Scab & swollen gum after injury

My son, 16 months old, fell on his mouth yesterday. Once the bleeding stopped, I saw that there was bleeding at the gum line of the front right tooth. I tried wiggling the tooth and it didn't move. This morning the gum line seems a little swollen and there is a black scab kind of looking thing. Should I worry about infection? He drank water and brushed with kids Colgate. He had a fever last night but that could be due to his MMR vaccine given last week. They are his baby teeth, but I'm concerned with infection.

Thank you.


Dear Maria,

First, Let me reassure you that the fact the tooth is immobile, and your son seemed to experience no pain with water or brushing are good signs. However, there are several concerns we have when a child falls and the teeth are involved in the injuries. These include fracturing the teeth, knocking the teeth out, changing the position of the teeth, pain, and infection. One of the biggest concerns regarding damage to primary teeth is the possibility that they were pushed into the gum thus causing damage to the permanent tooth below. I would recommend taking your child to the dentist for a radiograph (x-ray) to help determine if this is a possibility.

The "scab" is most likely a normal reaction to the trauma and the bleeding. Another possibility the radiograph might show is damage to the nerve of the primary tooth. If the nerve has been damaged, infection could also become a possibility. This damage may not be apparent immediately, however; I usually tell parents in this situation to watch the tooth and gum area around the tooth. If the tooth darkens or a swelling ("bump") occurs on the gum tissue close to the tooth, this is a sign the nerve in the tooth has died. If this occurs, it may be time to treat the tooth (with a "baby" root canal or extraction), especially if swelling is present. Your theory about the fever may be right, but, if you haven't done so already, take your son to the dentist to have it checked. If nothing else, you will be reassured that no problems are present.

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