Dra. Cléo Salustiano In this article
SummaryStep by stepWhat can happen to the tooth after a knock?The assessment and follow-upFAQRead nextChild hit their tooth: what to do and when to see a dentist
Quick summary of this article+
Child hit their tooth: first check for signs of a head injury (fainting, vomiting, drowsiness — emergency room). Then clean the mouth, press gauze on any bleeding and look at the teeth. A tooth that broke, became loose or crooked, was pushed in or came out needs a dentist the same day. A baby tooth that came out should not be put back; a permanent tooth should be put back or kept in milk, with immediate care. Even minor knocks deserve follow-up, because the tooth can darken weeks later.
Your child hit a tooth? What to do now: calm the child, rinse the mouth with water, press gauze or a clean cloth on any bleeding for a few minutes and look at the teeth. If a tooth broke, became loose or crooked, was pushed into the gum or came out, see a dentist the same day. If a baby tooth came out, do not put it back.
Before thinking about the tooth, check the head: if the child fainted, vomited, became drowsy or confused, or there is a deep cut on the face or bleeding that will not stop, go to a hospital emergency room first.
Falls are the most common cause of tooth injuries in young children, especially while they are learning to walk and run. Most knocks are minor, but even minor ones deserve follow-up, because a baby tooth sits right on top of the permanent tooth that is developing.
This article comes from Dr. Cléo Salustiano's dental office in Mooca, São Paulo (care in English, Portuguese and Spanish). See the general dentistry page to learn how the treatment is done here and book your assessment.
Step by step
- Calm the child and check for a head injury. Fainting, vomiting, drowsiness, confusion or bleeding that will not stop call for a hospital emergency room before the dentist.
- Clean the mouth and control bleeding. Rinse with water and press gauze or a clean cloth on the area for a few minutes. Lips and gums bleed a lot but usually stop with pressure.
- Look at the teeth calmly. Check whether any tooth broke, moved, became loose, was pushed into the gum or came out. If a piece is missing, look for it and keep it in milk.
- Baby tooth came out: do not put it back. Putting it back can damage the permanent tooth that is forming. Keep the tooth to show the dentist.
- Permanent tooth came out: put it back or keep it in milk. In older children, from around age 6, the tooth may be permanent. Hold it by the crown, do not scrub the root and go to the dentist immediately.
- Cold compress and soft food. Ice wrapped in cloth on the lip for a few minutes eases swelling. In the following days, offer soft food and, when possible, avoid pacifiers and bottles if the tooth is loose.
What can happen to the tooth after a knock?
Broken or chipped tooth: the visible part has an uneven edge. Small chips may just be monitored or smoothed; larger breaks may need a filling.
Loose tooth: after a knock, the tooth may wobble slightly, which usually settles within a few days. If it is very loose or interferes with the bite, it needs an assessment.
Crooked tooth or tooth pushed in: it is common for a baby tooth to be pushed back or up into the gum. Often it comes back down on its own within a few weeks, but an assessment decides whether treatment is needed to protect the permanent tooth.
Tooth that turns dark: weeks later, the tooth may turn grey, yellowish or dark. Sometimes the color improves over time; other times it means the nerve was affected. Darkening with swelling, a pimple of pus on the gum or pain needs a visit.
| What you see | What it usually is | What to do |
|---|---|---|
| Lip or gum bleeding, teeth in place | Soft-tissue injury | Press with gauze; dentist if it does not stop or the cut is large |
| A chip or piece of tooth missing | Tooth fracture | Keep the piece in milk and book a dentist |
| Loose tooth, still in place | Concussion or subluxation | Soft food and an assessment |
| Crooked tooth or tooth pushed in | Luxation or intrusion | See a dentist the same day |
| Baby tooth came out whole | Avulsion of a baby tooth | Do not put it back; take the child to the dentist |
| Permanent tooth came out whole | Avulsion of a permanent tooth | Put it back or keep it in milk and go immediately |
| Tooth turned dark weeks later | Change in the tooth's nerve | Visit for follow-up and an X-ray |
The assessment and follow-up
At the appointment, the mouth and teeth are examined carefully and, when needed, an X-ray is taken to see the root and the position of the permanent tooth that is forming. The goal is to treat what needs treating now and protect the tooth that comes next.
Many knocks to baby teeth need no procedure at all, only follow-up. International dental trauma guidelines recommend check-ups in the following weeks and months, because some changes — such as darkening or infection — only show up later.
At home, in the first days: brush gently with a soft brush, offer soft food and watch for signs such as gum swelling, a pimple of pus, fever or pain when chewing. If they appear, go back to the dentist.
At Dr. Cléo's office, children are seen for simple cases; when an injury calls for a pediatric dentist or other facilities, the family is advised and referred. See also broken tooth: what to do.
- Day PF, Flores MT, O'Connell AC, et al. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 3. Injuries in the primary dentition. Dent Traumatol. 2020;36(4):343-359.
- Bourguignon C, Cohenca N, Lauridsen E, et al. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations. Dent Traumatol. 2020;36(4):314-330.
My child fell and hit a tooth. What do I do first?
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Check for a hard blow to the head. Then rinse the mouth with water, press gauze on any bleeding and look at the teeth. If a tooth broke, moved, became loose or came out, see a dentist the same day.
When should I go to the emergency room instead of the dentist?
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If the child fainted, vomited, became drowsy or confused, or there is a deep cut on the face or bleeding that will not stop. In these cases, the hospital emergency room comes first.
Can a baby tooth that came out be put back?
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No. Putting a baby tooth back can damage the permanent tooth that is forming. Keep the tooth and take the child to the dentist.
The baby tooth is loose after the knock. What now?
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Slight looseness usually settles within a few days with soft food. If it is very loose, crooked or interferes with the bite, see the dentist.
The tooth was pushed into the gum. Will it come back down?
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Many baby teeth pushed into the gum come back down on their own within a few weeks, but only an assessment, sometimes with an X-ray, decides whether it is safe to wait.
My child's tooth turned dark after the knock. Is it serious?
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Not always. Sometimes the color improves over time; other times it means the nerve was affected. Darkening with swelling, pus on the gum or pain needs a visit.
Can a knock to a baby tooth affect the permanent tooth?
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It can, because the permanent tooth forms just above the root of the baby tooth. That is why follow-up in the following weeks and months is important.
The lip is cut and bleeding a lot. What should I do?
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Press a clean cloth or gauze firmly for a few minutes. Lips bleed a lot but usually stop. If the cut is deep or the bleeding will not stop, get care.
Can I give a painkiller?
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You can give a painkiller the child already uses, at the dose for their weight and age, as advised by the pediatrician or the label. Do not put anything on the tooth or gum.
What can the child eat after the knock?
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Soft, room-temperature food in the first days, avoiding biting with the front teeth.
A piece of the tooth broke off. Should I keep it?
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Yes. Keep it in milk or saline and bring it to the appointment. In some cases, the fragment can be bonded back.
When does an injured tooth need an X-ray?
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When a root fracture is suspected, the tooth was pushed in, it is very loose or it has darkened. The dentist decides at the appointment.
Do you see children who hit a tooth in Mooca, São Paulo?
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Yes, for simple cases, at Dr. Cléo Salustiano's dental office (CRO-SP 170844), Rua Hipódromo, 1141 – Mooca, every day including Sundays and holidays, from 8 a.m. to 10 p.m. When an injury calls for a pediatric dentist, the family is advised and referred. Message us on WhatsApp +55 (11) 97409-7834 describing what happened.
