Child knocked out a baby tooth?
Leave it out, and here is what to do instead.

The first few minutes

Mouth injuries bleed a lot, and a small cut mixed with saliva can look far worse than it is. Your calm voice helps more than anything else right now. Then work through these steps:

• Look at your child as a whole first: are they alert, acting like themselves, breathing easily? Check for head injury signs (see below) before you focus on the tooth.
• Have them rinse with cool water, or wipe the mouth gently with a clean, damp cloth, so you can see where the bleeding comes from.
• Press a folded piece of clean gauze or cloth on the bleeding spot and hold it steadily for about 10 minutes without peeking.
• Hold something cold against the outside of the lip, wrapped in a thin cloth. Older kids may prefer to suck on an ice pop.
• Find the tooth if you can and keep it in a clean container. You won't put it back, but the dentist will want to see that it came out whole.
• Give a children's pain reliever only as the label directs for your child's age and weight, or as your pediatrician advises.

Why a knocked-out baby tooth stays out

The adult tooth develops in the jaw right next to the root of the baby tooth. Pushing a baby tooth back into its socket can drive it into that developing tooth, and a replanted baby tooth can also become infected. The small benefit of keeping a baby tooth that would fall out in a few years isn't worth that risk, so dentists generally don't replant them.

Losing a front baby tooth early usually causes fewer problems than parents fear. The dentist will look at whether the space needs watching, especially if a back baby tooth is lost, because neighboring teeth can drift into the gap.

If you can't find the tooth, don't assume it fell out. It may have been pushed up into the gum, which can look exactly like a missing tooth, and only an X-ray can show it. If your child is coughing, wheezing or breathing noisily after the injury, they may have inhaled the tooth or a piece of it: go to the ER.

Baby tooth or adult tooth?

The right first aid depends on which kind of tooth it is, so this matters. A few clues help:

• Age. The first adult front teeth usually come in somewhere around age six to eight. In a younger child, a knocked-out front tooth is almost always a baby tooth.
• History. If your child has never lost a tooth in that spot, the tooth is a baby tooth.
• Look. New adult front teeth are noticeably larger and often have small bumps along the biting edge. Baby teeth are smaller and whiter.
• Root. A knocked-out baby tooth that was nearly ready to fall out may have very little root left.

If you aren't sure, or the child is older than about six, treat it as an adult tooth and follow our guide to a knocked-out adult tooth, where minutes matter and putting it back is usually the right move.

Chipped, pushed in, loose or moved

Chipped

A small chip with a smooth edge and no pain can usually wait a day or two for a visit. A larger break, or a pink or red dot in the middle of the broken surface, means the nerve may be exposed, so call for a same-day appointment.

Pushed into the gum

A baby tooth driven upward looks shorter than its neighbors, or seems to have disappeared. Many of these slowly come back down on their own over the following weeks or months, but the dentist needs an X-ray to see where the tooth is in relation to the adult tooth.

Loose or pushed out of position

A slightly loose tooth often firms up with a soft diet for a week or two. A tooth bent forward or backward so that your child can't close their teeth normally needs to be seen the same day. A baby tooth that is extremely loose may be removed so it can't be swallowed or inhaled.

A tooth that turns gray later

Days or weeks after a bump, a baby tooth may darken. Sometimes the color fades again; sometimes it means the nerve has died. Let the dentist know, and watch for a pimple on the gum above that tooth, which is a sign of infection.

When to go to the ER instead

Kids often knock out teeth in falls, and a fall hard enough to break a tooth can also injure the head. Go to the ER, or call 911, if your child:

• Lost consciousness, even briefly
• Vomits, seems confused, is unusually sleepy or hard to wake, or has a headache that gets worse
• Has bleeding that doesn't slow after 10 to 15 minutes of firm pressure
• Has a cut that goes all the way through the lip, or a gaping cut on the face
• Can't open or close the mouth normally, which can point to a jaw injury
• Has any trouble breathing, or swelling that spreads across the face

The teeth can be checked by a dentist afterward.

What the dentist checks, now and later

At the visit we look at the gum, lips and tongue, check the bite and test how loose nearby teeth are. A small, gentle X-ray shows the root, any broken piece left in the gum and the adult tooth waiting underneath. Many baby tooth injuries need nothing more than watching, with a follow-up visit or two over the next months.

Because a hit to a baby tooth can occasionally affect the adult tooth forming beside it, a spot or color change may only show up years later when that adult tooth comes in. Mention the old injury at future checkups.

Prana is a family practice, and Dr. Rana sees children for injuries alongside their regular care. If a young child needs extensive treatment, care under sedation, or the injury is complex, we refer you to a pediatric dentist, as explained on our kids dentist page. We keep same-day appointments Monday to Saturday, 8am to 8pm; call or text first. Our emergency dentist page explains how those visits work, and the first dental visit guide helps if this is your child's first time in a dental chair.

About the dentist

Dr. Aakash Rana, DDS

Dr. Aakash Rana, DDS is a general dentist trained at NYU College of Dentistry, with more than $100,000 in continuing education. He plans and treats each case at Prana Dental himself, works with our in-house lab, and refers to a specialist when a case needs one.

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