Do not put a knocked-out baby tooth back in. That is the reverse of the advice for an adult tooth, and it is the single most useful thing to remember when a toddler falls and comes up with a gap. Comfort your child, stop the bleeding, and arrange to see a dentist that day.
Front tooth injuries are very common between about one and three, when children are walking, running and climbing before their balance has caught up. Most heal without lasting trouble, but a quick check matters because the injury is not always what it looks like.
Why the baby tooth stays out
Just above each upper front baby tooth, the adult tooth is already forming inside the jaw. The root tip of the baby tooth sits very close to that developing tooth. Pushing a knocked-out baby tooth back into its socket can drive it into the adult tooth bud or carry bacteria into the area, which may affect how the adult tooth forms or erupts years later.
For that reason, the International Association of Dental Traumatology, whose guidelines dentists around the world use for tooth injuries, advises against replanting avulsed baby teeth. The small gain of keeping a baby tooth that will fall out anyway in a few years is not worth the risk to the permanent tooth.
The first ten minutes
Mouth injuries bleed a lot, because the lips and gums have a rich blood supply, so the scene often looks worse than it is. Hold your child, speak calmly and check for other injuries, especially to the head.
Fold a clean, damp cloth or piece of gauze and have your child bite on it, or hold it firmly against the gum, for about ten minutes. A cold pack wrapped in a cloth, held against the lip, can ease swelling. An icy pole may help an older toddler and gives them something to focus on.
Then look for the tooth. Finding it confirms the tooth is fully out. If you cannot find it, the tooth may have been pushed up into the gum, which can look almost identical to a lost tooth, or in rare cases it may have been swallowed or inhaled. Both of those need a dentist or doctor to check.
If you are unsure whether the tooth is a baby tooth or an adult tooth, for example in a child of six or seven, do not push it back in. Put it in a small container of milk and call a dentist immediately for advice. Our guide to when baby teeth fall out gives the usual ages.
Signs that need a doctor straight away
Go to an emergency department or call 000 if your child lost consciousness, vomits, becomes drowsy or confused, has bleeding that does not slow with firm pressure, has a deep cut through the lip, or has trouble breathing. These matter more than the tooth. Our article on what to do in a dental emergency covers other urgent situations.
What the dentist checks
At the appointment, the dentist will look at the socket and the neighbouring teeth, check the lips, tongue and gums for cuts, and often take a small X-ray. The X-ray can show whether a tooth is actually pushed into the gum rather than lost, whether any root fragment is left behind, and how the adult tooth underneath looks.
The teeth beside the gap often take part of the knock too. They may be loose, slightly moved or tender. Many settle on their own with a soft diet for a week or two.
Will the gap cause problems?
Losing an upper front baby tooth early does not usually cause the remaining teeth to crowd, because the front teeth are not the main space holders in a young child's mouth. The adult tooth often still comes through on time, though it can be a little earlier or later. Children may lisp slightly for a while, but speech usually adjusts.
The situation is different for back baby teeth, which hold space for the premolars. If a back tooth is lost early through injury or decay, a space maintainer is sometimes needed, as explained in our article on space maintainers for children.
Changes to watch for in the following weeks
Book a review with your dentist if you notice any of the following:
- a neighbouring baby tooth slowly turning grey, dark yellow or pink
- a small pimple or swelling on the gum above a tooth
- swelling of the lip or face, or a fever
- pain that returns after settling, or a tooth that becomes looser
A knocked tooth that darkens is fairly common. Sometimes the colour fades again, and sometimes it signals the nerve has died, which may need treatment if infection develops. Your dentist will usually plan follow-up visits and X-rays over the next months to keep an eye on it.
Common questions
Should I keep the tooth?
You can bring it to the appointment so the dentist can see the whole tooth came out, including the root. After that, it is yours to keep for the tooth fairy if you like.
Will the adult tooth be affected?
Most adult teeth come through normally. Occasionally, a severe injury to a baby tooth leaves a white or brown mark, or a change in shape, on the adult tooth. This only becomes visible when the adult tooth erupts, around age six to eight.
How can we prevent it happening again?
Falls in toddlers cannot be prevented entirely. Stair gates, padding sharp furniture corners and supervision on play equipment help. Older children playing sport should wear a fitted mouthguard, as described in our article on sports mouthguards for children.
Getting a mouth injury checked
If your child has knocked out or damaged a tooth, call us and we will see them as soon as we can. Our dentists treat children of all ages, and we are open Monday to Saturday, until 9pm on Thursdays. You can also see what is available for new families on the current deals page or contact our team in Melrose Park.
This article is general first-aid information, not a substitute for seeing a dentist or doctor. For a serious facial or head injury, seek urgent medical care.
