What to do in a dental emergency

When Michelle McKenzie’s* eldest daughter, Ava, was four years old, she smashed her front teeth on the back of the family minivan’s front passenger seat. “You could see her little teeth marks in the handrail on the back of the seat,” explains McKenzie, an Ottawa mom of three. Ava was bleeding pretty badly. “I didn’t know if her nose was broken,” she recalls. “She was scared and not really sure what had just happened.”

It turned out Ava’s front baby tooth had been pushed backward, toward her upper palate. They went to their family doctor, who sent them on to their dentist. Unfortunately the root was damaged, so they had to pull her tooth. In cases like this, it’s sometimes possible for the tooth to naturally move back into position if there was no other damage. Now, three years later, Ava’s adult teeth have come in, and everything looks fine, reports her mom.

McKenzie did the right thing by not just focusing on Ava’s teeth, says Toronto paediatric dentist Brett Saltzman. If a child hits her mouth, he recommends first figuring out where the area of injury is, so checking for a soft-tissue injury, like a cut lip or gum that might require a doctor’s attention, and then taking a look at the teeth. Teeth getting knocked out is a fairly rare case, says Saltzman, but if an adult tooth is knocked out, try to find it, as there’s a small chance the dentist may be able to re-implant it. (If it’s a baby tooth, it’s time to call the tooth fairy—re-implantation would affect the growth of adult teeth.) “The success rates of re-implantation are still very low,” he explains. It’s also a question of time, as the longer you wait, the less chance the tooth will take again, he says. If an adult tooth can’t be re-implanted, a dentist can make a denture for the child to use until he is fully grown, at which point his mouth will be ready for a dental implant. Dentures are only recommended for older children, though, who are able to manage the increased care required, says Saltzman.

Far more common is a tooth that is pushed inward or outward or fractured, he says. If the tooth is broken, take a look for the missing piece, says Saltzman, because if there was no other damage, the dentist might be able to use it to fix your child’s tooth. “You can bond it back on,” explains Saltzman. “It’s like a piece of a puzzle; it fits right back on the part where it broke.”

Whether you have the missing tooth or not, it’s time for a trip to the dentist. If you don’t have a dentist, you can try your family doctor, a walk-in clinic or your local hospital, which may have a dentist on staff. But don’t wait. “Seek treatment for these cases sooner rather than later, because a parent can’t always tell at the point of injury whether a nerve of the tooth has been exposed,” says Saltzman.

* Names have been changed

Back in black A bumped tooth can change colour for a couple of reasons, says paediatric dentist Brett Saltzman. Teeth are made up of layers—the enamel, the dentin and, in the centre, the pulp, which contains blood vessels. The part you can see above and below the gums is the crown. If damaged blood vessels in the pulp leak out to the crown, it can change colour, like bruised skin, and it doesn’t always change back. In other cases, the pulp tries to protect itself by adding extra dentin, which will show through the enamel and make it appear darker.

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