She Fell From the Top Bunk and Her Front Teeth Went Backwards

Quick answer: Displaced baby teeth are usually managed very differently from adult teeth. Where an adult tooth is repositioned and splinted, a baby tooth is often left alone to reposition itself, or removed — because the priority is protecting the permanent tooth developing above it.

The call

Ten at night in the Kirya Charedit. Rivky, 5, had fallen from the top bunk onto the tiled floor. Her mother phoned to say two front teeth had been pushed back and she could not close her mouth properly.

Our first questions were not about the teeth. Had she lost consciousness? Was she vomiting? Was she behaving normally? All no, all no, and yes — she was crying vigorously and complaining about her teeth, which is reassuring in a five-year-old.

What we found

Both upper primary central incisors displaced palatally by about 2mm, mobile but firmly in their sockets. The bite was interfering: her lower front teeth were hitting the displaced uppers when she closed. The gum was bruised and there was a small tear at the margin.

X-rays — a lateral view rather than a standard one, which is easier in a frightened five-year-old and shows the relationship between the baby tooth roots and the permanent tooth buds. The roots had been pushed backwards, away from the developing permanent incisors, not into them. That was the key finding.

Why baby teeth are treated differently. Everything is governed by one question: what is best for the permanent tooth developing above? A displaced baby tooth root sitting close to the permanent tooth bud can damage the enamel forming on it. Repositioning that root by force risks doing the same damage on the way.

So the approach is:

• Root displaced away from the permanent tooth (usually when the crown moves backwards): often leave it. Baby teeth frequently reposition themselves over weeks, and the bite guides them.
• Root displaced towards or into the permanent tooth bud: extract, rather than push it back through the same tissue.
• Very mobile, or interfering severely with the bite, or the child cannot cope: extract.

Rivky's roots had moved away from the tooth buds, and she was managing. So we left them.

What we did

Nothing surgical. That was a deliberate decision, and we explained the reasoning carefully, because parents often expect something to be done.

Adjusted her bite slightly by smoothing the very edge of the two lower incisors so the uppers were not being knocked every time she closed — a two-minute intervention that let the teeth settle.

Soft diet for two weeks, no dummy, no biting on the front teeth, gentle brushing with a soft brush, and chlorhexidine on a cotton bud twice daily.

Reviews at one week, one month, six months, and then annually until the permanent teeth arrive.

The outcome

The teeth repositioned themselves almost completely over about six weeks — the tongue and lip pressures do the work.

At the six-month review both had darkened to a greyish shade. That is very common after trauma to baby teeth and, importantly, is not on its own a reason to extract. Both remained symptom-free with no infection on x-ray, so we monitored them. They exfoliated normally at seven and eight.

The permanent incisors came through unaffected.

What to do if this happens to you

1. Check for head injury first. Loss of consciousness, vomiting, drowsiness or unusual behaviour means hospital, not a dentist.
2. See a dentist the same day for any displaced tooth in a child.
3. Do not push baby teeth back yourself. You may push the root into the developing adult tooth.
4. Expect a discoloured tooth afterwards. Grey baby teeth after trauma are common and do not always need treating.
5. Soft diet and gentle cleaning for two weeks.
6. Keep the long reviews. The permanent tooth is what is being watched.

Child fallen and damaged their teeth? Ramat Beit Shemesh Urgent Dental Care sees children's dental trauma the same day. 055-985-8845 · WhatsApp https://wa.me/972559858845 · Harav Kook 28/1, Beit Shemesh.

Based on real cases treated at the clinic. Names have been changed.