My kid knocked out a permanent tooth--now what?
December 9, 2006 7:25 AM   Subscribe

My 7-year-old got a bunch of his teeth knocked out, including a permanent front top incisor that the dentist put back in a very crooked position. What should we do? What is in our future?

It was a horrible freak accident. Last Monday, Wonderboy and a friend were running through the hallways of my college and eh fell and smashed the side of his face into a metal door jamb. He came up spitting out teeth and blood and crying like I have never heard. We got him quickly to a dentist with experience in this sort of thing, He lost 3-4 teeth and split/pushed back his gum along the top left side of his mouth. The dentist sutured up his split gum and managed to put back the permanent incisor.

But it is crooked, very crooked. It sticks out in an almost diagonal position! I said so at the time and the dentist commented on it on our followup visit yesterday. He explained that the position is where the tooth "fit" when he put it back in, I guess because the underlying bone was damaged by his collision. He said out best bet is to let it heal and to schedule him for some heavy orthodontia when he is 12 or so. He thinks the tooth will reattach, but it is too soon to tell.

What do I do? I want to get a second opinion, but thought we would wait until after Christmas to give it time to heal. And time for the little guys fear of dentists to subside, this has been traumatic as can be for him. Is it important to go to someone different right away?

I would also appreciate hearing from MeFites who have experience with little kids losing permanent teeth. If the tooth does not reattach, what can be done? Do we have a childhood full of dental surgeries ahead of us? How old does he have to be for a permanent implant?

I know that some other parents have much worse and tragic things to deal with, but this is just tearing my heart out. Thanks for your help and advice.
posted by LarryC to Health & Fitness (10 answers total)
I've been there. My permanent front teeth were knocked out and put back in, I believe I hold the record for longest use of re-implanted teeth, been featured in dentistry journals.

The nerves even retook to some extent for a while. The teeth had a lot of stress fractures and kind of progressively broke away over the years, pulling gloves off with my teeth etc. Orignal roots, eventually root canalled, supported posts and caps. Finally I gave up on the whole preservation thing and had them removed, and a bridge instead. With incisors you may need to include two teeth on each side to support a bridge, so my two missing teeth turned into a six tooth bridge.

I plan to take a trip to China sometime and have the whole mess replaced by implants. As an expert consumer of dentistry, I can tell you that asian dentists, especially women, are great because they can fit their whole hand in your mouth easily. I figure I could pay for my trip with the local savings, and China is very up to date on precision dental jewler's work.

My suggestion would be to make the most of what you have in place, enjoy the nicknames like "bugs," and let his jaw mature to something like its final dimensions before laying out a bunch of cash for the ultimate solution at a later date.

Going right to an implant and skipping the bridge would be a good thing for the neighboring teeth, but they are permanent so best to wait. The good news is the implants can be really permanent, out lasting the patient.

Since you won't have a lifetime commitment to the crooked tooth, I'd consider having it shaved and shaped or capped for cosmetic reasons rather than trying to re-set it.
posted by StickyCarpet at 8:14 AM on December 9, 2006 [1 favorite]

I would think you'd want to see an oral surgeon. They are skilled in mouth and facial reconstructions.
As far as your boy's anxiety, they can sedate him--in adults they use gas and/or a sedative like Versed, not sure what is used in kids.
Absolutely go get a second opinion. No one should ever feel weird about that. You'd get a second opinion on getting new siding on your house or an expensive repair on your car--why not a medical or surgical procedure?
You can ask your regular dentist for a referral to an oral surgeon who specializes in cosmetic procedures. Sometimes sports teams have an oral surgeon they work with. The guy who took out my wisdom teeth last year was the team doctor for the local pro hockey team. I imagine those doctors are very familiar with injuries like your son's. That may be a great place to look.
Good luck...
posted by FergieBelle at 8:32 AM on December 9, 2006

I would think you'd want to see an oral surgeon.

IANAOS, but sometimes I get a kick out of telling a younger dentist that I have probably spent more time in a dentists office than he has.

The heroic efforts to save the re-implanted teeth did take an inordinant amount of time from my youth, that's why I would suggest sliding by with whatever you can get away with for as long as possible. I think it would be better to hold out past 12 if you can, to be sure everything has fully matured.
posted by StickyCarpet at 8:44 AM on December 9, 2006

I only broke 2 permanent teeth (on 2 seperate occasions -- whee!), didn't fully lose any, but I imagine the experience was the same in a lot of respects. I'm a little shocked at how unconcerned the dentist was about putting the tooth back in crooked, but he probably does have a point that you should wait until the full set of permenent teeth comes in before you do any heavy orthodotia.

