Need the tooth, the whole tooth, and nothing but the tooth!

December 5, 2011 4:30 PM

Need advice on if/how to treat a four-year-old's injured tooth.

Hi MeFi,

I've got an emergency question from my sister regarding a mouth injury to her young daughter. Advice from dentists or those in the dental or medical field is appreciated. YANOD.

The tale of woe:

My four-year-old daughter jumped on her bed, fell, and smacked her mouth into a wooden post. Her bottom right center tooth was somehow pulled forward and downwards at an angle, and also slightly twisted to the left. (Her teeth weren't that straight to begin with, so I'm not entirely sure if it was already twisted or not.)

It didn't bleed that badly, but the gum is slightly split where the tooth came forward, maybe about an eighth of an inch. I tried my best to push it back into place, but it's still not completely right. It felt lose enough to give slightly, but not loose enough to pull out the rest of the way. It's already been about an hour, and it's not bleeding anymore, but I'm worried her gum won't be able to heal with the tooth jutting forward.

We are currently without dental or health insurance, and I don't know of any emergency dental services in our area. Should I take her to a children's urgent care, or should I just wait to see if the tooth falls out on its own?

Photos of injury: One | Two

Any advice is appreciated. She and I will be watching this thread for replies and I can do my best to respond to any questions.

Thanks!

posted by sprocket87 to health & fitness (5 answers total)

i'm not a dentist, but:

call around first thing tomorrow and explain the situation. since it's a baby tooth, it would probably fall out in the next few years anyway, right? i'd think after a quick evaluation it would get pulled and you'd be on your way.
posted by cupcake1337 at 5:03 PM on December 5, 2011

This is late and I'm sure she's in bed by now. My daughter had a similar injury at age 4 - at the time the tooth looked ok but overnight it became very painful and when we took her to the dentist the next morning it turned out the tooth had broken below the gum line and had to be pulled. If that's that case I would urge you to try to find a dentist who will sedate her to pull it. Our daughter was very traumatized by the experience and had night terrors for many years as a result. Not trying to scare you but having a tooth pulled can be a very scary experience for a little one.
posted by leslies at 7:29 PM on December 5, 2011

You may be able to find a dental clinic that charges on a sliding scale based on your income. Here is a database of free ones. If you can find a pediatric specialist, some of them are brilliant with kids.
posted by mkb at 7:37 PM on December 5, 2011

I caught this late, but it looks like the tooth was pretty far out of position in the first photo, probably avulsed from the socket, but you got it back into pretty good position after.
I take it there was no injury to the lip?
Unfortunately most physicians leave matters like this to dentists. the e.r. will not be able to take the relevant xray if necessary, and their knowledge of occlusion will not likely give them any sense of whether something needs to be done immediately or not.
it's likely to be sore, so a weight appropriate does of ibuprofen (if no allergies etc) would be ok, as would ice for ten minutes on/off.
a four year old girl is close enough to losing the tooth on its own to not worry overmuch if it has to go, so if it's really loose having it out is probably the best course at this point. if it stabilizes where it is and she can close normally and eat then watch it and allow it to heal and keep watching it for changes around the gums.
memail me if you want more specific advice, i know it's late, but it's ok tonight or tomorrow a.m.
posted by OHenryPacey at 10:16 PM on December 5, 2011

Thanks for the feedback all!

The daughter in question appears to be feeling much better and was even eating normally last night. Still waiting to hear how swollen or sore the tooth is this morning, but the input you guys provided is helpful. Hopefully it hasn't gotten worse and will come out naturally without complication.

mkb, thanks for the free clinic database as well!
posted by sprocket87 at 5:42 AM on December 6, 2011