Milk tooth injury: what to do when a child has knocked a tooth and it is loose, pushed in or has turned dark

A child has knocked a tooth: what should you do straight away?

When a child has knocked a tooth, first check for signs of a head injury, then look inside the mouth and take the child to a dentist. The 2020 guidelines of the International Association of Dental Traumatology (IADT) on milk teeth stress that a milk tooth is often treated differently from a permanent one, and that treatment is planned so as not to harm the permanent tooth developing beneath it.

The steps below can be carried out by a parent or carer. They require no instruments or medicines other than a painkiller intended for children.

• Calm the child and look at the lips, gums, frenula and teeth, checking for wounds, fragments and teeth that have changed position.
• Stop the bleeding by pressing on the area with clean gauze or a tissue.
• If a milk tooth has come out, do not put it back, but take it to the dentist; a tooth that cannot be found has to be checked for having been pushed in, swallowed or inhaled into the airway.
• Do not force a tooth that has moved back into position.
• For pain, give a children’s painkiller according to the leaflet; the IADT recommends painkillers when pain can be expected.
• Book a dental examination; for a fracture with exposed pulp, a root fracture and a luxation, the IADT recommends that the child be seen within a few days by a team experienced in treating injuries in children.
• If the wound was dirty, for example with soil, check the child’s tetanus vaccinations; if in doubt, the IADT recommends seeing a doctor within 48 hours.

When should you go to the emergency department or call 112 after a milk tooth injury?

After a milk tooth injury you need to go to the hospital emergency department (SOR) or call 112 when the injury has also affected the head, the facial bones or the airway. The IADT recommends looking for associated injuries with every dental injury, including head injury and fractures of the facial bones, and, when a knocked-out tooth has not been found, referring the child to an emergency department, particularly if there are respiratory symptoms.

• Loss of consciousness or vomiting after a blow to the head.
• Coughing or shortness of breath when the tooth or a piece of it could not be found.
• Suspected fracture of the facial bones, the upper jaw or the lower jaw, especially with difficulty breathing.
• Bleeding from the mouth that does not stop after 15 to 20 minutes of firm pressure with gauze.

What types of milk tooth injury are there, and what does the dentist do about them?

Injuries to milk teeth are divided into fractures, that is damage to the hard tissues of the tooth, and luxations, that is damage to the tissues that hold the tooth in the bone. The IADT states that in children with milk teeth luxations predominate, whereas in older children with permanent teeth crown fractures do.

According to the IADT, the evidence for many treatments of milk teeth is limited, and observation is often the most appropriate approach in an emergency, unless there is a risk of the tooth being swallowed or inhaled or the tooth is blocking the bite. The table summarises the IADT recommendations; the treatment of a particular tooth is decided by the dentist after an examination. After repositioning and splinting of a lateral luxation, the 4-week review is also when the splint is removed.

A pushed-in milk tooth: will it come back into place on its own?

A pushed-in (intruded) milk tooth usually comes back into place gradually on its own: the IADT recommends leaving it to re-erupt spontaneously regardless of the direction of displacement, and its position usually improves within 6 months, sometimes within a year. The child should be seen within a few days by a team experienced in treating dental injuries in children.

Earlier guidelines recommended immediate extraction of an intruded tooth when the root had been displaced towards the bud of the permanent tooth. The IADT no longer recommends this, because intruded milk teeth can re-erupt on their own, extraction can cause further damage to the bud, and there is no evidence that immediate extraction protects the permanent tooth.

The dentist assesses the direction of displacement on an X-ray: when the root tip has moved towards the lip, the tooth looks shorter on the image, and when it has moved towards the bud of the permanent tooth, longer. With deep intrusion the IADT recommends an additional check at the age of 6 to monitor the eruption of the permanent tooth.

A milk tooth is loose after a fall: when is it serious?

A milk tooth that is loose after a fall but has not changed position is, according to the IADT, a subluxation: it needs no treatment, only observation, careful eating and thorough cleaning of the area. Check-ups are planned after a week and after 6 to 8 weeks.

