If a tooth gets pushed up into the gum after a fall, treat it as a dental emergency. Do not try to pull it back down. Rinse gently with cool water, apply a cold compress to the outside of the lip, and call Line Dental Aloha at (503) 259-8641 within the hour. Baby teeth often re-erupt on their own over weeks. Permanent teeth may need splinting, monitoring, or a root canal depending on severity.

Most parents have heard what to do with a knocked-out tooth. Grab it by the crown, put it in milk, rush to the dentist. An intruded tooth is different. The tooth is still there, just shoved up into the gum so it looks shorter (or almost gone). The rules change, and the wrong move can hurt the permanent tooth underneath.

We wrote this for Aloha and Beaverton families who need a clear plan before the panic sets in.

What does it mean when a tooth is pushed up into the gum?

Dentists call this a dental intrusion. The tooth gets driven apically (upward for top teeth, downward for bottom) into its socket after a sudden impact. It is different from an avulsion (knocked completely out) and different from luxation (knocked loose sideways).

The usual culprits in our office? Playground tumbles, scooter spills, basketball elbows, bike crashes, and the occasional car seat buckle to the face during a hard stop. According to the International Association of Dental Traumatology, intrusion is one of the most severe traumatic dental injuries because of the force required and the collateral damage to surrounding tissue and, in kids, the developing permanent tooth bud.

Visually, the tooth looks shorter than the ones next to it. Sometimes it looks like it is missing entirely until you spot the edge tucked up inside the gum. There is usually blood at the gumline and the area will be tender.

Is an intruded tooth a dental emergency?

Yes. Call within the hour.

For kids with baby teeth, the risk is damage to the permanent tooth bud sitting right above the roots. For older kids and adults with permanent teeth, the concerns are pulp necrosis (the nerve dying), root resorption, and ankylosis (the tooth fusing to the bone so it cannot move normally).

Go to the ER first, not the dentist, if any of these are true:

• Loss of consciousness, even briefly

• Suspected concussion (vomiting, confusion, unequal pupils)

• Possible jaw or facial bone fracture

• Bleeding that will not slow after 10 minutes of pressure

• Deep lacerations to the lip or chin that may need stitches

For an isolated tooth injury without those red flags, call us. That is the whole triage.

What should I do in the first 60 minutes?

Here is the protocol we walk parents through on the phone.

1. Do not touch the tooth. Do not try to pull it back down, wiggle it, or reposition it. You can make the injury much worse.

2. Rinse the mouth gently with cool water to clear blood and debris. No swishing hard.

3. Cold compress on the outside of the lip or cheek. Ten minutes on, ten off. This limits swelling.

4. Age-appropriate pain reliever if needed. Acetaminophen or ibuprofen at the dose on the package.

5. Call Line Dental Aloha at (503) 259-8641. If it is after hours, follow the voicemail instructions or head to the ER if facial trauma is significant.

6. Save any tooth fragments in a small container of milk or saliva and bring them with you.

One scenario we see a lot: a parent in the Reedville area of Aloha calls after a 7-year-old went over the handlebars on the bike path near Mountain View Middle School. The front tooth looks "short." We tell them the same thing every time. Cold pack, no touching, drive carefully, we will be ready when they pull in off SW Alexander St.

The instinct is to fix it with your fingers. Please do not. Leaving the tooth alone until we can image it is the single most important thing a parent can do in the first hour.

Baby tooth vs permanent tooth: does the treatment differ?

Yes, significantly.

Baby (primary) teeth: Per the American Academy of Pediatric Dentistry, intruded primary teeth are usually left alone to re-erupt on their own, which can take weeks to months. The exception is when X-rays show the root has been pushed toward the permanent tooth bud. In that case, we recommend extraction to protect the adult tooth forming above.

Permanent teeth: Treatment depends on how deeply the tooth was intruded and how developed the root is. The IADT guidelines note that mildly to moderately intruded permanent teeth with incomplete root formation are often allowed to re-erupt spontaneously. More severe cases may require orthodontic or surgical repositioning, splinting to the neighboring teeth, and often a root canal because the blood supply to the pulp is usually damaged.

Age matters. Root development matters. A 9-year-old and a 15-year-old with the same injury can end up on very different treatment paths.

What happens at the dental visit and after?

When you arrive, we start with a clinical exam and dental X-rays to see exactly where the tooth sits and whether the root or surrounding bone is damaged. For permanent tooth intrusions, we may splint the tooth to the adjacent teeth for stability. For primary teeth, we usually confirm the position is safe and then send you home to monitor.

Follow-up is long. IADT guidelines recommend clinical and radiographic monitoring for at least a year to catch pulp necrosis or root resorption early. Expect visits at 2 weeks, 4 weeks, 3 months, 6 months, and 12 months for a significant permanent tooth intrusion.

At home for the next 1 to 2 weeks:

• Soft diet. Think yogurt, eggs, pasta, smoothies. No crunchy or chewy food on that side.

• Gentle brushing around the injured tooth with a soft brush.

• Chlorhexidine rinse if we prescribe one.

• No contact sports until we clear your child.

Watch for warning signs of infection: swelling that returns, a pimple-like bump on the gum, a tooth that turns gray or dark, or pain that gets worse after the first few days. Call us.

Traumatic dental injuries are not rare. NIDCR data suggest roughly 1 in 4 school-aged children experience some form of dental trauma during childhood. With Aloha High School sports in full swing, kids in the Beaverton School District on scooters and bikes, and busy family schedules on the TV Highway corridor, we see these injuries most weeks.

Frequently Asked Questions

Can an intruded baby tooth come back down on its own?

Often, yes. Most mildly to moderately intruded primary teeth re-erupt over 2 to 6 months without intervention. We confirm the position with an X-ray first to make sure the root is not threatening the permanent tooth bud, then we monitor at scheduled follow-ups.

Will my child need a root canal after a tooth is pushed into the gum?

For baby teeth, usually not. For permanent teeth, it depends on how severe the intrusion was and how mature the root is. Mature permanent teeth with deep intrusions frequently need a root canal because the blood supply to the nerve is interrupted. We make that call based on follow-up tests over the first few months.

What if the intruded tooth turns gray or dark weeks later?

That color change usually means the nerve has died or is dying. It does not always mean emergency treatment is needed on the spot, but it does mean we need to see your child. For a baby tooth we may simply monitor. For a permanent tooth, a root canal is often the next step.

Should we go to the ER or the dentist first?

If the injury is just the tooth, call Line Dental Aloha first at (503) 259-8641. If there is any sign of head injury, jaw fracture, uncontrolled bleeding, or a deep facial laceration, go to the ER first and see us for the tooth as soon as you are cleared.

How long does it take an intruded permanent tooth to re-erupt?

If we are letting it re-erupt on its own, expect several weeks to several months of gradual movement. Progress is checked at each follow-up. If the tooth is not moving after about 2 to 4 weeks, we may discuss orthodontic traction or surgical repositioning.

Call us if it happens

When a tooth gets driven up into the gum, the right first move is a phone call, not a trip to Google. Line Dental Aloha is at 18425 SW Alexander St, just off TV Highway, and we see families from Aloha, Beaverton, Hillsboro, and across Washington County. Call (503) 259-8641 and tell our team it is a dental trauma. We will make room.