Save this article right now. Don't even read it carefully. Save it, bookmark it, screenshot the bold parts, send it to your spouse and your babysitter. If you ever need this information, you will have minutes to act and no time to search.
Then come back and read it carefully when your child isn't bleeding.
Most pediatric dental emergencies happen when parents are least ready for them. A face-plant on the playground. A baseball that bounced wrong. A bite into a hard candy at a birthday party. A late-night toothache that wasn't there at bedtime. Our team at Pediatric Dentistry by Dr. Jeffries handles these calls every week, and we have learned that the parents who handle them best are the ones who knew what to do before the emergency started.
This article is the guide we wish every family had on the fridge.
Emergency 1: A Permanent Tooth Gets Knocked Out
This is the most time-critical dental emergency a child can have. A permanent tooth that has been completely knocked out can sometimes be saved if you act in the right way within thirty minutes. After two hours, the chance of saving it drops sharply.
Here is exactly what to do, in order.
Step 1. Find the tooth. It is probably nearby. Pick it up by the crown (the top, white part), not the root. Touching the root damages the cells that make reattachment possible.
Step 2. Rinse the tooth gently with cool water for no more than ten seconds if it is dirty. Do not scrub it. Do not use soap. Do not dry it.
Step 3. If your child is calm and old enough not to swallow it, place the tooth back in the socket. Have them gently bite down on a clean cloth to hold it there. Reimplanting it within minutes gives the best chance of saving it.
Step 4. If reimplantation is not possible, place the tooth in a small container of cold milk. Milk is the best storage medium most homes have on hand. If milk isn't available, use saliva (have your child hold the tooth between their cheek and gums if they are old enough, or spit some saliva into a container with the tooth). Plain water is the last resort because it damages the root surface, but it is better than letting the tooth dry out.
Step 5. Call our office immediately. If we are open, we will see you right away. If we are closed, call our after-hours line, which connects you to the on-call dentist. The faster the tooth gets to a dental professional, the better the chance of saving it.
The thirty-minute window matters. Call from the car. Don't wait until you arrive.
Emergency 2: A Baby Tooth Gets Knocked Out
Important: the instructions for a baby tooth are different. Do not reimplant a baby tooth. Putting a baby tooth back in the socket can damage the developing permanent tooth growing underneath it.
If a baby tooth is knocked out, control the bleeding by applying gentle pressure with a clean piece of gauze for ten to fifteen minutes. Have your child bite down on the gauze if they are old enough.
Once the bleeding has stopped, call us. We will want to see your child to make sure no fragments are stuck in the gum, to check the surrounding teeth, and to assess whether anything needs to be done about the empty space until the permanent tooth comes in.
Most lost baby teeth heal beautifully on their own with the right follow-up. The reason to call is not panic. It is making sure nothing was missed.
Emergency 3: A Chipped, Cracked, or Broken Tooth
Chips and cracks are common, especially in active kids. The right response depends on how big the chip is and whether it hurts.
Small chip with no pain. Save the broken piece if you can find it (place it in milk, the same way you would a knocked-out tooth). Call our office to schedule an appointment within the next day or two. There is no urgent rush, but you want a dentist to evaluate it before any food gets stuck in the rough surface.
Larger chip or visible crack. If you can see deeper layers of the tooth (yellowish dentin under the white enamel, or pink pulp in the center), this needs prompt attention. Rinse your child's mouth with warm water. Apply a cold compress to the outside of the cheek to reduce swelling. Call us immediately for an emergency appointment.
Cracked tooth with pain when biting. A crack that hurts when biting down may run deeper than you can see. Have your child avoid chewing on that side and call us as soon as possible. The longer a deep crack is left untreated, the more likely the tooth will need a root canal or extraction instead of a simpler repair.
In all three cases, save any tooth fragments you can find. Sometimes we can bond them back. When we cannot, having the piece helps us match the color and shape of the repair to the rest of your child's smile.
