Dr. Hans Reinemer explains what you need to do for everything from chips and cracks to fully knocked-out teeth.">

Jun 13, 2017 — Kids can be rambunctious and rowdy. Especially during the warm summer months when they're outside playing sports and running around. When they eventually take a spill that knocks out a tooth, do you know what to do? Pediatric dental specialist Dr. Hans Reinemer explains what you need to do for everything from chips and cracks to fully knocked-out teeth.

Interview

Interviewer: Your child fell down or ran into something and they hit their teeth. What should you do? That's next on The Scope.

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Interviewer: It's bound to happen once in a parent's life. Their kid falls and the brunt of the impact is on the teeth, and you cringe. What do you do at that point? Dr. Hans Reinemer is the section head of pediatric dentistry at the University of Utah School of Dentistry. What should a parent do next if a kid puts like that impact on their teeth?

Dr. Reinemer: Well, it's a very good question, and kids are always stumbling, falling, especially this time of the year at springtime. Summer kids are back outside on their skateboards, roller blades. They're falling down. Especially, in the five to seven-year-old age group, kids are always banging their teeth. So it's important that parents be aware of what to do.

Interviewer: All right. So it's not always, worst case scenario, tooth gets knocked out. There are some other things that can happen. So let's just start with maybe what those are.

Dr. Reinemer: Sure. It could be a simple bump of the tooth where you get some bleeding around the gum tissue. It could be a fracture of the tooth. It could be a tooth that's knocked out of place but still in the mouth, and it could be a tooth, worst case scenario, that's completely knocked out of the socket. And so first thing the parents need to be aware of is it's important to have a relationship with the dentist, so, in the case of any of those situations, they have somebody to call.

Interviewer: All right, because you can't necessarily go to an emergency room?

Dr. Reinemer: You can, but there will be a longer wait time and physicians don't always know. Most emergency rooms are not set up for dental emergencies. So the relationship with a dentist is your best bet.

Interviewer: All right. So, as a parent, if one of those emergencies does happen and I have a dentist, I can call and, generally, get in fairly quickly then?

Dr. Reinemer: You should be able to. Make sure when you establish your relationship with your dentist that they have an emergency number, so in the case of an accident after hours or during the weekends you have somebody to call.

Interviewer: All right, good. So what's kind of the least of the worst in these scenarios and what should a parent do?

Dr. Reinemer: The least of the worst is a bumped tooth that maybe slightly loose on a young child. If the tooth is in a normal position, very often, those teeth will tighten back over time. So soft diets, making sure you keep it clean, those things will tend to heal on their own. But, again, there can be some underlying issues there. So, even if it looks minimal, it's good to have a check by a dentist relatively soon just to make sure that it's in good shape.

Interviewer: All right. And I guess it just comes down to how quickly you need to get to the dentist at that point.

Dr. Reinemer: Absolutely, yes.

Interviewer: The least of the worst scenario, you should still go to a dentist, have them take a look at it to make sure everything's okay. But other than that, really not a lot to do.

Dr. Reinemer: Not in the short term. Even if you just bump a tooth and it appears to be okay, the tooth has the potential to die down the road, because there are nerves and blood vessels inside the tooth and if those are traumatized, it could cause the tooth to die. So that's why getting some baseline information, a good first look, is important.

Interviewer: All right. What's the next kind of up the ladder of severity?

Dr. Reinemer: Might be a couple examples of that. One would be a fractured tooth. For example, the crown of the tooth or the part of the tooth that you see, maybe a piece of that has been chipped away or broken off. Another example might be a tooth that's knocked out of position slightly. So those are teeth that need to be repositioned and then splinted. Those require a little bit more sense of urgency. Again, a relationship with a dentist is good.

Interviewer: Is there anything the parent should do in between when it happens and when they end up at the dentist if it's a chipped tooth or one of these other instances you just mentioned?

Dr. Reinemer: If a tooth is fractured, a piece is broken off, if you can find the piece that's broken off, oftentimes that can be bonded right back on to the remaining tooth structure. If a tooth is knocked out of position and is slightly loose, keep the child comfortable. Keep it clean. But, again, get into the dentist ASAP.

Interviewer: All right. And what's after that? We're getting worse and worse here.

Dr. Reinemer: Well, yeah, worse and worse. Worst case scenario would be a tooth that's completely knocked out. Now, in the case of a baby tooth, if you have the ability to determine if it's a baby tooth or permanent tooth. If it's a baby tooth, we generally do not put those back in. Again, important follow-up, because a piece of the tooth could remain in the socket, so it's good to establish that it was completely lost.

In the case of a permanent tooth, then we're dealing with probably the worst case scenario. Best thing to do is put the tooth back in the socket if you can. If you cannot, then it's important to put the tooth in a good storage medium such as cold milk. There is actually a commercially available product out there called Save a Tooth, which is the ideal storage medium, and then transport that with your child to the dentist as soon as possible. Time is of the essence. You want to get the tooth back into the socket in 30 minutes or less if possible. If you can't, prognosis goes down.

Interviewer: So, when you put it back in the socket, you just have the child hold it with their finger, their tongue, or . . .

Dr. Reinemer: Yeah.

Interviewer: Just however they can do it?

Dr. Reinemer: Very gently grab the tooth by the crown of the tooth or the top part of the tooth and put the tooth back into the socket, and then, just have the child hold it. Even if it goes in backward, just get the tooth in the socket, because as soon as it's surrounded by blood and saliva, that's a more natural environment, and the cells that surround the root of the tooth will stay viable and live longer, and increase your chance of success.

Interviewer: So that's the optimal situation.

Dr. Reinemer: That's the best. Now, you may not reposition it perfectly, but to get it in the right spot, the dentist can then reposition it and then splint it.

Interviewer: Fascinating. And the gel medium that you mentioned?

Dr. Reinemer: So there's a product out there called Save a Tooth.

Interviewer: Which would be great for like if you are a coach of a sporting team or something like that?

Dr. Reinemer: Absolutely. This is even a product that could be kept at home. It costs less than $20. You can get it on Amazon. But certainly every coach or athletic trainer should have this in their first aid kit.

Interviewer: So it sounds like that if there's any sort of a tooth damage for your child, whether it's a baby tooth or an adult tooth, you should always go see a dentist because there could be stuff going on you're unaware of. The severity would dictate how quickly you need to go do that. Is it within a day or two, or is it immediately? Even if it doesn't look like there's anything wrong, if somebody took a hit to the teeth, dentist trip probably a good idea?

Dr. Reinemer: Always good to follow up with your dentist because, again, like I said before, there could be some underlying conditions that are not visible to the eye. Maybe it requires an x-ray. It requires some other testing to make sure that it's in good shape. And, again, it provides you baseline information if you can correlate with down the future as you follow this too.

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