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Face First

By Scott Hamilton, MD
July 23, 2021
Hamilton Blog Headshot Updated 12.21.21

This week’s guest columnist is Priscilla Tutu, M.D., Family Practice Resident at Ochsner University Hospital & Clinics.

At age seven I got a new bike. First task: school my cousin Patrick in a race. I remember my heart thumping as I waited to hear “Go!” Next thing I knew I was ahead. Then Patrick pulled up, cut in front and his back tire hit my front one. I grabbed my brakes; my back tire flew up in the air and I plummeted to the pavement face first. I got up crying; as much from being beaten as from the pain and blood. My two upper front teeth were broken in half.

Dental injuries in kids are almost as common as rage at being bested by unworthy cousins. About a third of all kids break their “baby” teeth. Even crazier, 60 percent of school-age children injure their permanent teeth. Most commonly broken are the “incisors,” the eight front-most teeth (four upper, four lower) shaped like chisels. Incisors are that shape to cut into (“incise”) food. They also break easily since, besides being up front, they’re thin.

If a baby tooth gets broken or pulled out, it’s usually no big deal; there’s a permanent tooth waiting underneath to take its place. Broken permanent teeth need a dentist right away. If there’s no blood or red showing in the crack, it’s a simple matter of bonding the chip or an artificial bit back on. If red is showing or there’s bleeding, that means the tooth pulp is exposed, and can be more trouble.

Pulp is the jelly-like center of the tooth that contains the nerves and blood supply and grows new tooth material. If it’s exposed, pulp can get infected. Rinse broken teeth with warm water, cover them right away, and call your dentist.  Save tooth chips in saliva or milk.

When I got my new bike and crashed it, did I mention it was my birthday? With my two upper front teeth broken in half and bleeding, I cried hysterically. I was mainly upset that my unworthy cousin Patrick had beaten me at bike racing—and he knew it! But it also hurt. My folks saw the whole thing and were at my side in seconds. And like true helicopter parents, they banned racing and any other thrills from all future birthday celebrations.

Like we said above, rinse broken teeth with warm water and apply a compress for 10 minutes to contain bleeding. As I can attest, these also hurt, so give ibuprofen or acetaminophen (Tylenol). Don’t rinse with cold water: that really hurts!

If a tooth is completely knocked out, that’s another story. Baby teeth are less worrisome if they’re gone: there’s a permanent tooth underneath to take its place. But if a permanent tooth is knocked out, it needs to be put back in the socket right away. Find that tooth, wash it off with warm water, squeeze up your courage and push it back in. Make sure it’s not in backwards! Replacing that tooth immediately increases your chance of keeping it alive. Wait too long and it’ll die and require an artificial tooth in its place. When it’s back in, have your child gently bite down on a gauze or towel to keep it in place. Then off to the dentist.

If pushing that tooth in is too much for you, the next best thing is to put it in a tooth culture solution, but who has that at home? Instead, preserve it in saliva or milk. Then call the dentist!

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