What to do if your child's tooth falls out?

It’s 11pm. Your child is running around the house, with no intention of going to bed. You and your partner have had a long day, and all you want to do is crash asleep. As you run after your child, muttering threats, he stumbles and crashes into the dining table. When he sits up, there is blood everywhere. Oh, and also, his front tooth seems to be missing.

What was a daily pre bedtime routine suddenly becomes an emergency. So, what should you do your child’s tooth falls out?

First things first – stay calm.

Assess for any loss of consciousness, memory loss, vomiting, uncontrolled bleeding etc. If any major medical problem is noticed, rush to the nearest hospital/ emergency center.

If the child is conscious, oriented to time place and person, moving/ walking normally with no uncontrolled bleeding, focus on finding the lost tooth.

Depending on your child’s age, the knocked-out tooth may be a milk/primary tooth or a permanent tooth. The treatment plan for each is different. If at all possible, meet a dentist immediately, with the tooth that fell out.

Avulsion of Primary Teeth

If a milk tooth/ baby tooth has been lost, often there is no need to replace it. Reimplanting the tooth is not usually advisable, as it may lead to injury of the developing permanent tooth bud.

However, we do have various options for replacing the missing tooth. These depend on the age and need of your child. Your dentist will guide you, based on the clinical and radiographic examination.

A commonly used appliance is the pedo-partial appliance. This takes support of the back teeth and replaces the front teeth. This helps to maintain aesthetics and also ensures normal development of speech in the age group of less than 6 years.

Avulsion of Permanent tooth

This usually happens between the ages of 7 to 13. Specially in children with protruded upper front teeth

Following the loss of a permanent tooth, the first line of treatment is immediate replantation of the tooth. The earlier the tooth is placed back in its socket, the better the prognosis.

If the tooth fell out in a contaminated environment – like a playground or in a muddy area – it should be carefully held by the crown portion only. The root surface should be cleaned with sterile water or milk, and the tooth should be immediately repositioned in the oral cavity.

If this is not possible, the tooth should be placed in a physiologic storage media. Hank’s Balanced Salt Solution is the most highly recommended storage medium, but it is not commonly available. Milk may be used as the second option.

Visit your dentist as soon as possible. He/she will try to reposition the tooth in the correct position. If the tooth is already replanted it might need to be splinted or treated further. You will also be guided for tetanus prophylaxis if needed.

Some of the precautions you will need to take are:

- Soft diet for a few days

- No pressure to be applied on the front teeth

- Avoid any further trauma to the teeth.

An avulsed tooth will always need to be kept under long term follow up. Your dentist will advise you regarding the need for x-rays, root canal treatment or any further treatment that may be needed.