Things are different when the tooth is extruded or very loose. The IADT recommends extracting, under local anaesthesia, a milk tooth that is extruded by more than 3 mm or excessively mobile. A smaller extrusion that does not interfere with the bite is left so that the tooth can settle on its own.

Looseness after an injury has to be distinguished from the natural change of teeth. The milk central incisors usually fall out between the ages of 6 and 7 (American Dental Association, ADA), so a loose incisor in a two-year-old after a fall needs an examination.

A milk tooth dark, grey or yellow after a knock: what does it mean?

A dark or grey milk tooth after a knock is a common consequence of a luxation and does not always mean the pulp has died. According to the IADT, the discolouration may fade and the tooth may return to its original colour within weeks or months; teeth that stay dark may give no symptoms at all or may develop inflammation of the tissues around the root.

The IADT does not recommend root canal treatment of a discoloured milk tooth unless there are clinical or radiographic signs of infection. The guidelines count transient reddening, greying or yellowing of the crown and obliteration of the pulp chamber among the signs of pulp healing, that is, a favourable outcome.

Signs of infection that mean a visit is needed are swelling of the gum, a spot on the gum (fistula), an abscess and increasing mobility of the tooth. The IADT reminds that a child may not complain of pain even though an infection is developing. More about teeth that have darkened is given in the article on dead teeth.

Can an injury to a milk tooth harm the permanent tooth?

An injury to a milk tooth can harm the permanent tooth, because the root tip of the milk tooth lies right next to the bud of the permanent tooth. The IADT lists the possible consequences: developmental disturbances of the permanent tooth, its impaction in the bone and eruption disturbances; they most often accompany intrusion and avulsion of the milk tooth.

A systematic review of 18 studies (Lenzi et al., 2015) indicates that the younger the child at the time of the injury, the more frequent and serious the changes in the permanent teeth. In a 2022 review (Caeiro-Villasenín et al.), the frequency of disturbances in the permanent teeth ranged from 4.5% to 68.8% across the individual good-quality studies. The studies covered different injuries and groups, so this range does not describe the risk for a particular child; discolouration and enamel hypoplasia were the most common, and intrusion of the milk tooth was the most harmful.

That is why the authors of the 2022 review recommend follow-up until the permanent teeth have erupted, and the IADT stresses that parents should be informed of possible complications, especially after intrusion, avulsion and alveolar fracture, and that this should be recorded in the notes.

How to care for the tooth at home after an injury, and what the NFZ funds

After a milk tooth injury, healing depends on hygiene: the IADT recommends cleaning the area with a soft toothbrush or a cotton swab and eating carefully so as not to injure the tooth again, while returning to normal chewing as soon as possible. The dentist may recommend an alcohol-free antiseptic solution for wiping the gum for a week.

For children up to the age of 18, the NFZ, Poland’s National Health Fund, funds an examination after a dental injury with hygiene instruction and up to 3 follow-up examinations within the first 6 months after the injury, and the emergency dental service covers repositioning and splinting of a luxated tooth (legal status as of 24 October 2026). Since 1 January 2026 a child up to the age of 3 who does not cooperate despite adaptation visits and sedation can have the injury treated under general anaesthesia on the NFZ.

Milk tooth injuries at DentalBlue

DentalBlue at ul. Kazimierza Pułaskiego 35 in Białystok is open Monday to Friday from 8:00 to 20:00 and on Saturdays from 8:00 to 16:00; with an injury it is worth phoning before you come: 85 748 00 50. In the clinic’s price list, a “Wizyta z bólem” (visit in pain) includes a panoramic X-ray, a consultation, an examination and pain relief, and costs 340 zł; the final scope and cost are set by the dentist, and prices may change. Intraoral X-rays are taken in the clinic’s own radiology unit. Children are seen by the paediatric dentistry team, and when cooperation is not possible, treatment can take place under inhalation sedation or, after a joint qualifying consultation, under general anaesthesia in the clinic’s own anaesthesiology department.