Bill Klaproth (host): This is OMS Voices, an AAOMS podcast. I’m Bill Klaproth, and with me is Dr. Michael Safian, who is here to discuss, “My child’s tooth was knocked out. What do I do?” Dr. Safian, thank you so much for your time. We appreciate it.  

Dr. Michael Safian: My pleasure, Bill. Thank you so much for having me. You gave that title with all the due emphasis because that’s exactly how a parent is going to feel when their child’s tooth gets knocked out. 

Bill Klaproth (host): Oh yes, this has got to be one of the more scarier things when a tooth is knocked out of your child’s mouth. So, for a parent, what should they do immediately if their child’s tooth is completely knocked out? 

Dr. Michael Safian: Well, the funny part is, the answer doesn’t go directly to the tooth. That’s what everybody is going to concentrate on. But overall, just make sure your child is in a safe place. That’s the most important thing. Teeth can get knocked out in some unusual circumstances, so first make sure the whole child is safe and then let’s, then we can address that tooth but as we get to that, it’s really important to act quickly.

 Time is of the essence. Initially, you just want to find the tooth. If it’s dirty, you want to clean it. You can clean it with some milk if it’s handy, you can clean it with some saline, which is like a salty water that you can even kind of mix there are over-the-counter products, one called Hank’s Balanced Salt Solution, that’s not probably going to be out by the football field or soccer field where this happens, but if it’s available, you can use that, worst case scenario, you can use some just clean water to do that. 

If it’s possible, put that tooth right back in where it came out. Don’t hurt your child, but if it slips in easily, that’s the best thing you can do is get it in there. And if it goes in, fantastic. Have your child bite on some gauze, a napkin, a handkerchief, something to just kind of hold it in place and then get to your dentist or your oral and maxillofacial surgeon as quickly as possible. 

Bill Klaproth (host): So generally, when a tooth gets knocked out, it’s not going to fracture or crack. If it gets, somebody gets hit with a soccer ball, that whole tooth is coming out as a whole tooth. Is that generally what happens? 

Dr. Michael Safian: That’s more commonly what’s going to happen is the whole tooth will get knocked out. When you get hit by a baseball, um, you know something harder, a hockey puck, we might see them crack and larger cracks could cause the tooth to be unsalvageable, but smaller chips and cracks, if you can find that piece, save it, take it to your dentist, they may be able to reattach it right on to your child’s tooth. 

Bill Klaproth (host): Right. So, look for the tooth, find all of it or whatever you can, try to find it, hold it by the crown, keep it moist by placing in a cup of milk, as you say. And if you can, kind of insert it back in and then have the child just kind of bite down on a napkin or gauze or something to hold it in place. 

That’s really good information. And then you said time is of the essence. So, if you can get to the doctor right away, that’s the best. 

Dr. Michael Safian: Absolutely. Yeah. In the circumstances where you can’t get the tooth back into its own position, to its own natural position, don’t force it. And that’s when you want to put it in something you can store it in to transport it to your dentist or to your oral and maxillofacial surgeon. So again, same solutions. 

You can put it into milk, you can put it into that Hank’s Balanced Salt Solution that we talked about. You can put it into some saline solution. If you can’t find any of those, if your child’s old enough and alert and not unconscious from whatever knocked their tooth out, you can actually have them kind of put it between their gums and their cheek, and their saliva will be one of the best things to keep it moist.

 And that’s the important thing, is keeping the root of the tooth moist and not letting it dry out. And that’s where the timeframe comes in. There are cells, we call them PDL cells, periodontal ligament. Those are important towards the survivability of the tooth, and we want to protect them. So that’s why we’re handling it by the crown, that’s why we’re rinsing it, and that’s why we’re keeping it moist. 

So time, we want to get your child, we want to get their tooth and we want to get them to the dentist or the oral and maxillofacial surgeon as quickly as possible, ideally within 30 minutes. Sixty is pretty good too. But if we can get to one of those locations within an hour, that’s going to increase the success of getting that tooth back in and having it last a lifetime. 

