Key points in brief
- Slight looseness after a knock usually settles within a few weeks. After a dentist's check, discolouration alone or looseness that lessens day by day usually needs only watching and check-ups.
- Signs of infection, like a gum pimple or swelling, decide whether a discoloured tooth needs treatment. Show a darkening or sharp-edged baby tooth to a dentist within a few days.
- Have an unexamined tooth seen as soon as possible: within a few days at the latest, within 1–2 days if pushed into the gum. Photograph it every few days.
- A gum pimple or swelling, swollen lip or cheek, fever, pain at night or without cause, increasing or severe looseness, or a tooth blocking the bite need a same-day visit.
- With difficulty breathing or swallowing, swelling spreading to the neck or under the eye, or a high fever and feeling unwell, go to a hospital emergency department or call 112.
Consult your case with an expert and get your treatment plan
What happens when an injured baby tooth is loose or changes colour
When a baby tooth is slightly loose after a knock, the looseness usually settles within a few weeks. A tooth that has been pushed out of place or into the gum takes longer to heal, because it also has to return to its proper position.
A blow that leaves the tooth in its socket can also damage the pulp, the tissue with nerves and blood vessels inside the tooth. The baby tooth then turns pinkish, bluish or grey - sometimes after a few days, sometimes only after weeks or months. A change of colour is the most common consequence of an injury to a baby tooth, and it can be temporary. So a grey baby tooth after a knock does not necessarily mean that the pulp has died.
A yellow tint usually appears later. Most often it means that the inside of the tooth is gradually filling with hard tissue, which dentists regard as a sign of healing.
Things are more serious when the pulp dies and bacteria get into it. A dead baby tooth in a child often does not hurt, even when an infection is already under way. A small child may also not tell you about pain. The first sign is then sometimes a small pimple on the gum next to the tooth: the opening of a narrow channel through which pus drains out of the bone. This is how a sinus tract on the gum forms.
In a school-age child, an injured front tooth may already be a permanent tooth. A grey permanent tooth after an injury or a broken permanent tooth is assessed on different principles from a baby tooth.
What to note down at home and what to ask the dentist
After an injury, the dentist first checks exactly what has happened to the tooth. Your notes from the first few days will help:
- the day of the injury, and whether the tooth changed position straight away or the gum bled,
- photos of the tooth from the following days,
- whether your child bites with the injured tooth and eats without pain,
- whether a fever, swelling or a pimple on the gum has appeared.
At the appointment, you can ask:
- What kind of injury was it, and how many check-ups will we need?
- Which signs should we watch for until the next visit?
- Could this injury harm the permanent tooth, and when will we check that?
- What will we do if the tooth's colour does not fade or the tooth does not move back into place?
A small child copes more calmly with a check-up when they know what to expect. Before you come, read how to prepare your child for a dental visit.
Which signs can wait for the check-up and which need an earlier visit
Whether a change of colour, a chipped edge or a loose baby tooth after a knock in a child can wait depends on the signs that come with them. The three groups of signs below apply to a tooth that a dentist has already examined. If no dentist has examined the tooth yet, take your child to the nearest available dentist as soon as possible, within a few days at the latest, and within 1–2 days if the tooth has been pushed into the gum, even if the tooth looks fine. The signs in the last group need a visit the same day, even if a dentist has not yet seen the tooth.
Can wait until the planned check-up
| What you see | What to note down or photograph | What to bring to the appointment |
|---|---|---|
| a grey, bluish or pinkish tint that appeared in the first few days, with no pain and no changes on the gum | a photo every few days in the same light | the photos, arranged by date |
| a tooth that is turning yellow | a photo every 1–2 weeks | when the colour started to change |
| slight looseness that lessens from day to day | whether your child bites with this tooth; do not wiggle the tooth with your finger | notes on eating over the last few days |
| a tooth pushed into the gum that is slowly coming back out | a side-view photo every 2 weeks | photos comparing it with the tooth next to it |
A visit within a few days
| What you see | What to note down or photograph | What to bring to the appointment |
|---|---|---|
| pain when eating that lasts longer than a few days | which foods cause pain and since when | a list of situations in which your child complains |
| a chipped edge irritates the lip or tongue, or a red spot is visible in the break | a photo of the broken edge and of the small sore | whether the edge keeps chipping |
| colour that darkens instead of fading, or that appears after weeks or months | photos from the following weeks | the photos, with dates |
| looseness that has not changed for several days | since when the tooth has been equally loose | notes on eating and pain |
A visit on the day the signs appear
With the signs below, have your child seen by a dentist the same day, at the nearest practice with a free appointment or at an emergency dental service.
