouthguards for our patients in our in-house laboratory.

Detailed below are some of the most common childhood dental emergencies, in addition to helpful advice on how to deal with them.



Toothache is common in children of all ages and rarely occurs without cause.  Impacted food can cause discomfort in young children, and can be dislodged using a toothbrush, a clean finger, or dental floss.  If pain persists, contact the pediatric dentist.  Some common causes of toothache include: tooth fractures, tooth decay, tooth trauma, and wisdom teeth eruption (adolescence).

How you can help:

1.       Cleanse the area using warm water.  Do not medicate or warm the affected tooth or adjacent gum area.

2.       Check for impacted food and remove it as necessary.

3.       Apply a cold compress to the affected area to reduce swelling.

4.       Contact the pediatric dentist to seek advice.


Dental avulsion (knocked-out tooth)

If a tooth has been knocked-out of the child’s mouth completely, it is important to contact your child’s Pediatric Dentist IMMEDIATELY. 

Primary Teeth: In general, Pediatric Dentists do not attempt to reimplant avulsed primary (baby) teeth, because the reimplantation procedure itself can cause damage to the permanent tooth bud, which will cause damage to the permanent tooth.

Permanent Teeth: Pediatric Dentists almost always attempt to reimplant avulsed permanent teeth, unless the trauma has caused irreparable damage.  The reimplantation procedure is almost always more successful if it is performed within 5 minutes of the avulsion, so time is of the essence!

How you can help:

1.       Recover the tooth.  Do not touch the tooth roots! Handle the crown only (the part visible in the mouth).

2.       Rinse off dirt and debris with water without scrubbing or scraping the tooth.

3.       Reimplant the tooth in the original socket using pressure. If this can’t be done within the first 5 minutes after it has                     been knocked out, place the tooth so it is fully submerged in cold milk and bring it to your Pediatric Dentist or                     Emergency Room (that has dental services). Store the milk in ice if possible.

4.       Call your Pediatric Dentist or take your child to the Emergency Room (that has dental services). Time is critical in                           saving the tooth.

5.       Do not allow the tooth to dry out during transportation.  Moisture is critically important for reimplantation success.


Dental intrusion (tooth pushed into jawbone)

Sometimes, dental trauma forces a tooth (or several teeth) into the jawbone.  The prognosis is better for teeth that have been pushed in to a lesser extent (less than 3mm), but every situation is unique.  Oftentimes, the force of the trauma is great enough to injure the tooth’s ligament and fracture its socket.

If dental intrusion of either the primary or permanent teeth is suspected, it is important to contact your child’s Pediatric Dentist immediately.  Depending on the nature and depth of the intrusion, the pediatric dentist will either wait for the tooth to descend naturally, or reposition the tooth with orthodontics or surgical repositioning. Root canal therapy may be indicated to preserve the tooth.

How you can help:

1.       Rinse the child’s mouth with cold water.

2.       Place ice packs around affected areas to reduce swelling.

3.       Offer Tylenol for pain relief.

4.       Contact your Pediatric Dentist where possible, or proceed to the Emergency Room.


Tooth luxation/extrusion/lateral displacement (tooth displacement)

Tooth displacement is generally classified as “luxation,” “extrusion,” or “lateral displacement,” depending on the orientation of the tooth following trauma.  A luxated tooth remains in the socket – with the pulp intact about half of the time.  However, when tooth protrudes at an unnatural angle, the underlying jawbone is often fractured. The term “extrusion” refers to a tooth that has become partly removed from its socket. 

In young children, primary tooth extrusions may heal themselves without intervention. The tooth must be evaluated by a Pediatric Dentist to determine the severity of the extrusion and whether or not intervention is indicated. However, dental treatment should be sought for permanent teeth that have been displaced or loosened so your child’s Pediatric Dentist can evaluate if intervention is indicated. Repositioning and splinting may be indicated to stabilize your child’s teeth.

How you can help:

1.       Place a cold, moist compress on the affected area.

2.       Offer pain relief such as Tylenol or Advil (generic is acetaminophen or ibuprofen).

3.       Contact your Pediatric Dentist immediately.


Crown fracture

The crown is the largest, most visible part of the tooth.  In most cases, the crown is the part of the tooth that sustains trauma.  There are several classifications of crown fracture, ranging from minor enamel cracks (not an emergency) to pulp exposure (requiring immediate treatment).

Your child’s Pediatric Dentist can readily assess the severity of the fracture using dental X-rays, but any change in tooth color (for example, pinkish or yellowish tinges inside the tooth) is an emergency warning sign.  Minor crown fractures often warrant the application of a protective treatment, whereas more severe crown fractures sometimes require pulp treatments.  In the case of a crown fracture, the Pediatric Dentist should be contacted. Jagged enamel can irritate and cause inflammation of soft oral tissues, leading to infection.

How you can help:

1.       Rinse the child’s mouth with warm water.

2.       Place a cold, moist compress on the affected area.

3.       Offer pain relief such as Tylenol or Advil (generic is acetaminophen or ibuprofen).

4.       Call your child’s Pediatric Dentist immediately or visit an Emergency Room with dental services.


Root fracture

A root fracture is caused by direct trauma, and isn’t noticeable to the naked eye.  If a root fracture is suspected, dental x-rays need to be taken.  Depending on the exact positioning of the fracture and the child’s level of discomfort, the tooth can be monitored, treated, or extracted as a worst case scenario.

How you can help:

1.       Place a cold, moist compress on the affected area.

2.       Offer pain relief as Tylenol or Advil (generic is acetaminophen or ibuprofen).

3.       Contact your Pediatric Dentist.


Dental concussion

A tooth that has not been dislodged from its socket or fractured, but has received a bang or knock, can be described as “concussed.” Your child should visit the Pediatric Dentist following a concussion to the tooth. The tooth may turn dark due to blood pigments inside of the tooth (like getting a bruise inside the tooth). This usually is seen 2-3 weeks after a concussion injury. Dental concussion can cause the tooth to discolor permanently or temporarily.


Injured cheek, lip or tongue

If the child’s cheek, lip or tongue is bleeding due to an accidental cut or bite, apply firm direct pressure to the area using a clean cloth or gauze.  To reduce swelling, apply ice to the affected areas.  If the bleeding becomes uncontrollable, proceed to the Emergency Room or call your child’s Pediatric Dentist immediately.


Fractured jaw

If a broken or fractured jaw is suspected, proceed immediately to the Emergency Room.  In the meantime, encourage the child not to move the jaw.  In the case of a very young child, gently tie a scarf lengthways around the head and jaw to prevent movement.


Head injury/head trauma

If your child has received trauma to the head, proceed immediately to the Emergency Room.  Even if consciousness has not been lost, it is important for pediatric doctors to rule out delayed concussion and internal bleeding. Loss of consciousness takes priority over dental trauma!


If you have questions about dental emergencies, Dr. Renzi and Dr. House would be happy to discuss these with you.