The handbook is only useful if you read it on an ordinary Tuesday.

The signs that go past us first

We are the right people for teeth and the wrong people for the rest of your child. These are the things that send you to 911 or an emergency room ahead of any dental office, no matter what a tooth looks like:

• Breathing or swallowing that is not right. Any struggle for air, a cough that will not settle, drooling because swallowing hurts, or a voice gone thick and muffled. Trouble breathing means dialing 911 rather than driving anywhere.
• Bleeding that steady pressure is not slowing. Blood still soaking through a pad that has been held firmly in one place without lifting, or filling the mouth faster than anyone can clear it.
• Signs the head took the hit too. A blow to the head, drowsiness that does not match the hour, confusion, repeated vomiting, a headache that builds instead of fading, or a blackout of any length at all.
• A jaw that is not working. One that will not open or close the way it did this morning, sits off to one side, or a bite that suddenly comes together wrong.
• Swelling near the eye. Puffiness reaching up around the eye, or an eyelid that looks harder to open than usual, belongs at an emergency room rather than in a dental appointment slot.
• A fever alongside any facial swelling. The two together go on this list whatever the tooth underneath them is doing, and they do not wait for a call back.
• A child who is hard to rouse. Difficult to wake, or not staying awake, is on this list by itself, whether or not anybody saw a knock to the head.

None of those are dental judgment calls, and none of them get better while you work out the answer yourself. Being checked over and sent home is a good afternoon, not a wasted one. Once your child has been cleared, call us and the tooth becomes our half of the problem.

What a handbook can do, and where it stops

This page holds the map. It does not hold the treatment, and the difference matters enough to say out loud before anything else.

Everything described below is ordinary first aid: the sort of thing any parent can do with a clean cloth and something cold while somebody else finds the phone. There is nothing here about what to give a child by mouth, and there will not be. Putting a medicine, or an amount of one, on a page written for children nobody here has met is not something we are willing to do, and that is a straight answer rather than a dodge. Anything swallowed belongs to your pediatrician, or to a conversation with us.

The second boundary is repair. Nothing on this page fixes a tooth, and none of it replaces the call. First aid makes the next hour calmer. The call decides what actually happens next, and often decides that the answer is nothing much.

Walkthroughs for each situation, one at a time and in more detail, live in our dental emergencies section. That section exists to be the front door on the day itself, sorted by what happened, so nobody has to hunt through a long guide with one hand. Read this page now. Use that one then.

A tooth that has come all the way out

That sentence covers two different situations, and the right answer is opposite in each, so the first thing to settle is what you are holding.

A baby tooth. Small, bright, with a short thin root or barely any root left at all. It stays out. Nobody puts it back, at home or here, and the reason sits underneath: the tooth meant to replace it is already taking shape in the bone under that socket, and pressing the baby tooth back down can reach it. Fold clean gauze or a clean cloth over the gap, have your child bite gently, hold something cold against the outside of the cheek, and call us. Bring the tooth if it turns up easily. Do not take the lawn apart looking for it.

A permanent tooth. Bigger, usually a little duller in color than the baby teeth on either side of it, and carrying a long solid root. This is the one situation in this handbook where speed is doing real work, and the American Academy of Pediatric Dentistry classes a knocked-out permanent tooth as needing attention right away rather than at breakfast. Lift it the way you would lift a coin off a table, fingers on the flat white top only, and keep them away from the pointed end that was sitting in the gum. A brief rinse in milk or water if it is visibly dirty, and no more than that. Never scrub it, never let it dry, and never park it in a tissue. Into a cup of cold milk it goes, gauze over the socket, and then into the car while somebody calls ahead.

Cannot tell which one you are holding? Bring it in cold milk and let us sort that out. If it turns out to be permanent, you did the one thing that mattered. If it turns out not to be, you are out nothing but a cup of milk.

A tooth that is chipped, moved, or aching

Chipped or broken. Rinse gently with warm water so you can see what you are looking at. Hunt briefly for the piece, and if you find it, keep it wet in milk rather than dry in a tissue. Cold against the outside of the cheek if a lip is puffing up. Then call and describe it: roughly how big the break is, whether anything pink or dark shows in the broken face, whether the tooth moves or the bite feels tall on that side, and whether cold air makes your child flinch. You are describing, not grading. Not knowing is a fine answer.

Loosened or shifted. Leave it alone. No wiggling to test it, no nudging it back toward where it used to be. Soft food, chewing on the other side, and a call the same day rather than the next one.

Aching. A gentle warm water rinse. One careful pass with floss on each side of the sore tooth, because trapped food quietly ends a surprising number of these evenings. Something cold on the outside of the cheek. An extra pillow, so your child is not sleeping flat.

Never rest an aspirin, or any other pill, on a gum or against a sore tooth. It cannot reach an ache from the outside, and the tissue underneath it can be burned. No aspirin on gums is one of the few flat rules in this handbook.