| What you see | What to note down or photograph | What to bring to the appointment |
|---|---|---|
| a pimple or small blister with pus on the gum next to the tooth | a photo of the gum | whether the pimple disappears and comes back |
| swelling of the gum, lip or cheek | a photo of the face from the front | the time when the swelling appeared |
| fever | temperature readings with times | a list of the medicines given |
| pain that starts on its own or wakes your child at night | when the pain starts and how long it lasts | notes from the last few nights |
| looseness that is increasing instead of lessening, or a tooth so loose it could fall out | since when the tooth has been looser | notes on eating and pain |
| the tooth gets in the way when your child closes their teeth | whether your child can bite their teeth together | a photo of the teeth closed together |
In the following days, you can bring your child to Modern Dental & Orthodontics for an examination and further treatment. Facial swelling with a fever needs help the same day, and if dental practices are closed, help from a hospital emergency department (SOR).
There are also signs for which you do not look for a dentist: shortness of breath, difficulty swallowing or breathing, swelling spreading down to the neck or up under the eye, a high fever with your child feeling generally unwell. In that case, go to a hospital emergency department or call the emergency number 112. After a fall onto the face, do the same if your child loses consciousness, vomits, becomes drowsy or becomes confused.
When an injured baby tooth is watched, when it is treated and when it is removed
After most injuries to a baby tooth, the dentist watches the tooth rather than treating it straight away. This applies to a tooth that has been knocked, loosened, pushed out of place or into the gum, as long as it is not very loose and does not get in the way when the child closes their teeth. The dentist does not remove a baby tooth to protect the permanent tooth - there is no evidence that this helps, and removing it may cause further damage to the tooth growing underneath.
Colour on its own is not a reason for treatment. In a baby tooth that stays grey for many months, the pulp is often already dead. Without signs of infection, however, there is no evidence that root canal treatment gives a better result than watching the tooth, so international guidelines do not recommend it in that situation.
Studies of children after dental injuries show that in roughly 2 out of 5 baby teeth that changed colour, nothing further happens afterwards. A grey or darker tooth becomes infected in about 4 cases out of 10, and a yellow one in 1 in 6. Infection also occurs in a tooth that has not changed colour, in roughly 1 in 7.
The dentist considers removing the tooth when the baby tooth has been pushed well out of its socket or is so loose that the child could swallow it. Removal is also considered if the tooth gets in the way when the child closes their teeth, or if it has broken so deeply that it cannot be restored. The child's age, the time left until the tooth would naturally be replaced and how much the child can cope with in the dental chair all play a part. If the baby tooth is infected, the dentist either gives it root canal treatment or removes it. The choice follows the same principles as with a baby tooth abscess.
After a baby tooth has been removed, a dentist working in paediatric dentistry checks whether the space for the permanent tooth needs to be protected, and decides this after assessing the child's age and the tooth.
Chipped or broken baby tooth: what the treatment depends on
A chipped baby tooth in a child is treated according to how deep the break goes:
- If only a piece of enamel, the hard outer layer, has broken off, the dentist smooths the sharp edge. A follow-up visit is usually not needed.
- If the yellowish layer under the enamel, the dentine, can be seen, the dentist covers it with a tooth-coloured material. The dentist restores the missing part straight away or at the next visit, and checks the tooth after 6–8 weeks.
- If a red spot can be seen where the tooth broke, or the centre of the tooth is bleeding, the break reaches the pulp. Show such a tooth to a dentist as soon as possible, within a few days at the latest, because a decision is needed about treating the pulp under local anaesthetic.
- If a broken baby tooth in a child has a fractured root, the dentist often removes only the loose fragment carrying the visible part of the tooth. The piece of root stays in the bone and usually dissolves on its own.
A lot also depends on the child. If a two-year-old cannot cope with a longer visit, the dentist only protects the tooth to begin with.
Can an injury to a baby tooth harm the permanent tooth?
An injury to a baby tooth can harm the permanent tooth, because the tip of the baby tooth's root lies right next to the tooth germ, the permanent tooth developing underneath. In children treated after dental injuries, roughly one in three permanent teeth that come through in place of an injured baby tooth later shows some kind of mark. It is usually mild: a white or yellowish spot or discolouration of the enamel. Less often the enamel is incomplete, the tooth has an altered shape or it comes through late.
The risk rises the younger the child was at the time of the injury and the further the tooth was displaced. A mark is left most often after a baby tooth has been pushed into the gum - in about half of cases - and after it has been knocked out. In children younger than 3, incomplete enamel and an altered shape of the permanent tooth also occur after a baby tooth has been pushed to one side. Sometimes a mark is left even after a knock that did not move the tooth, although less often than after the tooth was pushed into the gum.
