Pediatric dental emergencies: what to do in the first hour
Knocked-out teeth, chipped teeth, severe pain, swelling. The first hour after a dental injury determines the long-term outcome more than anything else. Call (916) 638-8778 immediately and follow the guidance below.
Situations that need immediate care
Some dental situations need same-day care; others can wait until the next business day. Here is the difference.
Call us immediately for:
- A knocked-out permanent (adult) tooth. The first hour is critical for re-implantation success.
- A chipped or fractured tooth, especially if the inner tooth structure is exposed or the tooth is loose.
- Severe pain that is not responding to over-the-counter pain medication.
- Significant facial swelling from an apparent dental source.
- A tooth that has been pushed deep into the gum or out of position.
- Bleeding from the mouth that does not stop with pressure.
These situations benefit from same-day care. Call (916) 638-8778. If the office is closed, the after-hours line connects you to the on-call provider.
For traumatic injury to the head, face, or neck beyond the immediate dental concern, an emergency room is the right starting point. Mercy Hospital of Folsom on Iron Point Road, Mercy San Juan Medical Center on Coyle Avenue in Carmichael, and Sutter Roseville Medical Center are the closest pediatric emergency departments.
What to do when a permanent tooth is knocked out
A knocked-out permanent tooth (avulsion) is the most time-sensitive dental emergency. The chance of saving the tooth drops with each passing minute. Here is the protocol.
- Find the tooth. It usually lands within a few feet of where the impact happened.
- Pick the tooth up by the crown (the white part). Do not touch the root.
- If the tooth is dirty, gently rinse it with cool water for ten seconds maximum. Do not scrub. Do not use soap. Do not dry it.
- Try to reinsert the tooth into the socket immediately. Hold it in place by biting on a clean cloth or tissue.
- If reinsertion is not possible, place the tooth in a glass of cold milk. If milk is not available, use the child's saliva (have them spit into a container with the tooth in it). As a last resort, use saline. Do not use water; it damages the root cells.
- Call our office immediately at (916) 638-8778 and come in.
The fifteen to thirty minutes after avulsion are the highest-success window for re-implantation. After an hour, success rates drop substantially.
For knocked-out primary (baby) teeth, do not reinsert. Reinsertion of a baby tooth can damage the developing permanent tooth underneath. Call us for guidance and follow-up.
Chipped teeth, severe pain, and swelling
Chipped or fractured tooth: Save any tooth fragments if you have them. Rinse the mouth gently with warm water. Apply a cold compress to reduce swelling. Call us for a same-day appointment. Treatment options range from smoothing a small chip, bonding the fragment back on, placing a composite restoration, or in severe cases pulp therapy or a crown.
Severe pain in a tooth: Try age-appropriate ibuprofen or acetaminophen first. Cold water in the mouth can sometimes calm an irritated tooth. Avoid hot or cold extremes if they trigger pain. Call us for a same-day appointment. Severe pain often indicates a deep cavity that has reached the nerve, an abscess, or a cracked tooth, all of which need prompt treatment.
Facial swelling from a dental source: This is a sign of infection. Call us immediately. Significant swelling that interferes with breathing, swallowing, or that extends to the eye is a hospital emergency room situation, not an outpatient dental visit.
Tooth pushed into the gum or out of position: Do not try to reposition the tooth yourself. Call us immediately. The treatment depends on the position and whether it is a primary or permanent tooth.
Bleeding that will not stop: Apply firm pressure with a clean gauze pad or cloth for ten minutes. If bleeding continues despite pressure, call us or go to an emergency room.
How to reduce the chance of a dental emergency
Most pediatric dental emergencies fall into a few categories: sports injuries, falls, biting on hard objects, and untreated dental decay that progresses to acute pain.
Sports injuries: A custom sports mouthguard reduces tooth fractures, knocked-out teeth, and lip lacerations substantially. We make custom-fit mouthguards on a quick turnaround.
Falls: For toddlers, this is harder to prevent. Childproofing high-fall areas helps, and prompt evaluation after any face-first fall (even one that seems minor) catches early damage before it becomes more severe.
Biting on hard objects: Ice, hard candy, popcorn kernels, and pen caps are common offenders. Talk to your child about avoiding these.
Untreated decay: A small cavity caught at a six-month checkup is a small filling. The same cavity untreated for a year may become a pulpotomy, an extraction, or a 2 AM emergency. Routine checkups prevent emergencies.
Emergency questions parents ask
My child knocked out a permanent tooth. What do I do?
Pick the tooth up by the crown, rinse briefly if dirty, and try to reinsert it immediately. If you cannot reinsert it, put it in cold milk and call us right away at (916) 638-8778. Time matters.
My toddler knocked out a baby tooth. Should I put it back?
No. Reinsertion of a baby tooth can damage the developing permanent tooth underneath. Call us for guidance.
Can I just go to the emergency room?
For traumatic injury to the head or face beyond the dental concern, yes. For dental-only injuries (knocked-out teeth, chipped teeth, dental pain), a pediatric dentist can usually treat the situation faster and better than an ER. Call us first.
How long do I have to save a knocked-out permanent tooth?
The first thirty minutes are the highest-success window. The first hour is still good. After several hours, success drops substantially.
What if the emergency is at 2 AM?
Call (916) 638-8778. The after-hours line connects to the on-call provider for emergency guidance.
Do you take walk-ins for emergencies?
We reserve same-day emergency slots. Call ahead so we can be ready when you arrive.
My child has severe tooth pain. What can I give them?
Age-appropriate ibuprofen and acetaminophen, alternating doses if needed. Cold water in the mouth sometimes helps. Call us for a same-day evaluation.
Dental emergency right now?
Call (916) 638-8778 immediately. We reserve same-day emergency slots.