What should I do if my child has a dental injury?

Article at a Glance

• A chipped tooth is usually cause to see the dentist, but frequent tooth chipping merits a pediatrician visit.
• Soft tissue injuries inside the mouth that bleed continuously need to be seen by a pediatrician.
• Unexplained or general oral pain, swelling or bleeding should also be seen by a pediatrician.

When something happens involving your child’s teeth or mouth, your first impulse might be to schedule a dentist appointment. If it’s a serious injury, the emergency room is the right call. But some dental injuries or problems might be caused by issues that go beyond the mouth—which would call for a pediatrician. Here are three common scenarios involving the mouth and some guidelines on what to do (and who to see first):

Your child has chipped a tooth or had a tooth knocked out.

If roughhousing or run-of-the-mill childish hijinks have resulted in a chipped or gapped smile, you’re probably safe to visit a dentist first to check on things. However, if you notice that your child is chipping a lot of teeth, or that the teeth are unusually soft, it’s wise to visit a pediatrician.

Poor oral hygiene is one possible cause of recurring teeth problems, but your child might have nutritional deficiencies, too. Vitamin D deficiency (Rickets) and Vitamin K deficiency can both result in poorly developed, delicate teeth. Both deficiencies are more common in infants and children than in adults, especially when picky eaters are involved. In fact, the American Academy of Pediatrics recognizes Vitamin D deficiency as a key health concern and has issued guidelines since 2008 to help pediatricians prevent and treat this deficiency.

Finally, if your child’s tooth has been chipped or knocked out and you can’t find it, it might be time to make your way to an emergency room. An aspirated tooth could cause serious problems.

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   Most oral injuries are minor traumas that won’t require repair, but it’s still important to have them evaluated by your child’s pediatrician. In cases where there is unexplained bleeding, swelling, pain, or tooth damage—always call your pediatrician first. – Dr. Kevin Nelson

Your child’s mouth is bleeding.

Mouth injuries, even very minor ones, bleed a lot. For small scratches inside the mouth (common in adventurous toddlers), it’s probably safe to adopt a wait-and-see approach. If the bleeding doesn’t stop after ten minutes of pressure, call us. We can help you decide over the phone if you should come in or visit the emergency room. Large cuts or punctures in the roof of the mouth or throat (from falling with a lollipop or toy, for example) should always be looked at by a doctor but may not need repair.

If the bleeding has no obvious source, or is coming from the gums or tongue, your pediatrician is probably the first person you should call. Vitamin C deficiency (scurvy) can cause bleeding and discoloration in the mouth and is more common than you think. Children with diabetes can also suffer from bleeding gums.

Your child complains about mouth pain or pain in a specific tooth.

Toothaches are seriously painful. Infants and young, nonverbal children might refuse feedings or cry uncontrollably as a reaction. Cavities are a problem that only a dentist can address, but other kinds of mouth pain should be looked at by a pediatrician.

Children with generalized mouth pain, especially if it’s accompanied by scaling or white discoloration, may have oral psoriasis (an autoimmune condition) or oral thrush. If tooth or mouth pain is accompanied by a high fever, redness, trouble opening the mouth,  moving the neck, or neck swelling, you might be dealing with an abscessed tooth or another serious infection. In this case, call your pediatrician for an immediate evaluation. Pediatricians are specially trained to recognize and treat all the other kinds of mouth pain that aren’t caused by cavities.

Whatever the situation—don’t panic. Dental injuries can be traumatic and painful for children, so they’re counting on you for calm. If you’re ever in doubt about who to see, your pediatrician is only a phone call away.