Children's teeth take a lot of punishment. The toddler years coincide with learning to walk, run, and climb, and falls that involve the face are common. Beyond injury, dental decay in young children is a significant public health issue in the UK, with milk teeth affected in a significant proportion of five-year-olds at school entry.
Most dental emergencies can be managed effectively, but knowing what to do and how quickly it needs to happen makes a real difference to the outcome. The difference between a replanted permanent tooth surviving and not surviving often comes down to how many minutes passed before it went back in the socket.
Healthbooq (healthbooq.com) covers children's dental health from the eruption of the first tooth through the early school years.
Knocked-Out Baby Tooth
This is probably the most common dental emergency in toddlers and young children. A fall that hits the mouth can knock a baby tooth out completely, or partially (the tooth is still in the socket but displaced).
Do not replant a knocked-out baby tooth. This is the clear guidance from dental organisations including the British Society of Paediatric Dentistry. Attempting to replant can damage the developing permanent tooth bud that sits below, causing problems with the adult tooth that will emerge later.
Contact a dentist as soon as possible, but the urgency is for assessment rather than emergency action. The dentist will confirm that the whole tooth (including root) has come out, check the gum and surrounding teeth, and advise on follow-up to monitor the developing permanent tooth.
If a baby tooth is partially displaced (pushed in, pushed back, rotated, or sticking out at an angle), dental assessment within a few hours is needed. The dentist will determine whether the tooth can be repositioned or whether it needs to be removed to prevent damage to the permanent tooth below.
Keep any knocked-out tooth to show the dentist so they can confirm the whole root has come out and no fragment remains in the gum.
Knocked-Out Permanent Tooth
This is a genuine dental emergency where minutes matter. Permanent teeth can be successfully replanted if handled correctly and quickly.
Pick up the tooth by the crown (the white part), not the root. Do not scrub or rub the tooth. Do not wrap it in dry tissue.
If possible, rinse the tooth very briefly in milk or in the child's own saliva and replant it immediately: gently push it back into the socket in the correct orientation and ask the child to bite on a clean cloth to hold it in place. Then go to a dentist or hospital immediately.
If replanting is not possible (the child is very young and at risk of swallowing it, or the socket is difficult to access), store the tooth in milk (the best option), in the child's own saliva (held in the cheek is one approach though this has aspiration risks in young children), or in a tooth-preservation kit such as Save-A-Tooth if one is available. Water is the worst storage medium because it causes the root cells to swell and die quickly.
Get to a dentist within 30 minutes. The survival rate drops significantly after this. After an hour, replanting is still worth attempting but with lower success likelihood.
Toothache and Dental Abscess
Toothache in children is usually caused by tooth decay, a cracked tooth, or an abscess (infection). A visible swelling in the gum, face, or jaw alongside toothache suggests an abscess, which requires urgent assessment.
Dental infections in children can spread into surrounding tissue, including the jaw and neck, more rapidly than in adults, because children's tissue has different structural properties. A dental abscess that causes facial or neck swelling, difficulty swallowing or breathing, or fever is a medical emergency needing A&E assessment, not just a dental appointment.
For simple toothache without swelling, paracetamol or ibuprofen at appropriate doses will manage pain until a dental appointment. Ibuprofen tends to be more effective for dental pain because of its anti-inflammatory effect. Clove oil applied topically provides some short-term local anaesthetic effect and is safe for children.
Dental Care and Registration
The NHS recommends registering a child with a dentist as soon as the first tooth appears, and certainly by age one. NHS dental care for children is free. Regular check-ups, typically every six months in the early years, allow decay to be identified and managed early.
Brushing should begin with the first tooth, using a small smear of fluoride toothpaste (1000ppm fluoride or higher, which is standard in most UK children's toothpastes). Spitting out rather than rinsing after brushing maximises the protective effect of fluoride. Children need help with brushing until around age seven to eight, when manual dexterity is sufficient for effective independent brushing.
Key Takeaways
Dental injuries in children are common, particularly during the toddler and preschool years when falls are frequent. A knocked-out baby tooth should not be replanted because this can damage the developing permanent tooth underneath. A knocked-out permanent tooth is a dental emergency where time matters: replanting within 30 minutes gives the best chance of survival. Dental infections (abscess) in children can spread rapidly and need urgent dental or medical assessment. All children should be registered with a dentist and have their first appointment by the time their first tooth appears.