One thing that you're probably in for is a root canal on every tooth that was even marginally traumatized but remained in place (or was reinserted). Alas, it's probably better to get this done sooner than later -- I hemmed and hawed and put mine off, and had to go back for an apicoectomy some years later. Shudder.

As for getting the kid over the inevitable fear of dentists, definitely consider switching. Just coming back to the same place & seeing the same people after such an experience can be tough for a kid, and if the guy is at all brusque, fuggedaboutit. My childhood dentist was a bit of a dick and I still hate him for it, though I got over my general dentist-phobia some time ago. Also, for any major work (like, when he finally does get permanent implants and/or braces), seriously discuss general anesthesia and see if it's feasible & safe.
posted by rkent at 9:10 AM on December 9, 2006

I'm a little shocked at how unconcerned the dentist was about putting the tooth back in crooked

In his defense you had to be there--the blood and spit made it difficult to see anything, and my son's resistance was heroic, it took two dental assistants, my wife and myself to hold him down and still enough for the dentist to work. The screaming filled the whole building. When I came out everyone in the waiting room was silent and pale. I think a lot of kids got a dentist phobia on Monday.

I will get a recommendation for an oral surgeon on Monday.
posted by LarryC at 9:21 AM on December 9, 2006 [1 favorite]

As young adult I had 4 upper front teeth pushed out of place. My horse reared throwing his head up and back, I went down and forward, smacking my mouth on his neck.

All 4 teeth were pried back into place by dentist. One started causing me trouble within the next few days and started to abcess. The Dr did a root canal on that one tooth. The other three were fine.

Several months down the road same tooth started abcessing again, repeat root canal. Third time tooth abcessed, Dr wanted to do apicoectomy. Said there could be hairline fractures in the root causing the constant abcessing. I was sick of dentist by this point, elected to have the damm tooth pulled and now have a nice upper bridge.

I sometimes joke about my $30,000.00 smile.

Because the injury to the teeth were due to an accident, your health insurance should be paying for the expenses.
posted by JujuB at 9:42 AM on December 9, 2006

Find an oral surgeon who specializes in kids. I had a lot of dental problems and extractions as a kid, and had some really bad experiences with dentists and surgeons who weren't used to kids. Once my mom found this guy Dr Allen (if you were in the Bay Area I'd recommend him in a second), everything was so much better. He was really gentle and I woke up with a teddy bear in my arms. Basically, you need someone who understands kids' fears and has staff that can handle a screaming kid.
posted by radioamy at 1:37 PM on December 9, 2006

I hope you are recovering from the shock and horror of the accident and its aftermath. It is obviously very important that you help your son to be happy with a tooth that is crooked for now. You can make a huge difference to how he accepts looking (very slightly) unusual. I would brief any family who he may meet over the holidays if you think they might comment on his appearance -- or tell terrible dentist stories. You know it can be fixed, and if the cost is worrying you, your son is certainly too young to be burdened with that aspect.

It is unlikely that one permanent tooth is going to turn into a long-running medical melodrama. Discuss with the dentist the timing as well as the type of a suitable second opinion. 7 years old is rational enough to respond to the huge-bribe approach to behaving well while his mouth is being poked, and young enough that his idea of "huge" may be very affordable. Just make sure he gets the idea that if he doesn't cooperate he really won't get the bribe, sorry "prize for bravery". I would pay him off now for those parts of his behaviour over the incident/subsequent suffering that you can pick out as praiseworthy and to be encouraged.
posted by Idcoytco at 2:07 PM on December 9, 2006

Oh yes, I would also pay out generously to his friend for "helping" him/you after the accident if it is at all justifiable -- it should ensure that if he ever has another accident everyone will rally round.
posted by Idcoytco at 2:13 PM on December 9, 2006

I wouldn't take Idcoytco's approach of having all of your son's friends be merely children you practically paid to hang around him (not to mention they would only be there in the hopes that he gets hurt... I foresee an imminent "accident" coming out of that).
posted by KingoftheWhales at 10:05 PM on December 9, 2006

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