A mark usually becomes visible only once the permanent tooth has come through, which is mostly between the ages of 6 and 8. That is why, after a baby tooth has been pushed deep into the gum or knocked out, the dentist plans an extra check-up at around the age of 6.
When to bring your child back to the dentist before the check-up date
Come to the check-ups on the dates the dentist sets, even if the tooth looks fine. Have your child seen by a dentist the same day, without waiting for the appointment, if there is a pimple or swelling on the gum, swelling of the lip or cheek, a fever, or pain at night or for no reason. The same applies to looseness that is increasing or very marked, or a tooth that gets in the way when your child closes their teeth.
Within a few days, show the dentist a tooth that has hurt during eating for several days, or whose colour is getting darker instead of fading or appeared only after weeks or months. An injured baby tooth that is only grey or yellow and causes none of these signs can usually wait until the check-up.
Frequently asked questions
Can the dark colour of a baby tooth fade over time?
Yes, a grey or pinkish tint after an injury can get lighter over several weeks or months, until the tooth returns to its former colour. In some children the grey stays until the tooth is naturally replaced. If there is no pimple, swelling or pain, the dentist usually just watches such a tooth.
Does a baby tooth need an X-ray after an injury?
An X-ray is not always needed. After a light knock that has not moved the tooth, and after a small chip in the enamel, an X-ray is generally not taken. When the tooth is loose, has moved, has been pushed into the gum or has broken more deeply, the dentist usually takes one at the first visit as a reference point, and later mainly if there are worrying signs. The dentist does not test how the tooth responds to cold, because in baby teeth this test is unreliable.
Will a baby tooth pushed into the gum come back into place?
Usually yes, although a baby tooth pushed into the gum comes back slowly: most often on its own within a few months, sometimes only after a year. The dentist does not reposition it or remove it. After six months, roughly 2 in 3 such teeth have come back, and if nothing has changed after a week, that should not worry you. A baby tooth pushed to one side that does not get in the way when the child closes their teeth also usually moves back on its own within six months.
How can I protect my child's teeth from another injury?
Careful supervision and a safe home help: gates on the stairs, no baby walker, and a helmet when riding a bike or a scooter. A child who sucks a dummy, thumb or finger for a long time is more likely to have upper front teeth that stick out, and these get knocked more easily. It is worth discussing how to wean your child off the habit at an appointment. Regular check-ups also help to spot the effects of a previous injury early.
How long do check-ups continue after an injury to a baby tooth?
The number of check-ups depends on the type of injury. After a knock that has not moved the tooth, two check-ups are usually enough: after a week and after 6–8 weeks. After the tooth has been pushed out of place or into the gum, check-ups usually continue until a year after the injury, and after the tooth has been pushed deep into the gum or knocked out, there is an extra visit at around the age of 6. If the dentist is concerned about complications, they check the tooth every year until the permanent tooth comes through.
What can my child eat in the first days after the injury or after treatment of the baby tooth?
Your child can eat what they usually eat, just more carefully. Cut hard foods, such as an apple or a bread crust, into small pieces so that your child does not bite into them with the injured tooth. After treatment under local anaesthetic, let your child eat only once the numbness has worn off, because while it lasts a child can easily bite their lip or cheek.
How should I keep the injured area clean in the first few weeks?
Brush your child's teeth twice a day with a soft toothbrush and gentle movements, including the injured baby tooth. If the gum is sore, clean it with a cotton bud. The dentist may recommend an alcohol-free chlorhexidine antiseptic, applied with a cotton bud twice a day for a week. Plaque along the gum makes healing more difficult, so do not skip this area, even if your child pulls a face.
Read more:
- Paediatric dentist in Warsaw Wola
- Grey tooth after injury: is it dead and what improves its colour?
- Dental sinus tract on the gum — why it does not hurt and why it will not go away on its own
- Tooth resorption. What is worth knowing?
- Paediatric dentistry: How to prepare your child for their first dental visit — a guide for parents
Content and liability disclaimer
This article is informational and educational in nature and does not constitute medical advice, a diagnosis or a therapeutic recommendation — it does not replace a consultation with a specialist. If you are experiencing symptoms, have doubts or are facing a decision about treatment, consult a dentist. The methods described and the data cited are general in nature. The results of scientific studies relate to populations, not to an individual patient. The course and outcome of therapy depend on the individual clinical situation and may vary between patients. No information contained in this article constitutes a guarantee of result. The content has been prepared with due care, based on publicly available medical knowledge and the scientific publications indicated in the Sources section. We do not advise taking or refraining from any health-related action solely on the basis of the content of this article, without prior consultation with a doctor.
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