Bill Klaproth (host): So, generally, I would think you mentioned a hockey puck or a baseball. If you get smashed in the face with a baseball, chances are there’s going to be other corresponding damage around the mouth, right? So, there’s got to be some kind of complications following a facial injury in children. What is a child facing after having their tooth knocked out on a sporting injury or a car accident or skateboarding and falling and hitting something? What are the complications to follow? 

Dr. Michael Safian: It’s really nice in a way if it’s just a tooth that gets injured however, as you kind of hinted at, when a face gets hit, there’s a lot more structures that can be damaged. The other teeth can get damaged even though it’s not noticeable. The jaws can suffer fractures, you can get lacerations or cuts, so it’s important to get someplace where those can be evaluated really quickly. 

You’re looking for things, lacerations are pretty clear cut. Keep them clean, dress them. Fractures may not be as evident. So, fractures to the jaws might be noticeable only because your child’s bite is off. They can’t bring their teeth together in a normal way. So when you’re seeing things like that, even more important that you get that medical attention right away. 

Bill Klaproth (host): That’s a great point. If you don’t get that medical attention right away, there could be corresponding, lingering issues, difficulties in speaking or chewing, things like that, if it’s not treated properly right away, is that correct? 

Dr. Michael Safian: Yeah, absolutely. If there’s an unseen tooth injury, it could present itself later and at such a point where that tooth can’t be fixed versus if we catch it right away, that tooth can be repaired, that tooth can be saved and kept a long time. If there are unrecognized jaw fractures, then certainly a child’s bite could be off, their development could be hindered, and the jaw might not develop into a correct position as they age if those fractures go unrecognized and therefore untreated. 

Bill Klaproth (host): Absolutely. So, is there a way we can help prevent facial and dental injuries in children? I’m sure, you know, I’ve had two boys and I don’t want to wear a helmet, I don’t want to wear a mouth guard, but I mean, what are some of the ways we can help prevent these injuries? 

Dr. Michael Safian: Yeah, you know, the most common places these things happen, you know, as you kind of mentioned, they’re related to sports. So, mouth guards, when they’re appropriate to the sport and very few sports that are not. First that comes to mind is swimming, obviously. But there are plenty of sports, football, ice hockey, soccer, skiing and snowboarding. 

Any of these sports that involve the high risk of facial injury, mouth guards are appropriate. One of the best-selling points for kids is that they’re seeing their idols, the professional players wearing mouth guards. You see every football player with their mouth guard attached to their face mask. 

And that’s one of the best things. You see the hockey players, the professional hockey players are wearing their mouth guards as well. The more and more our kids see their idols wearing them, the easier it is to get them to wear. 

Bill Klaproth (host): Yeah, that’s a great point. I’m thinking of baseball catchers used to just be that wire metal mask, if you will. Now it looks like they’ve got full protection, like hockey masks all the way wrapped around their head, in fact. So really trying to protect all of their face as well. 

Dr. Michael Safian: You can’t have enough protection and, youth hockey players often wear, as you kind of described, that cage over their face and the kid might sit there saying, but I’ve got this cage on, why do I need this mouth guard in? Well, unfortunately, technology fails. So, you want that belt and suspenders protection for their teeth, for their jaws. 

And in a way, those mouth guards can also help prevent injury from concussions as well. They provide a little bit of a shock absorber that can help lessen a sustained concussion and help your child recover quicker from that as well. 

Bill Klaproth (host): Yeah, that’s a really good point. I know we’ve mentioned some of the bigger sports, hockey and baseball, football. What are some of the other sports? Do you have a kind of a list of sports that we really should, that we might not be thinking of? Like, hey, you need mouth guard protection as well. Can we kind of go through some sports? 

Dr. Michael Safian: Well, you might be surprised but even something like mountain biking. If you’re getting into some serious mountain biking, going down some trails, it’s not so uncommon to take a really good spill and we tend to land on our face when that happens. So, as strange as it may sound, even mountain biking is something that a mouth guard can help with. 

