Dental Trauma in Children: What to Do When a Child Chips or Knocks Out a Tooth

Baby Tooth vs. Permanent Tooth Injuries

When a baby tooth is injured, the primary concern is protecting the permanent tooth bud developing underneath in the jawbone. Aggressive treatment of a baby tooth injury can sometimes cause more harm than good to the developing tooth below. For this reason, dentists take a more conservative approach with baby tooth trauma.

When a permanent tooth is injured, the goal shifts to saving the tooth itself. A knocked-out permanent tooth can sometimes be replanted successfully if treated within 30 to 60 minutes. Time is the most critical factor in these cases.

Causes by Age Group

In toddlers (ages 1 to 3), most dental injuries result from falls while learning to walk, run, or climb. The upper front teeth are the most commonly injured because they are the most exposed. In school-age children (ages 7 to 12), sports injuries, playground falls, and bicycle accidents are the leading causes. In teenagers, contact sports, skateboarding, and physical altercations account for a large share of dental trauma.

Risk Factors

Some children are more likely to experience dental trauma than others.

• Protruding front teeth (overjet): Children with front teeth that stick out are 2 to 3 times more likely to injure those teeth
• Participation in contact sports without a mouthguard
• Active, risk-taking temperament
• Conditions that affect coordination or balance
• Previous dental injury (children who have had one dental injury are more likely to have another)

Types of Dental Injuries

Dental injuries are classified by the type and severity of damage.

• Enamel fracture: A small chip that affects only the outer layer of the tooth
• Crown fracture: A larger break that may expose the inner dentin or pulp
• Luxation: The tooth is loosened, pushed sideways, pushed into the gum (intrusion), or pushed outward (extrusion)
• Avulsion: The tooth is completely knocked out of its socket
• Root fracture: A crack in the root of the tooth, which may not be visible without an X-ray
• Soft tissue injuries: Cuts, tears, or bruising to the lips, gums, tongue, or cheeks

Knocked-Out Permanent Tooth

A knocked-out permanent tooth is a dental emergency. The goal is to get the tooth back into its socket as quickly as possible.

• Find the tooth. Pick it up by the crown (the white part), never by the root.
• If the tooth is dirty, rinse it gently under cold running water for no more than 10 seconds. Do not scrub it or use soap.
• Try to place the tooth back into the socket. Have your child gently bite down on a clean cloth to hold it in place.
• If you cannot replant the tooth, place it in a container of cold milk, saline solution, or your child's saliva. Do not store it in water.
• Get to a dentist within 30 minutes. Every minute counts. Teeth replanted within 30 minutes have the highest survival rate.

Knocked-Out Baby Tooth

Do not try to put a knocked-out baby tooth back in. Replanting a baby tooth can damage the permanent tooth developing underneath. Apply gentle pressure with a clean cloth to control bleeding, and see a pediatric dentist within 24 hours. The dentist will take an X-ray to make sure no tooth fragments remain in the socket and to check the status of the permanent tooth bud.

Chipped or Cracked Tooth

Rinse your child's mouth gently with warm water. Apply a cold compress to the outside of the face to reduce swelling. If you can find the broken piece of tooth, save it in milk and bring it to the dental appointment. See a dentist as soon as possible, ideally within a few hours. If the break exposes pink or red tissue (the pulp), this is more urgent because the nerve is exposed.

Loosened or Displaced Tooth

If a tooth is loose, pushed sideways, or pushed up into the gum, do not try to move it back into position. Have your child bite gently on a soft cloth to stabilize the tooth and see a pediatric dentist as soon as possible. The dentist will reposition the tooth if needed and may splint it to adjacent teeth while it heals.

Common Treatments for Dental Trauma

For minor chips, the dentist may smooth the rough edge or apply a tooth-colored composite bonding to restore the tooth's shape. For larger fractures, a crown may be needed. If the pulp is exposed, pulp therapy (pulpotomy or pulpectomy) may be required to save the tooth.

A loosened or displaced tooth is often repositioned and splinted (bonded to the neighboring teeth with a thin wire) for 2 to 4 weeks while the supporting tissues heal. A replanted knocked-out permanent tooth also requires splinting and close follow-up.

For severely damaged teeth that cannot be saved, extraction is followed by space management. In baby teeth, a space maintainer preserves room for the permanent tooth. In permanent teeth, options for replacing the missing tooth are discussed once the child finishes growing.

Recovery Timeline

Most soft tissue injuries (cuts to lips and gums) heal within 1 to 2 weeks. A splinted tooth typically heals in 2 to 4 weeks, after which the splint is removed. The dentist will schedule follow-up visits at 2 weeks, 4 weeks, 3 months, 6 months, and 1 year after the injury to monitor healing.

Some complications may not appear until months later. A tooth that looked fine after injury may later darken (a sign of pulp death), develop an abscess, or show signs of root resorption on X-ray. This is why follow-up appointments are important even when the tooth seems to have recovered.

Aftercare Tips

Give your child soft foods for the first few days after treatment. Avoid biting directly on an injured or splinted tooth. Use children's ibuprofen or acetaminophen for pain as directed. Keep the area clean by gently rinsing with warm salt water after meals. Attend all follow-up appointments so the dentist can catch any delayed complications early.

Typical Cost Ranges

An emergency dental exam with X-rays typically costs $75 to $200. Composite bonding for a minor chip may cost $100 to $300 per tooth. Pulp therapy ranges from $150 to $450 per tooth. A stainless steel or composite crown adds $150 to $400. Replantation and splinting of a knocked-out tooth may cost $200 to $500. Sedation or general anesthesia, if needed, adds additional costs.

Insurance Coverage

Most dental insurance plans cover emergency exams, X-rays, and necessary restorative treatment for dental injuries. Some plans classify trauma-related treatment differently from routine care, which can affect coverage levels. Medicaid and CHIP programs generally cover emergency dental treatment for children. Contact your insurance provider to understand your benefits before or shortly after the emergency visit.

Emergency vs. Urgent Situations

Some situations require immediate attention (within 30 minutes): a knocked-out permanent tooth, a tooth pushed deep into the gum, uncontrolled bleeding, or a suspected jaw fracture. Other injuries are urgent but can wait a few hours: a loose tooth, a chipped tooth with no pulp exposure, or minor soft tissue cuts. Even non-urgent injuries should be seen within 24 hours.

Preventing Dental Injuries

While not all dental injuries can be prevented, several measures reduce the risk. A custom-fitted sports mouthguard from a dentist provides far better protection than store-bought boil-and-bite models. Mouthguards are recommended for any child playing contact sports including basketball, soccer, football, hockey, martial arts, and skateboarding. Childproofing the home, using car seats properly, and supervising active play also help reduce dental injuries in younger children.