All I Want for Christmas

This week’s guest columnist is Ronald Hebert, M.D., Family Practice resident at University Hospital & Clinics in Lafayette.

My one year old daughter was climbing everything in sight, including standing and balancing on her bouncer seat. Quite a trick, until one day it flipped and she flopped, just avoiding a face plant. I thought about maybe storing the bouncer in the attic but, duh, decided against it. One Friday night she climbed again, balancing and babbling away, and flipped again, only this time landing face first. After consoling her, we went to wipe the blood that had poured from her upper lip, and found a tiny white chip on the floor. Looking in her mouth, an upper front tooth had that chip missing.

Toddlers are hurting their mouths all the time as they learn to stand, walk and run away when you need them to stand still the most! They trip and hit their mouths on floors, furniture, toys, etc. Fortunately, their mouths seem designed to take the punishment. The mucosa,  what we call that shiny wet skin inside your mouth, heals remarkably. Deep or long cuts that many parents, and walk-in clinic providers, think need stitches usually heal well without. Also, toddler teeth are primary, or baby, teeth. These are pretty much disposable. If they get chipped or knocked out, it’s no big deal - there’s permanent teeth waiting to replace them. Occasionally your dentist might want to put a knocked-out baby tooth back, to hold it’s space for the next tooth to come in straight. If the tooth is knocked out, put it in some cold milk or saliva. Then call your dentist about what to do next. Don’t put a baby tooth back in yourself - jamming it in may damage the permanent tooth underneath. When we got to the dentist with our daughter and tooth chip, alas, the piece was too small to glue back. It would likely break back off next time she bit something hard. Her beautiful smile has not been the same, but the adorable snaggle tooth smile has grown on me. And one day, it will fall out and be replaced by the new model.

I was sharing last week’s story with one of my mentors, and he had one to top mine. One day his seven year-old daughter was at a birthday party with a fun jump. She was jumping around, smiling away, when she hopped face first into the netting. Her two upper front teeth were snagged in the net, and just like that they were yanked out and gone! Like we said, if your child loses a baby tooth, it’s no tragedy. There’s spare parts, the permanent teeth, waiting underneath. Sometimes the dentist will want to put a baby tooth back, to hold it’s space open so the permanent tooth comes in straight. Otherwise, the other teeth may crowd that space and the next tooth be guided in crooked. Often though, it can be left out.

However, like my mentor’s daughter, permanent teeth are a different matter. To save them, they need to be re-implanted right away. Find those teeth! When you do, wash them off with clean water, without soap. It’s going to hurt briefly, but then push them back in the socket. Don’t put them in backwards! Then have your child hold the teeth in place with a clean cloth and get to the dentist. Like we said last week, don’t put baby teeth back in yourself- this may damage the permanent tooth underneath. If this makes you squeamish (there is usually a lot of blood when a tooth gets knocked out), or you’re not sure if the tooth that’s out is a baby or permanent, call your dentist. While waiting for a call back, put the teeth in cold milk or saliva after washing them off.

Sometimes teeth aren’t knocked out when injured, just crooked. This often can wait to see your dentist the next day, but call your dentist to check. A tooth may need to be straightened right away if it’s an upper tooth that’s pushed back so the tip ends up behind the lower teeth, instead of in front. In other words, your child’s tooth suddenly is an underbite, rather than an overbite. If you can’t push it back in place easily, your dentist may have to do the job.