Your child got hit in the mouth. Check your child first.

Put the tooth out of your mind for a minute

You want to see the tooth. Every parent does, and it is the wrong thing to look at right now.

Sit your child down somewhere with decent light and talk in a low, boring voice. A calm, steady voice helps your child more than almost anything else you can offer. Mouths bleed a great deal from very little, so the red in the sink tells you far less than your child's face does.

Then work down this page in order. A tooth injury will still be there in five minutes, and the checks below decide whether this is a hospital trip or a phone call.

The head comes before the tooth

Force enough to hurt a tooth is force enough to have rattled other things on the way through. Before anybody examines a mouth, look at the child. Any one of these means 911 or the emergency room first, and the teeth wait:

• Trouble breathing or swallowing, or coughing that will not settle
• Bleeding you cannot slow with gentle, steady pressure held in one spot
• Drowsiness that does not fit the hour, confusion, or answers that do not make sense
• Vomiting after the impact
• Any loss of consciousness, even briefly, even if your child seems perfectly well now
• A jaw that will not open all the way or close the way it did this morning, or a bite that suddenly meets crooked, which can point to a broken jaw
• A cut that goes clean through the edge of the lip, or an injury from a car, a bike wreck, or a fall from a height

None of that is a dental question, and there is no prize for working it out yourself. Go, get checked, and let somebody send you home relieved. We pick up the dental side afterward.

Now the mouth check, once your child is clearly okay

Wash your hands, get your child under a bright light, and look. You are not diagnosing anything, you are collecting a description for the phone call.

Rinse gently with warm water first so you can actually see, then check for:

• Chips. Run your eye along the biting edges of the front teeth. Note whether the broken face is white all the way across, or has a spot of pink, red or yellow in the middle.
• Teeth that moved. Compare left to right. A tooth sitting farther back, farther forward, or lower than its twin has shifted, even if it is not wobbling.
• Teeth that feel loose. Touch lightly, do not wiggle. Ask your child to bite together slowly and say whether anything feels tall or hits first.
• A tooth pushed up into the gum. A tooth driven upward instead of outward looks like a gap, and parents often search the yard for a tooth that never left the mouth.
• Bleeding right at the gumline around one particular tooth. A split lip bleeds everywhere. Blood welling from the collar of gum around one tooth is a different signal, worth naming on the phone.

Then keep half an eye on it over the next several days. A tooth that darkens, turning gray, brown or pink beside its neighbors, is the late sign that matters most, and it can show up long after everyone stopped thinking about the fall.

A tooth that looks fine still earns a call

Here is the part that catches parents out. What you can see and what is actually damaged are not always the same thing.

A tooth takes the blow through its crown, but the parts that get bruised are out of sight: the nerve and blood supply inside it, and the ligament holding the root into the bone. Neither shows up in a bathroom mirror. A tooth can look untouched on the evening of a fall and show signs of trouble weeks later, which is why a gray tooth turns up in a child who seemed fine at the time.

So call and describe the hit, even when nothing looks wrong. What happened, what it struck, how hard, whether your child bit down on something. That is how we work out together whether your child comes in now, comes in soon, or is simply watched at home. Watching is sometimes the right answer, and a better one when we know to watch.

What to do about what you found, then call

Match what you saw to the line below, and call (239) 482-2722 either way.

A tooth that is loose or has moved

Leave it alone. No wiggling, no testing it every ten minutes, no nudging it back into place. Soft food for now, and a cold compress against the outside of the cheek if the lip or gum is puffing up. Call us today rather than tomorrow, because a shifted tooth is easiest to help early.

A chipped or broken tooth

Find the broken pieces if you can and drop them into a container of milk. Rinse gently with warm water, cold compress on the outside of the lip or cheek, and call. Our guide to chipped and broken teeth, on the emergency guides page, walks through it properly.

A tooth that came all the way out

That one is its own situation and the clock is already running, so stop reading and call us now: (239) 482-2722. A baby tooth never goes back in, and a permanent tooth belongs in cold milk and in our office immediately.

Whatever you found, do not put aspirin on the gum or against a sore tooth. It can burn the soft tissue. The phone runs Monday to Friday, 8 to 5, and a real human answers. For anything on the list further up, the hospital goes first and we go second.

If we do see your child

An urgent visit is short and unsurprising. We look at the tooth, its neighbors and the gum around them, with a digital X-ray only if one is needed to see above the gumline. The outcome is often a plan and a follow up rather than treatment that day, and what to expect covers how a visit runs.