Two patterns are worth knowing in advance. A fever alongside any facial swelling sits on the first list on this page, which means an emergency room rather than a dental appointment; swelling on one side with no fever is still not a wait-and-see, so call us and describe what you are looking at. And pain that disappears overnight has not necessarily been solved, so the call still happens in the morning.

Bleeding, bitten lips, and the injury behind the injury

Mouths bleed out of all proportion to what caused it. A wet mouth spreads a small amount of blood across everything it touches, which is why the state of the washcloth is a poor guide next to how your child is looking and acting.

The first aid is unglamorous and it works. Clean gauze or a clean cloth, folded thick rather than laid flat. Placed directly on the spot rather than somewhere near it. Held firmly, without interruption, while your child sits upright rather than lying down. Something cold on the outside of the face. The most important part is leaving the pad where it is. Lifting it to check restarts the bleeding every time, which is why bleeding that seemed to be settling starts up again.

Then comes the part parents skip, and it is the reason a bitten lip gets a phone call at all. A split lip usually means something struck the mouth, and that same force carried on through into the teeth sitting directly behind it. A tooth knocked loose or pushed out of line is easy to miss while every adult in the room is watching blood. So call once things are calm, and lead with how it happened rather than with what you think is wrong.

One more that catches careful families: after treatment involving a local anesthetic, a numb lip or cheek feels interesting rather than sore, and plenty of children chew at it without registering they are doing it. The swelling turns up later, once feeling returns. It is common, it is not a supervision failure, and it is worth a call if it worries you.

Braces, wires and appliances

Hardware sits in a mouth that is busy all day and still growing, so pieces work loose and edges turn up. Most of what gets called an orthodontic emergency is a comfort problem rather than an urgent one, and it is usually a this-week call rather than a tonight one.

Orthodontic wax is the one genuinely useful thing to keep in a drawer. Pressed over a sharp edge, it takes the edge off within seconds. Beyond that: keep any piece that comes off entirely and bring it with you, and leave the repairs to us. No clipping a wire, no pressing a bracket back into place, no glue and no household tools. Hardware built to move teeth in one particular direction is easy to damage with a home repair.

Then call during office hours and describe what you are seeing, in whatever words you have. Sharp or dull, one piece or several, cutting a cheek or merely annoying. That description is what sorts today from next week, and two children with what sounds like the same problem can honestly get two different answers.

The exception is worth stating plainly. Braces do not change any of the categories above. A hard hit to the mouth, a tooth that has moved, bleeding that will not settle, or anything on the first list on this page is exactly what it would be without hardware in the way.

One number, and a real person on the end of it

Every situation in this handbook ends at the same place. One phone number reaches both the Fort Myers and Naples offices, (239) 482-2722, Monday to Friday, 8 to 5, and a real human answers. Not a menu, not a form.

Triage happens in conversation on purpose, which is the same reason booking does: your child's health details stay in a conversation with our front desk, never typed into a website. The questions coming back at you are short and practical ones. The story of what occurred, and roughly when. Which side of the mouth, and whether the tooth in question is one of the baby set or an adult one, if that is something you can tell. What you can see: blood, movement, swelling. And how your child seems in themselves compared with an ordinary evening.

You are describing rather than diagnosing, and that distinction takes a lot of weight off a phone call. Nobody expects you to arrive at the correct label first. One family will be asked to head over now. Another will be given a job to do at home and a time to come in. A third will hear that what they are describing is common, unalarming, and fine to fold into the next routine appointment. None of those three is the answer that means you wasted the call.

Whichever one you get, an urgent visit here is still a child's visit, at the same pace described on our what to expect page. Nobody hurries past a frightened kid to get to a tooth.

Three things worth doing this week

Small, dull and quick, and they help more on a bad evening than anything you could look up during one.

1. Put the number where you will find it twice. Saved in your phone as something you would actually search for, and written on a card in a drawer, because a card still works with a flat battery, and because the person holding your phone is not always you. (239) 482-2722.
2. Decide where three ordinary things live. Clean gauze, something cold that can be wrapped in a towel, and a small cup with a lid. Then say it out loud to everyone else in the house, because supplies nobody can locate in the dark are not really supplies.
3. Hand each adult two sentences. A permanent tooth that comes out travels in cold milk and comes with you. A baby tooth, once it is out, is never returned to the socket. Grandparents, sitters and coaches often carry advice from a generation with different rules, and those two sentences settle it.

Then leave it alone. Cover it once, the way you would a fire drill. A child who has been told once where the gauze lives is better prepared than a child who has been rehearsed into worrying.

When something does happen, start at our dental emergencies section, which is sorted by what actually occurred. Shorter answers to single questions are in Quick Answers, and the rest of our long-form parent guides cover the ordinary days in between.