Kids' toothache: what parents should do

What’s probably going on

Children get toothaches for mostly the same reasons adults do, just in smaller teeth. The usual causes, most common first:

• A cavity. More than half of children aged 6 to 8 have had a cavity in a baby tooth, according to the CDC. Pain with sweets or cold, or a tooth that hurts to chew on, often means a cavity.
• Food stuck between teeth or under the gum. A popcorn hull wedged in can ache like a bad tooth.
• A new tooth coming in. Gums can be sore and puffy while a tooth breaks through, including the big back molars in older kids.
• An injury. A fall or a ball to the face can bruise, crack, loosen or push a tooth out of place. Sometimes it hurts right away; sometimes problems show up later, so have a dentist check any tooth that took a hard hit.
• An infection (abscess). A cavity left long enough can infect the root. Watch for swelling, a bump on the gum or a fever. See tooth abscess.

Kids are often poor at pointing to the tooth that hurts. If your child is chewing on one side, avoiding food, or rubbing their cheek or ear, look in the mouth with a flashlight.

What to do tonight

The American Academy of Pediatric Dentistry and the American Academy of Pediatrics suggest similar first steps.

1. Rinse with warm water. If your child can swish and spit, warm salt water is fine too.
2. Floss gently around the sore tooth. If something was stuck, the pain may ease once it’s out.
3. Cold pack on the cheek if it’s swollen. Wrap it in a thin cloth and hold it on for up to 20 minutes at a time. Never use heat on a swollen face.
4. Give a children’s pain reliever as the label directs. Children’s acetaminophen or ibuprofen are the usual choices. Use the dose chart on the label for your child’s weight or age, and the measuring device that comes in the box.
5. Call a pharmacist or your pediatrician first if your child is younger than the youngest age on the label, takes other medicines, or has a health condition, or if you’re not sure of the dose.
6. Call your child’s dentist in the morning, even if the pain settles. Pain that fades usually means the cause is still there.

What not to do

• Don’t give aspirin to a child or teenager. The American Academy of Pediatrics links aspirin during viral illnesses to Reye syndrome, a rare but very serious condition that injures the brain and liver.
• Don’t put aspirin or any pill on the tooth or gum. It burns the tissue.
• Don’t use benzocaine gels (Orajel, Anbesol and similar) on children under 2. The FDA warns they can cause a rare, serious blood problem. For an older child, ask a pharmacist before using one.
• Don’t double up. Many cold and flu products already contain acetaminophen or ibuprofen. Check the labels so your child doesn’t get two doses of the same medicine.

If a tooth gets knocked out

What you do depends on whether it’s a baby tooth or an adult tooth. If you’re not sure which kind it is, treat it as an adult tooth and call a dentist right away.

A baby tooth: don’t try to put it back. HealthyChildren.org, from the American Academy of Pediatrics, says there’s no need to replace it and in most cases no treatment is needed. Call your child’s dentist so they can check the area.

An adult (permanent) tooth: this is an emergency, and minutes count.

1. Pick the tooth up by the crown, the part you normally see. Don’t touch the root.
2. If it’s dirty, rinse it gently with milk or saline. Don’t scrub it.
3. If you can, and your child will let you, push it gently back into the socket and have them bite gently on gauze or a clean cloth.
4. If not, put the tooth in a cup of milk. Don’t use tap water.
5. Go straight to your child’s dentist or the nearest emergency room.

The best chance of saving it is when it goes back in within 15 minutes, and it may still be saved within the first hour.

How a dentist fixes it, and what it costs

A dentist will look, and usually take an X-ray, to find the cause.

• A small cavity gets a filling.
• A deep cavity in a baby tooth may need a baby-tooth version of a root canal (often called a pulpotomy), usually followed by a crown or filling, or the tooth may come out.
• An infected or badly broken tooth may need to be taken out. If a baby tooth comes out early, the dentist may suggest a space maintainer to hold room for the adult tooth.
• An injured tooth may just need watching and follow-up visits, or it may need treatment.

The price depends on the treatment, where you live and your coverage, so ask for a written estimate first. Many kids qualify for free or low-cost coverage. Medicaid and CHIP both must cover children’s dental care, and Medicaid’s must include relief of pain and infections. Call 1-877-KIDS-NOW or use the InsureKidsNow dentist finder to find one who takes your child’s plan. Without coverage, see how to see a dentist without insurance and dental savings plans (a discount, not insurance).

Finding a pediatric dentist: pediatric dentists train for two to three extra years after dental school and see only children. Many general dentists see kids too. Ask whether they can fit in a toothache visit this week.

How to keep it from coming back

Most kids’ toothaches start as cavities nobody noticed.

• Brush twice a day with a fluoride toothpaste. Use a tiny smear for babies and toddlers and a pea-sized amount from about age 3 to 6. Help them brush, and teach them to spit it out.
• Floss where teeth touch, once a day. Parents usually need to do it for young kids.
• Keep sweet drinks and sticky snacks to mealtimes instead of sipping and grazing all day.
• Ask the dentist about sealants on the back teeth. The CDC says they prevent 80% of cavities in those teeth. Fluoride varnish helps baby teeth too.
• Start dental visits by the first birthday, then keep up regular checkups.

A brush with a timer helps kids keep going for the full two minutes. For more on brushes, see the best electric toothbrush.