todays parent

What to do if your toddler chips, cracks or knocks out a baby tooth

Toddlers tend to fall down a lot—they’re top-heavy, they’re still getting used to this walking and running thing and they often have zero fear—so it’s not surprising that their teeth can bear the brunt of the impact.

“Everything’s OK; it’s just a little tiny chip,” Victoria Russell-Matthews’s mom told her over the phone. Her two-year-old son, Rockwell, had wiped out while racing around the house with his uncle and chipped the corner of one of his front teeth. “Then my mom sent me a picture of the chip and it wasn’t small at all!” Russell-Matthews says.

Her first instinct was to call her dentist, but it was after hours on a weekend, so they had to wait a day to be seen.

Toddlers tend to fall down a lot—they’re top-heavy, they’re still getting used to this walking and running thing and they often have zero fear—so it’s not surprising that their teeth, especially the top front teeth, can bear the brunt of the impact, says Paul Andrews, a paediatric dentist in Mississauga, Ont.

First, check out the injury. If there’s a fair bit of blood, they may have torn the frenulum, the little piece of skin that attaches the top lip to the gum. “Toddlers will do this repeatedly—I’ve seen numerous kids who have torn their frenulum two or three times,” says Andrews. While there is blood and swelling, the injury heals up easily in a few days, without scar tissue forming. Give over-the-counter pain meds if your kid’s mouth is sore, and swish out the mouth with water to keep things clean. (When brushing, be careful to lift the top lip gently.) You don’t need a visit to the dentist for this one. You do need to have your toddler checked out by a dentist in many cases, though. If the tooth is bleeding, discoloured, loose or seems out of position; if it’s cracked, chipped or knocked out; or if your child says it hurts when they bite down, call your dentist that day, says Andrews. They may advise you to wait and see, or tell you to come in. En route to the dentist, give your kid a cold washcloth to hold against their gums—unless the tooth is loose, in which case, they shouldn’t have anything in their mouth that might dislodge it further.

A paediatric dentist will most likely recommend an in-office X-ray to see what exactly is going on. If you stay calm and matter-of-fact at the dentist visit (even if you’re inwardly freaking out), your toddler likely will, too. A poster or TV on the ceiling can provide distraction as well.

If the tooth is chipped

A small broken-off piece can be rebuilt using a white filling, but it’s only for cosmetic reasons and the material generally doesn’t adhere well to baby teeth. A dentist may also smooth or file a damaged tooth. “You can often smooth the corner off or reshape them to hide the fact that the tooth has been chipped,” says Andrews. In Russell-Matthews’s case, their dentist said the slightly rough edge would smooth out on its own through normal chewing.

If the tooth is loosened

A baby tooth that is wiggly but still in the correct position can often be left alone (after a dentist checks it out) as it may firm up on its own. Stick to softer foods and gentle tooth brushing after every meal to encourage healing. If the tooth has been bumped out of position, a dentist may be able to reposition it if you can be seen within a day of the injury. However, they may also recommend taking the tooth out completely, depending on the situation.

If the tooth is cracked

Your dentist will need to see how deep the crack is and if it extends under the gum, usually using an X-ray. The vast majority of cracks are superficial. Be careful with a cracked tooth as it’s more likely to break if it’s whacked again, says Andrews. If it’s a deep crack that affects the blood vessel and nerve, you can have the tooth pulled or do a root canal. (Andrews discourages root canals because they’re costly and uncomfortable, but some parents choose them for cosmetic reasons.)

If the tooth is discoloured

There are a few possibilities here: A tooth that is hit hard can actually become bruised because blood leaks into the tiny tubules inside the tooth. In this case, a greyish tooth is just there to stay until the baby tooth comes out naturally, or you could opt for a capped tooth. A discoloured tooth could also be a sign the nerves and blood vessels are dying, posing a risk of infection. (It may need to be pulled.)

If the tooth is knocked out

Well, this means you get a gap-toothed grin until the permanent teeth grow in, between ages six and eight. This can be hard on parents—those wee white teeth are gone too soon!

Andrews says he tries to be reassuring. “Nobody wants this to happen to their child, but you just have to do your best with reasonable supervision and childproofing, and also realize that kids are going to fall down. It’s just reality.”

For Victoria Russell-Matthews’s son, Rockwell, now three, the chipped tooth has just become part of his mischievous smile.

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