Does a one-year-old with a loose tooth due to trauma require emergency evaluation?

Management of Dental Trauma in a One-Year-Old with a Loose Tooth

A one-year-old with a loose tooth due to trauma does not require emergency evaluation unless there are signs of severe displacement, bleeding, or interference with breathing or eating. 1

Assessment of Primary Tooth Trauma

When evaluating a one-year-old with a loose tooth after trauma, consider:

• Type of injury: A loose tooth indicates a luxation injury (likely subluxation or extrusive luxation)
• Severity: Degree of mobility and displacement
• Associated symptoms: Pain, bleeding, swelling
• Interference with function: Ability to eat, risk of aspiration

Subluxation vs. Extrusive Luxation

• Subluxation: Tooth is loose but not displaced

  • No treatment is typically indicated
  • Monitoring for signs of pulpal necrosis is recommended 1

• Extrusive Luxation: Tooth is partially displaced out of socket

  • Minor extrusion: Gentle digital pressure to reposition
  • Excessive extrusion: May require dental referral for repositioning 1

Management Algorithm

Immediate Assessment (Non-Emergency)

1. Assess tooth mobility and displacement
2. Check for bleeding from gingival sulcus
3. Ensure the tooth is not interfering with bite/occlusion
4. Rule out risk of aspiration

When to Seek Emergency Care

• Severe displacement that interferes with bite
• Risk of aspiration
• Excessive bleeding
• Facial swelling
• Signs of airway compromise
• Associated jaw fracture 1, 2

When to Seek Non-Emergency Dental Care

• Within a few days for:
  • Minor tooth mobility without displacement
  • Minimal bleeding that has stopped
  • No interference with eating 1

Follow-up Care

Parents/caregivers should be advised about:

• Maintaining good oral hygiene
• Soft diet for 10 days after injury
• Restricting pacifier/digit sucking if possible
• Monitoring for signs of pulpal necrosis:
  • Gingival swelling
  • Increased mobility
  • Parulis (gum boil)
  • Gray discoloration of the tooth 1, 2

Important Considerations

• Primary teeth should NOT be replanted if completely avulsed 1
• Routine antibiotics are not indicated for primary tooth trauma 1
• The American Academy of Pediatrics and American Academy of Pediatric Dentistry recommend all children have a "Dental Home" by 12 months of age 2
• Consider the possibility of abuse in cases of unexplained or unusual dental trauma in children under 5 years 2

Conclusion

For a one-year-old with a loose tooth due to trauma, immediate emergency evaluation is typically not necessary unless there are concerning signs such as severe displacement, risk of aspiration, or significant bleeding. However, a dental evaluation within a few days is recommended to assess for potential complications and ensure proper healing.