How to Prevent The Top 5 Pediatric Dental Emergencies

Medically Reviewed by Dr. Reena Grover on July 19, 2026

We get roughly five types of between-appointment calls from parents. A knocked-out tooth. A chip or fracture. A swelling that appeared near a tooth. Something wrong with orthodontic hardware. A toothache that has been going on for a few days. These five account for most of the same-day situations we see at our Palo Alto practice. Knowing which one you’re dealing with changes how you respond in the first few minutes.

At Little Bytes Pediatric Dentistry, Dr. Michelle Haghpanah and Dr. Reena Grover both maintain privileges at Lucile Packard Children’s Hospital at Stanford and Kaiser Santa Clara and handle pediatric dental emergencies as a regular part of our practice. Here’s what to know about each of the five.

1. Knocked-Out Teeth

For a permanent tooth knocked completely out, the clock starts the moment it leaves the socket. Under 30 minutes from injury is the window where reimplantation success rates are meaningfully higher. An hour out, those numbers have already moved. By two hours, it rarely holds. The clock starts when it comes out, not when you walk in the door — which is why what happens in the first five minutes at the scene matters as much as anything we do at the office.

Pick it up by the crown, not the root. If there’s dirt on it, rinse with water — gently, not scrubbing. Keep it moist: in milk, in a small cup of the child’s saliva, or placed back into the socket if the child is old enough to hold it there without swallowing. Then call and drive. Tell us you’re coming so we can be ready.

Baby teeth: we don’t put those back. The risk to the permanent tooth forming underneath is too high. A call is still worthwhile to check whether surrounding gum tissue was damaged in the impact.

Most knocked-out teeth in kids trace back to sports without a mouthguard. Our sports guard guide walks through what a custom-fitted guard does during impact versus what a store-bought version does. A child playing contact sports without one is the most common denominator in these cases — soccer, basketball, martial arts, football.

2. Chipped or Broken Teeth

The question that moves this to same-day: is the inner tooth exposed? A small chip off the corner of a baby tooth, no pain, visible enamel only — that can wait for a regular appointment. A crack or fracture reaching the nerve of a permanent tooth: that’s today. Pain on biting or temperature sensitivity with a visible fracture into the inner pulp, we want to see it now.

If you find the broken piece, keep it — in milk or saliva — and bring it in. There are cases where the original fragment bonds back on, and when that’s possible it gives the best cosmetic and structural result. It’s worth the effort to save it.

We notice a pattern: children who chew on hard candy, ice, or pen caps chip teeth more often. Repeated stress on enamel finds fault lines, and eventually one of those incidents ends up in our emergency slot. Bruxism — grinding at night — does the same thing over a longer timeline. Catching grinding early and addressing it cuts into that fracture pattern. If your child grinds audibly or wakes up with jaw soreness, mention it at the next visit.

3. Dental Abscess and Tooth Infection

The infections that end up in our emergency schedule usually started as a cavity that nobody caught. The cavity reached the nerve, the nerve died, and the infection worked its way into the surrounding tissue. The swelling on the gum, the pimple-like bump near a tooth — those appear after the infection has been building for a while. Fever, swollen lymph nodes, or a child who won’t eat because of mouth pain are the markers that put this in same-day territory.

The part that concerns us about dental infections in kids is how fast they can move. There’s a pathway from a tooth to the jaw and neck, and a tooth infection can travel it. We take any swelling near a tooth seriously, especially when fever is also present. Tooth swelling plus fever on a Saturday night: that’s a call, not a Monday morning situation.

Treatment runs: antibiotics first to control the infection, then either a pulpotomy to preserve the tooth with the nerve removed, or an extraction, depending on which tooth it is and how far the infection has spread. We see it sooner, we have more options.

Prevention here is mostly about not letting cavities run. Cleanings are how we find the small ones before they’ve made it to the nerve. Our brushing habits guide has the at-home piece broken down by age — that daily consistency is what slows how fast cavities form.

4. Orthodontic Emergencies

A wire end that has shifted and is now jabbing the inside of the cheek is the call we get most often from kids in braces. Orthodontic wax, which comes in the kit most orthodontists hand out at the start of treatment, covers the sharp end. That’s usually enough to get through to a non-urgent appointment. An actual cut in the tissue or an open wound from the wire is same-day.

Second most common: a bracket that’s come loose. If it’s still hanging on the wire, leave it in place, call the orthodontist, and schedule a repair at the next available slot. If it has come completely free and the child could swallow it, take it out, keep it, bring it to the appointment. Neither situation requires emergency treatment unless there’s tissue damage involved.

The situation that does need same-day evaluation: a fall or impact while wearing braces. Hardware attached to teeth changes how force distributes through the mouth. A hit that would be minor without braces can cause tooth trauma with them. If a child takes an impact to the mouth during a game and they have orthodontic appliances in, we want to see them.

5. Toothaches That Come and Go

A child who mentions tooth pain once after something cold and then doesn’t bring it up again — probably transient sensitivity, not necessarily a problem. A child who has mentioned the same tooth two or three times, who is eating on one side, or who woke up with jaw or tooth pain at night — that’s a pattern we’d want to look at.

Parents sometimes tell us “it seemed to get better on its own.” That happens. What happened in those cases: the nerve in the tooth died. It stopped sending the signal — not because the tooth healed, but because nothing was left to send it. An infection can grow silently after that, with no pain warning, until swelling or fever brings it back to our attention. If a toothache lasted more than two days before stopping, that tooth is still worth an x-ray.

For pain management while waiting: children’s ibuprofen or acetaminophen at the appropriate dose, an ice pack held against the outside of the cheek for swelling. One thing that doesn’t help: aspirin applied directly to the gum. It doesn’t do what people think and can cause soft tissue burns. For an exposed nerve from a chip or fracture, dental wax covers it temporarily. None of this fixes the tooth. It gets you to the appointment.

Schedule at Little Bytes Pediatric Dentistry in Palo Alto

Dr. Haghpanah and Dr. Grover are both board-certified pediatric dentists with hospital privileges at Lucile Packard Children’s Hospital at Stanford and Kaiser Santa Clara. We see children from infancy through adolescence, and dental emergencies are a regular part of our practice. If your child has an injury or you have a concern about pain or swelling that’s developed, contact us at our Palo Alto office.