One of the more rare ones I kind of hinted at before was skiing or snowboarding. You don’t really associate those with facial injuries, but I’ve seen my fair share of folks go out into the trees. And it’s your face that’s gonna hit. We see more and more folks on those slopes wearing helmets and we can’t emphasize that that’s an important protective device as well. But those mouth guards can come in handy, too. 

Plus, they look really cool if you get them in some nice bright fun colors. 

Bill Klaproth (host): And, I’m thinking a lot of girls play softball, too. You know, you hit a softball hard, it’s coming at you. You’re not able to catch it, you catch it right in the mouth. That’s another one you might think about is, is softball even. 

Dr. Michael Safian: Absolutely and anything that’s got objects that are flying at your face any kind of balls, pucks. Volleyball. You know, you think about that one. A nice spike comes down on your face. That mouth guard can help out a lot. 

Bill Klaproth (host): So I know that the specific function of this podcast is we’re talking about my child’s tooth was knocked out, and we kind of alluded to other facial injuries as well. When the tooth gets knocked out, chances are there’s other facial injuries. So, let’s help the parents out listening to this right now, Dr. Safian. Are there any specific first aid steps to follow for other types of facial injuries in children? 

Dr. Michael Safian: Absolutely, Bill. First off, as I mentioned, make sure your child is in a safe place. That’s going to be key. When it comes to their other facial injuries, cuts, fractures, it’s important to keep those wounds clean. Use some water. If there’s some kind of sterile or clean bandage around, protect them with that. Ice can help reduce some swelling. Plus the cold can numb things and make things more comfortable. Try not to move their face or their jaw around if a fracture is suspected, that can cause more problems. If there’s a lot of bleeding, gentle pressure is going to help out with that a lot. But don’t apply too much force because if there is a fracture, again, that could disturb things. 

And then, most importantly, seek that professional medical attention as quickly as possible. Especially if there’s heavy bleeding, especially if you’re unsure of your child’s condition or concussion was suspected. Get them to an emergency room if need be, an oral and maxillofacial surgeon or their dentist. 

Bill Klaproth (host): Very well said. Really important points to remember, Dr. Safian, so thank you for that. And when you talk about you’ll get expert help, sometimes I think we overlook the OMS in this. How is an OMS a key expert in treating facial injuries? For someone listening that might not first think of an OMS for that purpose, explain to us why that is. 

Dr. Michael Safian: Well, oral and maxillofacial surgeons or OMSs as you said, are specifically trained in trauma to the head and neck area. Our professionals go through four to six years of training beyond their dental school. And a fair amount of that is in treating patients that come to their residency programs and to their hospitals with facial injuries.

 So whether it’s treating lacerations, whether it’s treating fractures of the skull, the nose, the maxilla or the upper jaw, the mandible or the lower jaw. We’re highly trained and we are the experts when it comes to treating these types of injuries. 

Bill Klaproth (host): So don’t just think of teeth when it comes to the OMS, actually the full face, you said head and neck region, fully trained to treat somebody that has a facial injury. 

Dr. Michael Safian: Absolutely, it’s where I want my child treated. 

Bill Klaproth (host): Wow, that’s a great way to put it. This has been fascinating, Dr. Safian, really great information. As we wrap up, is there anything else you want to add? 

Dr. Michael Safian: So, ultimately the goal of any medical professional, especially the OMS, is to get your child back to their normal function, their normal dentition as soon as possible. So knowing these tricks, knowing these skills when that tooth gets knocked out is going to be imperative to getting your child treated properly, getting them back to their proper form and function. 

And we encourage you to know these tricks in advance because you can’t prepare afterward. You can only prepare before. 

Bill Klaproth (host): Absolutely. Dr. Safian, this has really been informative. I always enjoy talking with you. Thank you so much for your time today. We appreciate it. 

Dr. Michael Safian: My pleasure, Bill. It’s been a pleasure as always. Thank you. 

Bill Klaproth (host): You bet. Once again, that’s Dr. Michael Safian. And for more information and the full podcast library, please visit MyOMS.org. And if you found this podcast interesting, please share it on your social media.

And don’t forget to subscribe. Thanks for listening.