1 Has a tooth been knocked out, or has part of a tooth broken off?

2 Is it a permanent tooth (not a milk tooth)?

3 Has a tooth become loose as the result of an accident?

4 Does your child have continuous toothache with or without a fever?

5 Does your child feel pain in his or her teeth when they are exposed to hot or cold foods?

6 Does the pain last only a few seconds?

7 Does your child feel pain when he or she bites on a tooth that has been filled recently?

8 Does your child have pain in several of the teeth in the upper jaw?

9 Does your child have tender gums behind the back teeth?

10 Call your doctor now

Action If the gum is bleeding, place a gauze pad over it, and tell your child to bite down hard. Find the tooth, but handle it as little as possible and do not clean it. Put it in a glass of milk, and take it to the dentist with your child. Your dentist may be able to graft a knocked-out permanent tooth back into your child's gum. If part of the tooth has broken off, it may be possible to reattach it.

11

Action If the gum is bleeding, place a gauze pad over it, and tell your child to bite down hard. Try to find the knocked-out tooth or broken piece to ensure it has not been inhaled or swallowed. A knocked-out milk tooth cannot be grafted back into the gum. If only part of the tooth is broken off, contact your dentist, who may advise removal of the remaining fragment. In most cases, a permanent tooth will erupt to fill the space (see The order in which teeth appear). If the tooth is lost much earlier than normal, other teeth may fill the space. This can cause problems with the eruption of permanent teeth.

12

Action An accidental bump or knock can loosen a tooth, but if it is left alone, the tooth should tighten itself again. A milk tooth may remain loose or fall out early. If a permanent tooth is still loose after a few days, you should consult your dentist.

13 Call your doctor now

Possible cause Your child may have a dental abscess, in which pus forms in or beneath a tooth as a result of an infection.

Action If your child has a dental abscess, your dentist may prescribe antibiotics to treat the infection. Once the infection has cleared up, your child may need further dental work to treat the underlying cause. In rare cases, the tooth may need to be removed.

14

Possible cause Teeth can become sensitive to extremes of temperature if their protective surfaces become thin or damaged. This may be due to tooth decay. Consult your dentist.

Action Your dentist will examine your child's teeth and treat any decay. If no abnormality is found, he or she may advise that your child brushes with a toothpaste for sensitive teeth and rubs a small amount over the teeth afterwards.

15 See your doctor within 24 hours

Possible cause Your child may have decay deep within a tooth or in a crack in a tooth. This is especially likely if your child also has bouts of throbbing tooth pain not brought on by food or drink.

Action Your dentist will examine your child's teeth and may need to remove and fill any decayed areas.

16

Possible cause and action It is quite common for a tooth to feel uncomfortable for a while after a filling has been put in, especially if the filling is large. If the pain gets worse or if your child is no better within 48 hours, consult your dentist, who will check the filling and adjust it if necessary.

17

Possible cause Aching in several teeth can be a symptom of sinusitis (inflammation of the membranes lining the air spaces in the skull), especially if your child has recently had a cold or a runny or blocked nose. Children under the age of 8 are rarely affected because their sinuses have not yet developed.

Action Give your child paracetamol for the pain. Steam inhalation may help ( Treating a cold). Consult your doctor if your child's symptoms are no better within 48 hours; he or she may need treatment with antibiotics.

18

Possible cause Your child's second molars may be beginning to emerge (see The order in which teeth appear). The gums may become inflamed as the teeth erupt, but this is usually short-lived.

Action If necessary, give your child the recommended does of a painkiller, such as paracetamol. Consult your dentist if the pain is severe or if it is no better within 48 hours.

19

Consult your dentist if you are unable to make a diagnosis from this chart.