Emergency 4: A Severe Toothache
A toothache that hurts a little is not an emergency. A toothache that hurts so much your child cannot eat, sleep, or focus is one.
While you are arranging an appointment, here is what helps.
Rinse the mouth with warm salt water (one teaspoon of salt in a cup of warm water). The salt water cleans around the painful area and reduces some inflammation.
Use dental floss to gently clean between the teeth on either side of the painful one. Sometimes a piece of food stuck between teeth is the entire cause of the pain. Removing it can solve the problem in seconds.
Apply a cold compress to the outside of the cheek for swelling. Do not put aspirin or any other pain reliever directly on the gums. Children's-strength acetaminophen or ibuprofen taken by mouth, in the dosage on the bottle, is appropriate for the trip to our office.
Do not put heat on the area. Heat can make swelling worse if there is any infection.
Call us. Severe toothache in a child often means a deep cavity, an infection, or an abscess. None of these get better on their own, and all of them are easier to treat early.
Emergency 5: Soft Tissue Injury (Lip, Cheek, Tongue, or Gums)
Children fall. Lips and tongues bleed dramatically. The amount of blood is usually scarier than the actual injury.
Rinse the mouth gently with water to clear the blood and see what you are dealing with.
Apply gentle pressure with a clean piece of gauze or a soft cloth for ten to fifteen minutes. Hold the bleeding area firmly but not painfully.
Apply a cold compress to the outside if there is swelling.
If bleeding continues for more than fifteen minutes despite firm pressure, or if the cut is deep or longer than half an inch, this needs immediate attention. For minor mouth cuts that involve only soft tissue and stop bleeding promptly, our office can handle the follow-up. For deeper cuts, especially ones that go all the way through a lip or involve the tongue, the emergency room is the right call.
Either way, after the immediate first aid is handled, give us a call. We will want to make sure no teeth were damaged in the same incident.
When to Call Us vs the Emergency Room
For dental injuries, our office is almost always the right first call. We are trained for these situations, our equipment is built for children's mouths, and we can usually see your child faster than an ER can.
Go to the emergency room first if:
- Your child has lost consciousness
- There is uncontrolled bleeding from anywhere
- You suspect a broken jaw (severe pain when opening or closing the mouth, an obvious shift in the jaw position)
- The injury is part of a larger one (head trauma, a fall from height, a car accident)
- It is the middle of the night and the bleeding is significant
For everything else dental, call us first. Even at night, our after-hours line connects you to a dentist who can guide you through the next steps.
The 60-Second Emergency Kit
Here is what we suggest keeping in your home and your car. Total cost: under twenty dollars. Total prep time: five minutes.
- A small empty container with a tight lid (for storing a knocked-out tooth)
- Gauze pads (for bleeding control)
- A small bottle of saline solution
- A travel-sized container of milk in the fridge (refresh weekly)
- Children's acetaminophen and ibuprofen in age-appropriate dosages
- A cold pack stored in the freezer
- The phone numbers of all four of our offices saved in your contacts and your spouse's contacts and your babysitter's contacts
That last one is the most important. The number you cannot find at midnight is the one you cannot use.
Our four office numbers:
- Greensboro: (336) 230-0346
- Winston-Salem: (336) 748-0033
- Raleigh: (919) 954-8570
- Monroe: (704) 282-9961
After the Emergency
Once the immediate situation is handled and your child is comfortable, the follow-up appointment is what saves teeth and prevents long-term problems. We will check the injury, take any X-rays needed to look for cracks or root damage that aren't visible from the outside, and make a plan for any treatment.
Most pediatric dental emergencies, handled correctly in the first hour, end up just fine. The kids who do best are the ones whose parents stayed calm, did the right first aid, and got them to a dentist promptly.
You don't have to remember every detail of this article. You just have to remember to come back to it when something happens. Save it now, while there is no emergency. That's the only preparation that matters.
If you ever have a dental emergency with your child and want a clear head on the other end of the phone, we are here. All four of our locations across North Carolina handle pediatric dental emergencies, and our team is built for exactly this kind of moment.