Pediatric dental emergencies most often occur after office hours. The following information may provide some guidelines regarding the urgency of care and some intervention that you may provide for your child. If any doubt, please call Dr. Soxman at 412-486-2668. If unable to reach her, please phone Children’s Hospital at 412-692-5325 and ask for the dental resident on call.
Abscessed Incisor or Molar-Primary (Baby) or Permanent
If your child has a fever, redness, a swollen face or neck or is complaining of severe pain, he or she requires emergency care. An abscess that is draining (looks like a pimple on the gum above the tooth) and has no other symptoms can wait until normal office hours for treatment.
Sometimes an ulcer on the gum (apthous ulcer) may be mistaken for an abscess. These ulcers are typically painful to the touch or with exposure to some foods. The best way to alleviate pain and hasten healing is with a dab of vitamin E. Poke a hole in the end of a vitamin E capsule and squeeze the liquid onto the ulcer.
If there is any doubt as to the need for urgent treatment, please phone!
Apthous Ulcer (fever blister)
An apthous ulcer may be mistaken for an abscess. These ulcers are typically very painful. A dab of Vitamin E may alleviate the pain and hasten healing. Pierce the end of a vitamin E capsule and squeeze the liquid onto the ulcer.
Avulsions (knocked out front teeth)
An avulsed baby tooth should not be replaced and normally requires no emergency intervention. Attempt to locate the tooth. If unable to locate the tooth, it may have been pushed up into the bone below the gum line. If your child is coughing, a chest radiograph should be obtained in order to rule out aspiration. If aspiration has been ruled out, immediate care is not necessary. Please call the office to schedule an appointment for an examination.
An avulsed permanent incisor requires immediate intervention. Every effort must be made to “save” the tooth by maintaining the vitality of the cells that cover the root. Notify Dr. Soxman as soon as possible. Urgent treatment is necessary. Replacing the tooth in the socket significantly improves the prognosis for the tooth.
Hold the tooth by the crown and do not touch the root. If there is soil or debris on the tooth’s root, it should be cleaned off prior to replanting the tooth. Rinse the tooth gently with water, milk or Hanks Balanced Salt Solution (HBSS 1-888-788-6684). If possible, gently replace the tooth in the socket. Swelling and a blood clot in the socket may impede replacing the tooth later. Make sure that the tooth is facing in the right direction. If unable to replace the tooth in the socket, place it in cold white milk or HBSS (ideal transport medium) for transport to the dentist.
A wire splint will be placed to stabilize the tooth as soon as your child is seen. How the tooth is stored for transport, if not replaced in the socket, and the tooth’s root development will determine the treatment plan and prognosis.
A discolored primary incisor can be evaluated whenever the child can be scheduled for an appointment, unless the discoloration is accompanied with pain, fever or swelling.
A discolored permanent incisor will be referred to a root canal specialist, an Endodontist.
Displaced Teeth (teeth pushed out of their normal position)
If a primary incisor is displaced, the first thing to check is whether or not your child can fully close his or her mouth. If the displaced tooth is interfering with the bite, it may be repositioned or extracted.
If a permanent tooth is displaced, this may require an emergency visit for repositioning and possible splinting. Dr. Soxman should be notified.
Fractured Teeth (chipped teeth)
A fracture that is limited to the bottom half of the crown does not require immediate treatment. Dr. Soxman should be notified as soon as possible in order to schedule an appointment. This injury is deemed to be Subacute or Delayed in terms of the treatment urgency. Subacute injuries are to be seen within 24 hours and Delayed injuries may be seen in more than 24 hours. Dr. Soxman should make the determination regarding the urgency of treatment.
If the fracture is so deep that blood is apparent on the surface of the fractured area (rule out bleeding from the gum surrounding the tooth as the source of this blood), treatment should be performed within 24 hours. Try to locate the crown fragment that fractured off the tooth. Dr. Soxman may be able to reattach the fragment to the remaining tooth structure. Keep the fragment moist with water until you see Dr. Soxman.
Frenulum Laceration (cut piece of tissue that attaches the upper lip to the gum)
The maxillary frenum is a thick band of tissue that attaches the upper lip to the gum above the upper front teeth. A laceration or cut may result in profuse bleeding. Give your child a Popsicle. The pressure of the lips around the Popsicle will help to stop the bleeding by placing pressure on the cut and the coldness of the Popsicle will also help to stop the bleeding. This does not require emergency intervention. Your child may be seen for an examination during normal office hours.