A child runs across the playground, trips, and plants their face on the concrete. Within 30 seconds you're looking at a bloody mouth, a panicked toddler, and a tooth on the ground — and the decisions you make in the next half hour genuinely change the outcome. The two big things to know: a baby tooth and a permanent tooth are managed completely differently after a knock-out, and a dental abscess that is causing facial swelling is not a "wait until Monday for the dentist" problem. For more on common childhood injuries and illnesses, visit Healthbooq.
Knocked-Out Baby Tooth
The most common dental emergency in toddlers — usually from a fall onto the face during the wobbly walking and running phase between 12 and 36 months. The instinct is to put the tooth back. Don't.
Do not replant a knocked-out baby tooth. This is firm guidance from the British Society of Paediatric Dentistry and the American Academy of Pediatric Dentistry. Replanting can damage the developing permanent tooth bud sitting in the bone underneath the empty socket, leaving the eventual adult tooth deformed, discoloured, or stunted.
What to do instead:
- Stop the bleeding with gentle pressure using clean gauze or a clean tea towel for 10 minutes
- Keep the knocked-out tooth in case the dentist wants to see it (to confirm the whole root came out)
- Book a dental appointment within 24–48 hours for assessment
- Soft food and avoiding the area for a few days
If a baby tooth is not knocked out but pushed in, pushed back, rotated, or hanging at an odd angle, that needs dental assessment within a few hours. The dentist will decide whether to leave it, reposition it, or remove it to protect the underlying permanent tooth.
If there's significant bleeding that won't stop, persistent severe pain, or the child has hit their head hard enough to be concerned about concussion (vomiting, loss of consciousness, drowsiness, persistent crying), go to A&E — that's a head injury question, not a dental one.
Knocked-Out Permanent Tooth — Time Matters
Permanent teeth typically start coming in around age 6. From that point, a knocked-out front tooth is a true dental emergency where minutes change the outcome. The periodontal ligament cells on the root surface die quickly when exposed to air; getting the tooth back in the socket within 30 minutes gives the best chance of long-term survival.
What to do, in order:
- Pick the tooth up by the crown (the white part) — never touch the root.
- Do not scrub, wipe, or wrap in tissue. The cells on the root surface are what you're trying to save.
- If the tooth is dirty, rinse it briefly — about 10 seconds — under cold milk if available, or saline, or in a pinch the child's saliva. Avoid tap water if possible (water osmotically damages root cells).
- Replant it. Slot it back into the socket the right way round, push gently until it's level with the neighbouring teeth, and have the child bite gently on a clean cloth or piece of gauze to hold it in place.
- Get to a dentist or A&E urgently — within 30 minutes if you can.
If you cannot replant — the child is too young, too distressed, or the socket is bleeding too heavily — store the tooth properly:
- Cold milk is the best widely available storage medium
- Saline (contact lens solution or sterile saline) is also good
- The child's own saliva, in a small pot — not held in the cheek if they're under about 8 (aspiration risk)
- Never store in water, tissue, or a dry container
- Specific tooth-preservation kits (Save-A-Tooth, Hank's solution) exist if you happen to have one
After 30 minutes the chance of long-term survival drops sharply, but it's still worth attempting up to about 60 minutes — and the dentist will still want to see the tooth even later.
Toothache and Dental Abscess
Toothache in a child is most often decay, less often a cracked tooth or an abscess. The presence of swelling changes everything.
Toothache without swelling: book a dental appointment in the next day or two. Manage pain with paracetamol or ibuprofen at standard weight-based dosing (paracetamol 15 mg/kg every 4–6 hours up to 4 doses in 24 hours; ibuprofen 10 mg/kg every 6–8 hours, with food, in children over 3 months and 5 kg). Ibuprofen tends to work better for dental pain because of its anti-inflammatory effect. Topical clove oil on a cotton bud gives short-term local relief.
Toothache with visible swelling of the gum, face, or jaw: this is an abscess. It needs a same-day dental appointment. Children's tissue planes are looser than adults', and dental infections can spread along these planes into the deep neck spaces faster than people expect.
Abscess with fever, facial or neck swelling that's spreading, difficulty swallowing, drooling, or any difficulty breathing: this is a 999/A&E emergency. Spread of dental infection to the deep neck spaces can compromise the airway. Drooling and reluctance to swallow are particularly worrying signs.
Antibiotics alone do not fix dental abscesses — the source needs to be drained or the tooth treated. Antibiotics are an adjunct in serious cases, not a substitute for dental treatment.
Cracked or Chipped Teeth
A small chip without sensitivity to cold or air is usually not urgent — book a dental appointment within a week. The dentist may smooth it down or build it up with composite.
A larger fracture that exposes pink/red tissue (the pulp) inside the tooth is more urgent. Cover with a clean wet gauze, give pain relief, and see a dentist same-day. A pulp exposed to the mouth gets infected.
A tooth that hurts to bite on after a knock or fall but didn't come out may have a root fracture — needs a dental X-ray within a day or two even if it looks fine.
Bitten Lip, Tongue, or Cheek
Mouth wounds bleed dramatically because the area is so vascular, but most stop with 10 minutes of firm pressure using clean gauze. A small cold pack on the lip can help with both bleeding and swelling.
A&E is needed for:
- Bleeding that hasn't stopped after 10–15 minutes of firm pressure
- A through-and-through cut of the lip (gaping, requires stitches)
- A tongue wound longer than about 1 cm or that gapes open at rest
- A wound caused by a dirty object that may need a tetanus check
Routine Care That Prevents Most of This
Most dental emergencies in children are reactive, but two things shift the odds:
- Mouthguards for sport. Any contact sport, plus skateboarding, scootering, and BMX — sport-related dental trauma is one of the largest categories. A custom-fit mouthguard from the dentist is best; a boil-and-bite from the sports shop is much better than nothing.
- Regular dental visits. First visit by age 1, then 6-monthly through the early years (NHS standard recommendation, dental care free for under-18s). Decay caught early is filled; decay caught late is extracted. Find an NHS dentist accepting children at nhs.uk/find-a-dentist.
Brushing twice daily with at least 1,000 ppm fluoride toothpaste (the actual concentration on the back of the tube), parental brushing until age 7–8, and "spit don't rinse" after brushing are the basics that prevent most of the appointments that turn into emergencies.
Key Takeaways
A knocked-out baby tooth should never be replanted — it can damage the developing permanent tooth underneath. A knocked-out permanent tooth is a true emergency: replant within 30 minutes for the best chance of survival, store in milk if you can't replant, and never store in water. A dental abscess with face or neck swelling, fever, or trouble swallowing or breathing needs A&E, not just the dentist.
